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The health hangover

South Africans drink. This was how awed American satirist PJ O’Rourke, himself no slouch with the booze, summarised a visit here in the Eighties. But most South Africans claim they don’t — about half the men and almost 80% of women claim to be abstainers from the devil’s brew. If this is true, it implies that those South Africans who do indulge do so on a grand scale.

In 2000, the latest year for which statistics are available from the Medical Research Council, it was estimated that every adult knocked back 10,2 litres of pure alcohol a year. Given the levels of claimed abstention, this would mean that South African drinkers put away about 20 litres of pure alcohol a year.

The economic and health impact of this mass consumption of toxin is severe. A report last year by the Burden of Disease unit at the Medical Research Council found that while alcohol taxes raised R4,2-billion in the 2002/03 tax year, the economic costs of alcohol were estimated at double that. About 1% of South Africa’s GDP, or R9-billion was lost because of alcohol abuse in that year.

Economist Paul Berkowitz said the cost to the economy was mainly “related to productivity issues”. People being less productive because of a hangover, or missing work entirely. There were also the costs to the public health system because of “lifestyle-related diseases such as liver cirrhosis”.

Research in three areas in the Western Cape “suggests little awareness of the health risks of alcohol”, according to the Burden of Disease report, with 24% of women reported drinking enough alcohol to put their unborn children at risk. South Africa has the highest levels of foetal alcohol syndrome in the world — in one town 12% of children starting school in one year were discovered to have been damaged by alcohol.

The impact of alcohol depends how it is consumed, as well as the quantity. The health benefits of alcohol are seen among people who drink small amounts regularly with meals. Taking alcohol in this way appears to protect people against some forms of heart disease, and brain disorders such as Alzheimer’s. The theory is that the alcohol helps keep fats from clogging arteries and also relaxes people, thus dropping the levels of damaging stress hormones.

Unfortunately this is not the South African way. According to the South African Demographic and Health Survey in 1998, one-third of drinkers reported consuming at least five drinks a day for men, or three for women. In 2002, the Youth Risk Behaviour Survey found that almost a quarter of high school students reported binge drinking in the last month. In 2000, alcohol was implicated in about 7% of all deaths in South Africa; worldwide the figure was 3,2%.

Among South Africans about 40% of intentional injuries and 20% of unintentional injuries are linked to alcohol. In contrast, the World Health Organisation estimates that 12% of intentional and 25% of unintentional injuries are due to alcohol. Dr Debbie Bradshaw and her team from the Burden of Disease unit estimated that in 2000 alcohol caused almost 34 000 deaths.

It’s probably a toss-up whether people lie more in surveys on alcohol or on sex and national, up-to-date information on South Africans and drink is sparse. But the unit looked at four grouped impacts of alcohol: chronic conditions and low birth weight, acute conditions, such as alcohol related injuries, depression associated with alcohol dependence, and conditions totally attributable to alcohol such as foetal alcohol syndrome.

The impact on health was profound. Compared with people who abstain, the heaviest drinkers had more than five times the risk of cancer of the mouth and more than three time the risk of cancer of the liver. Heavy levels of alcohol consumption increased the risk of epilepsy by almost seven times among men and more than seven-fold among women. Unsurprisingly the heaviest drinkers had a 13 times higher risk of cirrhosis.

Among women alcohol consumption is highest among 45- to 50-year-olds, while among men it peaks from the age of 30 all the way to more than 80.

Alcohol consumption has been linked with reduced inhibition, therefore riskier sexual activity and may play a role in reducing adherence to chronic medication such as antiretrovirals.

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