Callum Narita, Editorials and Publications Team PMSA
Alcohol use is associated with many poor health outcomes and represents a significant global disease burden(1). It can affect health directly, including liver disease and cancer. Additionally, there is a risk of addiction, which can lead to further health and social issues. Indirectly, alcohol influences health through increased rates of domestic violence and alcohol associated injuries(1,2). It is associated with risky sexual behaviour including unprotected sex, which is an issue given the rates of sexually transmitted diseases in some Pacific nations(3).
Alcohol use in the Pacific islands varies greatly between countries and within certain population subgroups(4). Males appear to consistently have higher rates of drinking and heavy drinking, defined as six or more drinks in a day of drinking. In Nauru, an astounding 89.2% of men and 80.1% of women between 25-64 years of age reported heavy drinking, followed closely by the Cook Islands (87.6% of men and 66.0% of women)(4). Conversely, whilst the rates of heavy drinking were unavailable, the prevalence of daily drinkers in both Fiji (36.9% in males, 4.3% in females) and Vanuatu (31.7% in males, 7.2% in females) was significantly lower than other Pacific nations, and close to the global World Health Organization estimate of prevalence(5). Therefore, the issue is not necessarily generalisable to the Pacific, and appears localised to specific nations.
An area of particular concern is youth drinking rates, which albeit once again variable, are high in the Pacific region(4). In students between 13-15 years of age, 43.7% of males and 19.3% of females in Kiribati reported being current drinkers. 35.4% of males and 10.4% of females also reported being drunk on at least one occasion(4).
The Marshall Islands reported a high use of alcohol on school premises (18.9% of males and 11.7% of females)(6). Additionally, the use of alcohol in the same region before last sexual contact in school students was extremely high (40.5% of males and 26.2% of females)(6). There are similar rates in American Samoa and Palau. This demonstrates a significant preventable health problem in a group targetable with public health campaigns and education. Such education programs have been found to be effective in the reduction of binge drinking rates(7). Given this is a vulnerable population, developing and implementing these strategies is paramount and can have lasting effects.
Despite the high burden, there are other interventions that have been demonstrated to be effective in controlling alcohol use and abuse. Public health measures that can decrease the economic burden of alcohol-related conditions include taxation, restriction of advertising and decreased accessibility to alcohol, particularly in young populations(8). These are simply implemented and would likely lead to improved health outcomes in these nations.
1. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet. 2009;373(9682):2223-33.
2. Kyriacou DN, Anglin D, Taliaferro E, Stone S, Tubb T, Linden JA, et al. Risk factors for injury to women from domestic violence. N Engl J Med. 1999;341(25):1892-8.
3. Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: Systematic review and meta‐analysis of experimental studies. Addiction. 2012;107(1):51-9.
4. Kessaram T, McKenzie J, Girin N, Roth A, Vivili P, Williams G, et al. Alcohol use in the Pacific region: Results from the STEPwise approach to surveillance, Global School‐Based Student Health Survey and Youth Risk Behavior Surveillance System. Drug and alcohol review. 2016;35(4):412-23.
5. Organization WH, Unit WHOMoSA. Global status report on alcohol and health, 2014: World Health Organization; 2014.
6. Howard J, Ali H, Robins L. Alcohol, cannabis and amphetamine‐type stimulants use among young Pacific Islanders. Drug and alcohol review. 2011;30(1):104-10.
7. Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV, Stackpole KM. School-based adolescent drug prevention programs: 1998 meta-analysis. J Prim Prev. 2000;20(4):275-336.
8. Bloom D, Chisholm D, Llopis E, Prettner K, Stein A, Feigl A. From burden to" best buys": reducing the economic impact of non-communicable disease in low-and middle-income countries. Program on the Global Demography of Aging; 2011.