Alcohol in the Third World


By Shanthi Ranganathan

Abstinence from alcohol is a value which is deeply rooted in Indian culture and religion, and as such is the only approach to drinking that could be called “sensible” in this country. Hinduism has the largest following in India, and in the Hindu scriptures drinking is referred to as one of the five heinous crimes, which include murder and adultery. According to the laws of Manu it is a sin to consume alcohol, and the only way to atone for it is to have the image of a liquor bottle branded on your forehead. The ancient Tamil poet, Thiruvalluvar, whose work entitled THIRUKURAL offers some foundations for ethical values in society, also condemns alcohol, calling it a social evil and equating a drunkard to a dead body.

The Indian Constitution strongly endorses the principle of prohibition, a concept that was first introduced by Mahatma Gandhi, and total prohibition throughout India was imposed in 1977. It only lasted for two years but the State of Tamil Nadu was “dry” for a total of 23 years, and the State of Gujarat still is. In addition, some states have partial prohibition in the form of a ban on “country liquor”. Even today it appears that most Indian women favour total prohibition, and politicians often advocate some form of it to win their vote.

It is illegal to advertise alcoholic beverages in India, and they do not have a cultural role to play in religious and social activities. Thus it could be said that there is quite a strong “supportive environment” for abstinence here. The modern trend towards serving alcohol at parties reflects the influence of Western culture and is limited to small pockets in urban areas. The large majority of Indians still live in the villages. Furthermore, annual per capita income in India is less than US$ 160, which means that alcohol is a luxury few can afford. For most, it can only be bought at the expense of basic necessities.

Not surprisingly for a country in which the doctor-patient ratio is 1 to 2310, the health services are focused on providing bare essentials such as immunization. When questions of alcohol consumption do arise, the answer is usually simple: “Don’t drink”. Religiously, culturally, socially and economically it is the only answer that makes sense. In other words, for an average Indian abstinence in not a matter of choice but an imperative.– Shanthi Ranganathan

Mrs Ranganathan is Honorary Secretary of the TT Ranganathan Clinical Research Foundation, at TTK Hospital, 17 IV Main Road, Indira Nagar, Madras 600 020, India. Excerpted from WORLD HEALTH FORUM (World Health Organization) Sept. 1994.

Alcohol: a “Gift” of Christianity and European Influence

By N.N. Wig

My own experience in India and later in many countries of the Eastern Mediterranean Region, has amply convinced me that alcohol drinking has a different meaning in different countries and also within different communities in the same country. The three major religions with which I have some familiarity, Christianity, Islam and Hinduism, seem to have differing views on the subject. While excessive indulgence in alcohol is condemned by all religions, Christianity seems to be more liberal in accepting its use for social purposes while Islam totally rejects it. The Hindu position lies somewhat in between. Their scriptures generally disapprove of alcohol consumption but seem to condone its occasional use by certain classes of people such as kings, nobles, warriors and manual workers but prohibits its use for priests, students and those seriously following a religious way of life.

When the British and other European colonial powers came to India in the eighteenth and nineteenth centuries, cannabis and opium probably enjoyed more popularity as the drugs of recreation than alcohol. However, under the patronage of British rulers, the popularity of alcohol started increasing. In the public’s mind, alcohol soon got associated with the Western way of life. In the days of the freedom struggle in India, the opening of liquor shops by British rulers was seen as a form of exploitation and was strongly resented. At the time of Independence in 1947, India boldly wrote in the directive principles of State policy in the Constitution that “the State shall endeavour to bring about prohibition of the consumption of intoxicating drinks”. Unfortunately, even the written provision in the Constitution of the country has not been able to prevent the rapid increase in the consumption of alcohol in India during the last few decades.

It seems that most of the developing countries in Asia and Africa have had a similar experience in the matter of alcohol consumption during the last hundred years. Originally, alcohol was not such an integral part of the social scene in most of the countries of Asia and Africa as it was in the Christian communities of Europe, but now it has become very much associated with the concept of “Westernization” and “modernity”. Condemned and regarded as something alien to local cultures a century ago, it is now fast becoming “the in thing”, a sign of social sophistication and a symbol of prestige. Most of the developing countries have now set up their own breweries and distilleries, and the tax on alcohol is a major source of revenue for many of them. High-pressure advertising by the alcohol companies further speeds up the trend.

Barely three decades ago, less than 1% of the cases in psychiatric wards were admitted for alcohol-related problems; now the number exceeds 20% in most of the major psychiatric centres. The position in many newly independent countries of Africa is equally bad or worse.

Thus, in spite of the past social stigma and serious cultural reservations, the use of alcohol has gradually spread to most of the communities in developing countries, except perhaps in the Islamic countries of the Middle East. Since there are no previous cultural norms in this area to refer to, there are no clear social guidelines about when, where and how much to drink. We are witnessing a bewildered social response, usually of an extreme kind. While reformers keep urging a total ban on alcohol, the common people are drinking more and more. Also, people are drinking not so much for social enjoyment as to get intoxicated. It is in this context that I see the relevance of the concept of “sensible drinking” in developing countries–an idea whose time seems to have come. The rapid social change has already overtaken us. The old debates and old solutions have become irrelevant. The first battle to be won in developing countries is to accept the reality of alcohol drinking in our societies, so that we can approach it realistically.

The choices are very hard for developing countries. Any general condonement of drinking alcohol seems sure to increase the number of heavy drinkers. On the other hand, it is equally dangerous not to educate our youth about how much to drink, when we know that very soon they are likely to drink recklessly, especially if uninformed about the consequences. The solution is somewhat similar to the dilemma of sexual education in AIDS programmes. Sexual education may encourage promiscuity and disrupt traditional societies but unsafe sex can lead to the death of our children.

Before we move further in popularizing the concept of sensible drinking, there are many hard questions to answer. Can we isolate drinking behaviour from other personal behaviours? In non-European cultures, in popular imagination, alcohol has become linked with other features of Western lifestyle which give high priority to the pursuit of personal pleasures in life, personal freedom in sexual matters, unlimited consumption, assertiveness in social relations, etc. Can we put a control on drinking behaviour without controlling other aspects of human behaviour? Furthermore, should drinking of alcohol be left only to the discretion of the individual as a private matter or should society set the norm? How much alcohol is good for the individual? Should this be governed by rules made by science or by rules made by religion?

Obviously the answers to such questions will vary according to different cultural perceptions and expectations. Islam has already taken a clear position in this regard. Other cultures have to evolve answers depending on their past history and traditions. Ideas like “sensible drinking” will succeed only if they are conveyed as part of larger programmes of public policy and health education in which moderation in all spheres of human behaviour is accepted as a basis for healthy life, and where the growth and happiness of other members of society are seen to be as important as one’s own. In the matter of personal behaviour, probably science alone cannot set all the rules. Sensible drinking can only be a part of sensible living.

Dr Wig is former Professor of Psychiatry at the All India Institute of Medical Sciences, New Delhi, and former Regional Adviser in Mental Health at WHO’s Eastern Mediterranean Regional Office. His address is 279 Sector 6, Panchkula, Haryana 134109, India.