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May 6, 2010

Randomized Controlled Trials: panacea or mirage?

May 6, 2010

Alcohol in Africa – more illegal, but not more deadly

May 6, 2010
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Today is election day in the UK, so there’s a fair chance that politically active people of all stripes will be hitting the bottle in celebration or regret this evening – or just drowning their sorrows at the prospect of weeks of haggling/constitutional crisis over a hung parliament. So spare a thought for the boozers of Africa discussed in last week’s Economist:

“THE Korogocho slum is one of the poorest in Nairobi, Kenya’s teeming capital. Its 120,000 alcohol Africaresidents occupy a stinking square kilometre by the city rubbish dump. Nearly three-quarters are under 30 years old. Many are alcoholics.

The equivalent of $1 is enough to buy four glasses of illegally brewed chang’aa—and oblivion. Some drink the local special, jet-five, so called because the fermentation of maize and sorghum is sped up with pilfered jet fuel. It can damage the brain. Elsewhere in Nairobi, chang’aa is spiked with embalming fluid from mortuaries.

The name, meaning literally “kill me quick”, is well chosen. This and other methanol-based kickers are sometimes fatal: 10ml of methanol can burn the optic nerve; 30ml can kill. Even without the kicker the brew is impure. The water is filthy with fecal matter. When police recently made some raids, decomposing rats and women’s underwear were found in servings of chang’aa. But the price and the potency are more tempting than the heavily taxed bottles of beer that are the staple of richer Kenyans.

Kenya is not alone. The UN’s World Health Organisation reckons that half of all alcohol drunk in Africa is illegal. Neighbouring Uganda may consume more alcohol per person than any country in the world. Much of this is waragi, a banana gin. Some 100 Ugandans died from toxic waragi in April alone. Botswana, arguably sub-Saharan Africa’s most successful country, serves up laela mmago, meaning “goodbye mum”.

East African Breweries is one of Kenya’s biggest companies and taxpayers. It wants to see illicit chang’aa replaced with a safer commercial version. Yet bringing the price of alcohol down to that of water risks increasing alcoholism and forcing the very poorest into even dodgier booze dens. In any case, it could add other costs: crime, violence to women and children, unsafe sex and bad health. Catholic priests in Korogocho host an Alcoholics Anonymous meeting, but in Kenya, as elsewhere in Africa, state help for recovering alcoholics is rare.

What is clear is that urbanisation is changing the way alcohol is drunk. Illicit brews smooth dealmaking and reconciliation in the countryside. But in the sprawling city slums, where most of Nairobi’s people live, they are more often a cheap way of blotting out a sense of abandonment.”

gin palacesThis reminds me of the gin palaces of Victorian London, when alcoholism was far worse than it is today. The temperance movement then was one of the biggest social movements of its time, and in many poor countries, churches play a similar role today (in Latin America one of the reasons why so many women join the evangelical protestant churches is their success in getting their menfolk to stop boozing).

According to the WHO, 2.5 million people a year die of alcohol-related disease (on a par with HIV/AIDS, and considerably more than malaria): “Globally alcohol consumption has increased in recent decades, with all or most of that increase in developing countries. This increase is often occurring in countries with little tradition of alcohol use on population level and few methods of prevention, control or treatment. The rise in alcohol consumption in developing countries provides ample cause for concern over the possible advent of a matching rise in alcohol-related problems in those regions of the world most at risk.”

Burden of disease attributable to alcohol

Religion or regulation may hold the answer, but this is one ill that economic development doesn’t seem to solve – the burden of alcohol-related death and disease does not appear particularly correlated with income. Russia  and Eastern Europe are the worst affected, followed (to my surprise) by China, Latin America and Central Asia. The Northern half of Africa, Europe and South Asia are actually the least affected. North America, southern Africa, south-east Asia and Australia lie somewhere in between.


  1. The map is slightly deceiving: the reason why `the burden of alcohol-related death and disease does not appear particularly correlated with income’ is that the statistic is percentage of deaths – and obviously in Africa people have plenty of other things to die of.

    So development might help to solve the problem, but just not as fast as it solves other causes of death.

    I guess a more comparable statistic would be something like % of x year olds who die of alcohol related illness (as opposed to dying or something else or surviving). Not without problems either, of course…

    Duncan: Good point Liam, I was wondering about that, but didn’t have the time to dig around – anyone got this kind of data?

  2. Interesting stuff. I was just wondering what the implications of this would be for the UN´s frequent claim that drugs prohibition is necessary to protect developing countries from falling prices in the event of legalisation…This makes me think it´s more likely that legalising drugs like marijuana and cocaine wouldn´t affect developing countries in terms of consumption much at all, as the real danger would still come from illegally produced drugs which come far cheaper. Economic development certainly doesn´t seem to reduce drugs consumption either, if anything it seems the combination of rising incomes and growing middle classes who become culturally more ‘globalised’ make drug consumption more likely. Just a thought, but how else could you explain the fact that a country like Brazil, where there has been strong economic development and poverty reduction for quite a few years, drug-related crime is still a massive issue? Could it actually be the case that these growing middle classes are actually contributing to this by consuming more drugs?

  3. Although the risk of death from alcohol might not be correlated with income, surely other health related risks are greater when drinking the cheap stuff. No one goes blind from a bad batch of beer in the U.S.

  4. It is sad that these countries don’t have programs for alcohol addiction, here in Canada we have programs everywhere, numbers to call, hospitals you can check youself into, healthcare pays, but as the saying goes ‘you can lead a horse to water but you can’t make it drink’ so many die in alcoholic poverty all because of thier own bullheadedness and it’s no ones fault but their own. People choose. I’ve seen it. I know.

  5. I agree with Scott it seems to have a strong correlation with cheap alcohol, but more taxes don’t seem to match the increased costs with related health problems.

  6. I feel quite privileged to be among such enlightened company. I heard it here last:”so many die in alcoholic poverty all because of their own bullheadedness and it’s no ones fault but their own. .” Clearly this blog needs a disclosure policy. Any one who can’t hear 2.5 million people dying must be working for a private incarceration monopoly, a distillery or a self help group – all people who will go out of business when we can stop biological cravings.

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