Buckling under the burden of booze

Weak enforcement of alcohol laws/policies has left a growing menace that cries for attention 

Health: Bhutan lost a life every two days from alcohol-related diseases last year.  Ever since alcohol became the top killer in the country six years ago, it has claimed 12 lives a month.

For a country where alcohol has distilled into its culture, per capita alcohol consumption was eight litres, higher than the global per capita consumption of six litres in 2010, according to health officials.

With about 5,407 alcohol outlets in the country, there was one alcohol outlet for every 98 Bhutanese above 15 years last year.

A health ministry’s policy brief on alcohol control in urban Bhutan points out that, while Bhutan’s laws and policies can control alcohol access and availability, the enforcement of these laws has been neglected for so long that the intentions of these laws have not translated into social benefits.

Bhutan has not only lost lives by neglecting to enforce its 11 policies, some of which have been in place for over a decade but also lost economically.

The policy brief points out records with the National Statistics Bureau, which show that “the economic burden of alcohol in Bhutan amounted to Nu 5 billion in 2014, four times higher than the Nu 1 billion it earned in economic returns”.

The net economic affects, the policy brief states, must be carefully measured after discounting direct and indirect social costs of excessive alcohol consumption in the forms of loss of productivity, property damage, years of life lost and forgone income.  The Nu 5B economic burden is inferred from studies in countries, which have recorded an economic burden of alcohol consumption exceeding five percent of the GDP.

Alcohol policies 

Although efforts to address the growing menace of alcohol began since the last government’s time, the draft “national policy and strategic framework to reduce harmful use of alcohol”, which envisages a nation free of alcohol menace, is yet to be endorsed.

This national policy, which the cabinet has discussed twice, and is still reviewing highlights that at least seven percent of road traffic accidents are attributed to drink driving, making Bhutan one of the few countries in the world where alcohol-related conditions are the leading cause of hospital-based mortality.

“Thirteen percent of the deaths in 2005 and 16 percent in 2009 were reported as alcoholic liver disease,” the policy paper states.

Health officials said the policy was taking time because the government didn’t want it to become like the tobacco act.  Pubic health director Dr Pandup Tshering said their advocacy and treatment activities were continuing and that today there were 30 hospitals and 18 BHUs across the country providing alcohol detox services.

The health ministry’s stand, health officials said, was to address harm reduction and work towards behavioural change. “From the health perspective, we’d love to not have alcohol at all,” a top health official said. “But that doesn’t work, since alcohol is a culture ingrained in our society, and addressing the problems it has brewed needs a multi faceted approach.”

What’s holding up the policy?

One of the main areas that need further consultation for the policy to be endorsed, officials said, was to get the ministry of economic affairs and the department of local government with the home ministry to identify their roles in controlling alcohol, and ensure that there was no overlap of responsibilities.

The policy paper points out that liquor licensing, taxation, and enforcement responsibilities adopted in alcohol polices are shared among multiple agencies.

“For instance, the department of trade and industry is responsible for licensing and regulations of all entrepreneurial activities but has only two inspectors covering five districts,” it points out.  “Similarly, Royal Bhutan Police appear to be too stretched to monitor alcohol service practices due to their responsibility for maintaining general law and order.”

A health official said alcohol was today accessible, affordable and available (3As) in the country, and that the policy’s strategy was to address these three aspects of alcohol.  Sources said that one of the contentious proposals on the cabinet’s table was to consider suspending the issuance of licenses for new breweries.

The reason is because monitoring and enforcement of the existing rules has been a challenge, given the number of alcohol outlets in the country, and its availability in almost every shop today.  The policy paper notes that pilot studies in Thimphu and Trashigang found that alcohol service polices were violated 90 percent of the time in licensed outlets.

“The health ministry is making an issue because people are dying and more are getting into rehabilitation,” a health official said. “Even the imports of alcohol is very high and, for the health ministry, the supply of alcohol should be reduced.”

Although both past and present governments have been supportive of the policy, and efforts have been made by stopping the issuance of bar licenses  since 2005, and suspending the issuance of retail licenses since last December, officials say that there has been little impact.

“We fought on bar licenses to be reduced and now industries are selling alcohol in smaller bottles through retail shops,” a health official lamented. “This has become a serious concern, which is conflicting with the bar licensing issue.”

A study on alcohol use and abuse by the head of research division with the National Statistics Bureau, Lham Dorji, found that, in 2010, the annual domestic industrial liquor production rose to about 6.9M (million) litres, and domestic sales increased to about 6.7M litres.  This implies that about 97.3 percent of the total liquor produced domestically was sold within the country in 2010, the study noted.

Lham Dorji said that there was first a need to determine a standard level of alcohol that could be consumed by a Bhutanese. “The standard level would determine how much alcohol the body can take and based on this standard, we can come up with ways to moderate consumption and reduce harm,” he said.

Economic affairs minister Norbu Wangchuk agrees that there was a serious need for an alcohol control policy. “The fight is on to address the accessibility, availability and affordability aspects of alcohol,” he said.  However, on the licensing aspect, lyonpo said,  “We need to strike a balance; we cannot take away the rights of the people to start businesses nor can we take away the right to drink alcohol.”

What’s important, he said, is to ensure that the sale of alcohol takes place in authorised outlets only. “Good rules are there, it’s just that we’re unable to enforce it consistently and diligently,” he said.

Lyonpo said it was more important to focus on consumption than on production.  As long as there was demand, there would be supply, he said and while the country may be able to stop imports, the supplies were met from domestic producers.

“That was exactly what was happening during the alcohol import ban era, where we already had a beer brewery,” he said. “While we stopped alcohol imports, production doubled up here in our own market. I think putting a ban on imports like this isn’t smart governance and it’s in that spirit we lifted the ban.”

Although consumption did not change, spending on imported alcohol declined during the two-year ban on import of alcohol.  After the ban was imposed in March 2012, alcohol import dropped to Nu 316.7M, which further declined to Nu 203.2M the following year.

Soon after the ban was lifted, alcohol imports spiked.  Last year, a total of Nu 301M was spent on importing 3.3M litres of foreign alcohol.  However, officials argue that the ban on import of import alcohol had favoured the local distilleries, which is today evident from the growing demand for local beer.

Former health minister Zanglay Dukpa said the last government couldn’t endorse the policy because their term had come to an end, and that there was a need for more research and consultation.  He said the ban on import of alcohol was imposed not only to curb Indian Rupee spending but also to address the social problems related to alcohol.

“But time was a factor and to address alcohol problems comprehensively, there’s a need to find out why alcohol is abused,” he said. “Alcohol can’t be seen as an independent entity; it’s part of our culture and there is a need to create awareness on its harmful consumption first.”

Lyonpo Norbu Wangchuk said that, while the last government’s intention was perhaps not to favour domestic production, it did turn out that way. “That situation was in favour of one single brewery and we didn’t lift the ban to correct this situation – we lifted it because it wasn’t smart regulation, trading and governance,” he said. “The two years of liquor ban had in no way affected our alcohol deaths in hospitals and accidents.”

The power of local government 

While discussions on the roles and power of local government were still on, officials said that it was the centre, which makes the national policy and guided the rest of the dzongkhags and gewogs. “We have a trade policy on alcohol, but the local government will have a say in providing local clearances, such as in drayangs,” he said. “Only on the production of the local clearance, would the authority issue licenses for alcohol retail outlets.”

Alcohol policy making, the policy paper states, can get stalled in political gridlock due to the influence of alcohol producers, sellers and buyers on legislators. “Bhutan has already missed years of benefits of good polices that could potentially reduce health care costs, other societal costs and improve the wellbeing of the Bhutanese,” it states. “Further delay in implementation of alcohol control polices will neither serve the public interest not be of political benefit.”

Perhaps not, because the minister insists that this government is serious about alcohol. “We’ve been taking decisions, sometimes unpopular ones and with alcohol we’re very serious,” he said. “This policy will come through and it won’t be shelved because two ministries are opposed in their views.”

Sonam Pelden

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