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India. Alcohol prohibition poor policy, it’s not a moral problem

Prohibition of alcohol is back on the political agenda with the recently elected Bihar government banning its sale and consumption to fulfil a key electoral promise. Other parties, such as the DMK and the AIADMK in Tamil Nadu and the Congress in Kerala, are also championing this cause.

These states join a growing list, including Gujarat, a clutch of northeastern states and Lakshadweep, in imposing a policy which is currently not practised in any country outside the Islamic world. That prohibition can win elections is a vivid reminder of the tragic social consequences of alcohol consumption in the form of household impoverishment, domestic violence and premature mortality. That these policies are completely at odds with history and public health science testifies to the failure of our commonsense.

There is no evidence to show that prohibition has ever had its intended impact. Of course, just as banning beef has reduced beef consumption, banning alcohol will lead to reduced alcohol consumption. But, there appears to be little or no correlation between, say, domestic violence or household impoverishment and prohibition. Instead, there is an enormous cost to society, and here I refer not to the obvious massive losses to the exchequer but to the criminalisation of the majority of people who drink sensibly to address the problems caused by the minority who do not. It is, in effect, equivalent to banning motor cars because a few drive rashly.

Prohibition is a very poor policy option to address the adverse consequences of alcohol abuse when compared with a range of more effective public health approaches. The most notable international example of the failure of prohibition is that of the US where a constitutional amendment implemented this policy in the 1920s, only to be revoked 13 years later. The reason was simple: The policies led to the criminalisation of an entire section of the population, from those who manufactured the product to those who consumed it. It replaced a way of life which is as old as mankind with a corrupt nexus of smugglers, police, politicians and bootleggers.

The story is no different in India. As any reader of this paper who has been invited to a party in Ahmedabad can testify, the truly remarkable thing about prohibition in Gujarat is the range of alcoholic brands which are served in private homes. Of course, this is restricted to the rich who bypass regulations by virtue of being able to buy “permits” on medical grounds and escape police harassment. Lisa McGirr argues in her recent book, The War on Alcohol, that the enforcement of prohibition in the US was intrinsically biased against the poor, the working class, immigrant communities, and the marginalised. Prohibition, like so many other policies imposed from the moral high-ground, typically by those who do not drink, disproportionately affects the poor who resort to illegally brewed alcohol when they want a drink, not infrequently leading to their death, and are more likely to be harassed by the police.

Prohibition is rejected by most public health scientists who know this field; even the World Health Organisation does not recommend it. The complete lack of a public health approach to alcohol abuse in India is illustrated by the way in which the government has permitted the shameless surrogate advertising of alcohol by corporations, for example, through selling “bottled water” under the same brand names as their much better known alcoholic beverages. Amongst the many crimes Vijay Mallya seems to have gotten away with, that he could run an airline named after the most popular alcoholic beverage in the country has been perhaps the most damaging of all in terms of its impact on the burden of disease in India.

India remains one of the few nations which still focuses entirely on an archaic de-addiction model, administered by the ministry of social justice and empowerment, to address drinking problems, adhering to a centuries-old idea of these problems being a moral disorder rather than a health condition. There is a total absence of effective counselling interventions for those who wish to control their drinking. Instead, we live in such surreal times that “medicinal grounds” is the one situation in which drinking is permissible in states where prohibition is enforced. Essentially, this means that a person who wishes to drink can obtain a permit, after paying the required fee to a malleable physician, because he is a sharabi and his life would be threatened without a drink. This, of course, is the precise group who in any other country would have been offered psychological or medical interventions to control their drinking!

So, let us be prepared for more criminal activity, more deaths amongst the poor fuelled by illegally brewed poisonous alcohol, more hard liquor being drunk secretly in dingy corners, more corruption in the police force and more misery for those who wish to drink sensibly.

Prohibition of substances which give pleasure to people does not work. Addiction is a health problem, not a moral one, and there are many proven strategies which can reduce its burden. The desire to address the serious social problems caused by a minority of those who consume alcohol by prohibition is a travesty of the experience of history and public health science. When Mizoram repealed prohibition in July 2014, 17 years after it had been imposed, its excise minister explained that he had proposed this bill so that “those people who cannot do without drinks can find good quality liquor at cheaper prices”. He also claimed that he had “asked god to prevent me from introducing the bill in the assembly if that is what he really wanted”. Clearly, god had commonsense. Do our politicians?

28 Apr. 2016

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