Opinion Our hypocrisy on alcohol: It’s about politics and money — not health

The societal definition of abuse is when one is not able to discharge one’s role or becomes a nuisance to others in the family or society regularly. Only when the externality of its impact on others (domestic violence, traffic accidents, family impoverishment) becomes pronounced, do we call it an issue worthy of a public response. If an individual suffers due to alcohol use disorder — say with cirrhosis of the liver — the attitude often is that no sympathy should be wasted. Most national surveys in the last five years show that around 20-25 per cent of men and 1-2 per cent of women consume alcohol and one in five of them are dependent or indulge in harmful use and need treatment.

Women have generally been at the receiving end of alcohol use by men. That is why most social protests around alcohol have been women-led. In general, our thinking is that the rich can choose to do whatever they want but the poor should behave responsibly as they cannot afford this habit. Upper castes equate alcohol use with “tamasic” food, taking a moral high ground, while most tribal societies openly embrace it. Many Indians, including those from upper castes, consume alcohol at home but not publicly — a clear sign of hypocrisy. A politician, more so a woman, drinking alcohol is seen as irresponsible, even though it may have no impact on his or her performance. Some consider alcohol as a corruption brought in by Western culture, despite enough evidence that it has always been a part of our culture. Alcohol use has always been seen from a religious lens. While Islam forbids its consumption, Christianity is seen as permissive, nothing in Hindu religion bars alcohol consumption. Many religious sects prohibit its consumption. A balance has been struck by society by proscribing it on some days and allowing it on others!

In recent times, the WHO has changed its policy of “some alcohol is good” to “no alcohol is good”, following pressure from public health and activist groups. In 2013, when global targets were being set, WHO and some countries opted for a 10 per cent decrease in harmful use of alcohol. India opted for a 10 per cent reduction in alcohol use — not just harmful use of alcohol. This is in keeping with the Directive Principles Of State Policy (DPSP) in the Constitution: “The State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and drugs which are injurious to health.”

However, our current political approach does not support this thinking. Haryana, for example, after experimenting with prohibition in the 1990s, today has a licencing system that has resulted in alcohol vends every few hundred metres in Faridabad and Gurgaon. These measures have been driven by the revenue generation potential of alcohol sales. Delhi and Haryana have often competed by revising state taxes. Delhi’s controversial alcohol policy, revoked last year, allowed vendors to give discounts. Kerala is another example where the need for revenue generation resulted in the state government stepping back from partial prohibition. The Tamil Nadu government, learning from multiple hooch tragedies, has gone into the business of selling alcohol through its State Marketing Corporation to ensure citizens’ safety. Most states are not ready to get alcohol into the GST scheme as they fear foregoing revenue. Prohibition in Gujarat is a Gandhian legacy that no one wants to fiddle with. Mizoram, a Christian-majority state, has imposed prohibition and recently, following protests, allowed local wineries.

This muddled approach is compounded by the bureaucracy. India has developed the concept of official “dry days” — when the sale and public consumption of alcohol is banned, mainly on religious grounds, and salary days. These days get notified so that people can buy in advance and are not inconvenienced. The recently revoked order in Uttarakhand on riders for home use of alcohol exemplifies this bureaucratic approach. Neither the politicians nor the bureaucracy have health at the core of the policy.

A public health approach to curb alcohol use follows the approach for tobacco control like limiting access (licensing and age bar on sale), raising tax, prohibiting marketing and raising awareness. However, their enforcement is quite weak. Though advertising bans are in place, alcohol firms have flouted them, including in the ongoing cricket World Cup, by using surrogate advertising. Governments have looked away. This violation can be addressed by an appropriate legislative remedy, but governments have not shown any intent to do so.

Addressing this ambivalence and hypocrisy needs open and non-judgemental discussions in society. The false dichotomy between traditionalism and modernism, the professed role of religion and trade-offs between health impact mitigation and revenue generation need to be debated. Alcohol brings the hypocrisy of society out in the open. Are we ready to confront it and take steps to deal with it? Till that time, a rational national alcohol policy will remain a delusion.

The writer is Professor at the Centre for Community Medicine at the All-India Institute of Medical Sciences, New Delhi. Views are personal