It is very common to believe that great mortality figures in Ukraine are caused by poor living conditions, lack of resources for adequate health care assistance and nutrition and other mainly economic factors. However, when comparing current mortality figures in Ukraine with such figures 20 years ago, we can see the following: mortality among children and elderly people, who suffer most from poor economic conditions, was more or less stable, while mortality increased greatly for middle-aged persons.
For men aged 30-44, it more than doubled during this period. Detailed analysis of this middle-age mortality increase reveals that more than half of deaths were caused by alcohol-related causes. According to the State Statistics Committee data in 2008, 24,337 persons died in Ukraine from so-called direct alcohol causes: alcohol psychosis, alcohol cirrhosis, alcohol cardiomyopathy and alcohol poisoning. Alcohol also contributed to various accidents, suicides, homicides, some cancers and other diseases, bringing total annual alcohol-related mortality in Ukraine to more than 100,000 deaths. According to the World Health Organization, alcohol causes 12 percent of the disease burden in Ukraine.
Ukraine’s situation is not unique. Other countries also experience similar alcohol problems. In the European Union, alcohol is responsible for 7.4 percent of all disabilities and premature deaths.
However, many countries managed to find effective ways to decrease alcohol-related mortality. These ways are presented in numerous publications, such as the European Commission report Alcohol in Europe http://ec.europa.eu/health-eu/news_alcoholineurope_en.htm. The most effective alcohol policies are: tough drunk-driving restrictions; advice to reduce or stop drinking by health workers to patients; increase in alcohol taxes; restrictions on sale by age, time and place; and a complete ban on alcohol advertising. The European report stresses that: “Educational interventions, which show little effectiveness in reducing the harm done by alcohol, are not an alternative to measures that regulate the alcohol market, which have the greatest impact in reducing harm, including amongst heavier and younger drinkers.”
The sharp increase of middle-age mortality in Ukraine in recent years, which was mainly alcohol-driven, also reveals that this trend can be reversed. Such a possibility is proven not only by other countries, but by Ukraine’s own experience. In 1995-1998, Ukraine experienced a mortality decrease, especially among middle-age persons. Some experts believe that the main reason behind that decrease was the rise of real prices for vodka due to fiscal policies. However, after the economic crisis of August 1998, vodka again became relatively cheap and mortality started to rise again. It is worth mentioning that the mortality decrease during those years was not a result of a deliberate governmental health policy, but simply a byproduct of the fiscal policy.
In 1986, mortality in Ukraine became lower than in Poland, mainly as a result of Mikhail Gorbachev’s anti-alcohol campaign. In 2006, mortality in Ukraine was 60 percent higher than in Poland, where some effective alcohol policies were implemented.
A review of alcohol policies in Ukraine reveals that they started to be implemented only recently. In Ukraine, alcohol taxes are below not only minimum European Union levels, but also Russian ones. Only in 2009 was their increase above inflation.
Outdoor alcohol advertising was banned only in 2009, but TV advertising is still present. Since January 2009, shops where alcohol is sold to under-age persons can lose their license to sell alcohol.
Punishment for drunk driving (as other driving violations) recently became more severe. According to State Statistics Committee data during January-March 2009, in comparison with the same period the year earlier, the number of death in transport accidents decreased from 2063 to 1176.
The number of alcohol poisoning deaths also decreased from 2,854 to 2001, and number of alcohol psychosis deaths from 494 to 359. This mortality decrease was mainly caused by economic crises, as many Ukrainians stop spending money on alcohol. But governmental policies also contributed to this positive trend.
However, the recent improvement of the alcohol mortality situation in Ukraine is not a result of deliberate alcohol policies, as there is no governmental document where such policies are articulated. If the Ukrainian authorities really want to continue the recent reduction of alcohol related problems, they have to face the following challenges:
1. Continue the process of alcohol tax increases, not only for fiscal but also for health reasons. In March 2009, parliament increased taxes for spirits and recently government proposed to increase taxes for beer and wine.
2. Ban alcohol advertising in media, especially on TV. Recently Prime Minister Yulia Tymoshenko called for a ban on alcohol and tobacco advertising and there is hope that new legislation will be submitted.
3. Legally beer is still not considered an alcohol beverage in Ukraine, so all restrictions on alcohol sales and advertising do not apply to beer. So beer is readily available for youngsters. The European Health Behavior in School-Aged Children (HBSC) revealed that Ukrainian students aged 11-15 had the highest level of alcohol consumption in Europe, mainly due to beer consumption. Ukraine should implement the European approach, where all beverages which have more than 1.2 percent of ethyl alcohol are considered as alcoholic ones.
Public attitudes to alcohol also need to be changed. The World Health Organization alcohol policy slogan is very simple: Alcohol – less is better. Unfortunately, private intolerance to non-drinking and even moderate drinking is very common in Ukraine, while publicly everybody agrees that people should drink less. Another challenge for public attitudes is the misperception that only fake alcoholic beverages are dangerous, while conventional alcohol is safe. In reality, all kinds of alcoholic beverages are dangerous and the toxicity of fake beverages, in most cases, is only a little higher than the toxicity of conventional alcohol beverages.
Currently, annual per capita alcohol consumption in Ukraine estimated as 12-13 liters of pure alcohol (including illegal alcohol). It is lower than in Russia, but higher than in most countries of the world. In European Union countries, average alcohol consumption decreased from 12 liters in 1980 to nine liters now. Those countries where alcohol consumption decreased the most also experienced highest reduction in alcohol-related problems. Ukraine has already experienced such reductions in the past and can use evidence-based alcohol policies because such policies really save human lives.
Konstantin Krasovsky is a founder of the Alcohol and Drug Information Center (ADIC-Ukraine) in Kyiv. He can be reached at [email protected], while more information about ADIC-Ukraine can be found at http://adic.org.ua/adic.
