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Civil Society Organisations have demanded alcohol sector regulation to combat alcohol-related health problems.

They reiterated their position during their interactions with the Parliamentary Committees of Health and Trade on Monday, January 29, in the House.

According to them, the alcohol sector players have launched an assault on the proposed Alcohol Drinks Content Bill 2023 which aims to curb irresponsible alcohol consumption, among other issues.

Alcohol cancer-related risks

Dr Alfred Jatho from the Uganda Cancer Institute said that alcohol consumption has been linked to more than 200 diseases and injury conditions, including infectious diseases, cirrhosis, cancer, and mental disorders, among others.

“Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver and female breast and possibly cancer of the stomach, pancreas, lung, and gallbladder. Even light alcohol drinking increases the risk of these cancers,” he said.

According to Dr Jatho, alcohol at any level is associated with an increased risk of a type of oesophageal cancer called oesophageal squamous cell carcinoma. He said that the risks, compared with no alcohol consumption, range from 1.3-fold higher for light drinking to nearly 5-fold higher for heavy drinking.

Even after stopping alcohol consumption, Jatho said cancer risks don’t immediately stop. However, he said the risks eventually decline, although it might take years for the risks of cancers to return to those of the never drinkers.

Cancer care treatment costs go up to about $600,000(about sh2.286bn) annually according to a report presented by Uganda Alcohol Policy Alliance (UAPA).

The report indicates that breast cancer, oesophageal, liver, and colorectal cancers are alcohol-associated cancers. In 2020, including both new cases and deaths, these cancers were the third, fourth, fifth and eighth leading cancers in Uganda.

The most common cancer, cervical cancer, the fifth, Kaposi sarcoma, the seventh, non-Hodgkin's lymphoma, and the tenth, penile cancer, are associated with infections. Alcohol may also affect the risk of acquiring these infections.

Also, the report indicates that age-standardized incidence rates per 100,000 cases of most of these cancers continue to rise based on the last three years leading to 2020.

In another study, alcohol drinking was associated with breast cancer risk by two-fold. Worst still, the experts from the CSOs reasoned that alcoholic beverages in Uganda are heavily contaminated with carcinogens and the lifelong risk of developing cancer due to exposure to alcohol alone.

Overall, Prof. Nazarius Mbona from the Makerere University School of Public Health, said alcohol drinking remains high and this affects both public health and social economic indicators.

Prof. Mbona said there is a need for multi-sectoral consideration and a healthy balance of interest especially among trade, revenue, health and alcohol use for social function and leisure should be evaluated and considered in the provisions.

“I also recommend that prohibitive fines be set for the breach of the provisions of the Alcohol Control Act, in addition to the provision of quality assurance and monitoring the content of alcohol in Uganda,” he said.

MPs support the Bill

The Members of Parliament on the committees were pro the suggestions of the civil society and noted that alcohol is one of the causes of domestic violence, sexual abuse, mental health illness, and transmission of communicable diseases like Tuberculosis, among others.

The health committee chairperson, Charles Ayume (Koboko Municipality, NRM), said they are yet to meet Uganda National Bureau of Standards (UNBS) and Uganda Revenue Authority (URA) to extrapolate on issues of regulation and economic impact and the public health aspect.

“We shall try to synthesize all the information so that we can come up with a good law. There is a need for psychiatrists in regional referral hospitals so as to operationalise the machines in these hospitals that are lying dormant.

Dr George Didi Bhoka (Obongi County, NRM), urged the MPs saying, “We need to support this bill. People are ignoring the effects of alcohol, but people have died due to its misuse, and I stand to say that I support this Bill....the health side of it might win...I think.”

He added, “This is a war that we must fight. The local people we represent should be healthy and sober in mind to make healthy decisions and that would make us proud.”

Dr Nicholas Kamara (Kabale Municipality, FDC), who is also the chairperson Non-communicable Diseases Forum, said he supports the Bill from the public health perspective. “People are going to attack this law through legal means and also basing on its contribution of alcohol to the revenue basket, but what we need to do is ensure we stratify our messages,” he noted.

The need for a balance

However, Richard Gafabusa (Bwamba County, NRM) said that they also need information on the economic and socio-economic impacts of the regulation so that they can strike a balance. “But we all agree that there are economic benefits, and we also know that it has setbacks. But how do we strike a balance,” he queried.

Other MPs wondered how much revenue the government gets from alcohol and where it is spent. They said that the government needs to also compare how much money is spent on medical care for alcohol-related cancers, rehabilitating addicts, etc., to find out the balance between trade and public health concerns.

Meanwhile, other legislators castigated blame on some MPs for promoting the misuse of alcohol, saying that it is politicians who buy it for voters, and even going to the level of buying their voters alcohol with the highest content to kill them faster.

Breweries make their case

But the alcohol barons, who have in the last few months become battle-hardened veterans of lobby wars, fought back. They painted pictures of economic prosperity, of tax-fuelled coffers, of jobs bubbling like foam on a beer mug.

They argued for "responsible consumption," a phrase that tasted hollow in the mouths of those who had seen the devastating consequences of even the most "responsible" drinking.

Breweries and stakeholders who recently petitioned the government over the Bill they termed as controversial, predicted a staggering 4.2 million job losses if the Bill is implemented in its current form.

Onapito Ekomoloit, the board chairperson of Nile Breweries Limited argued that the proposed regulations on alcoholic beverages are unrealistic and unsustainable, threatening the survival of the industry and potentially leading to job losses.

The cost of rehabilitation

On the other hand, Civil Society has urged the Parliament to pass into law the Bill, citing the high cost of treating people battling alcohol dependence and abuse.

With over four million Ugandans struggling with alcohol addiction, Uganda would need 96 trillion to rehabilitate patients according to Richard Baguma from the Uganda Health Communications Alliance.

“I have a patient in rehab, I pay at least sh2m per month. On average, each patient requires sh2 million monthly and sh24 million annually for treatment in a rehabilitation facility,” he noted.

According to Juliet Namukasa from the Uganda Alcohol Policy Alliance, there is a high correlation between alcohol consumption and socioeconomic problems people face at various levels in the country.

She cited that in Uganda's participatory poverty assessment report carried out by the finance ministry in the recent past, alcohol was cited as second most common cause of poverty.

“Alcohol consumption undermines commitments to achieving 14 of the United Nations Sustainable Development Goals, impacting a range of health-related indicators, such as child health, infectious diseases and road injuries,” said Namukasa.

Rehabilitation beneficiary speaks out

Albert Elwa, an Addiction Professional, representing Addiction Prevention and Rehabilitation Association of Uganda (APRAU), an association that brings together organisations in treatment, prevention, and cared of persons battling addiction and other mental health conditions in Uganda, shared his experience. 

He narrated that he started drinking at the age of 15 which developed into an alcohol use disorder/addiction, noting that the problem messed up his education, job, and relationship.

"I got oesophagus cancer 5 years after I quit drinking. The doctors concluded that my drinking lifestyle years earlier had set the foundation for the cancer to attack. I was treated successfully, thank God today I'm free from it. It's painful to imagine the number of people especially young people coming for treatment and others have passed on," he said.

He added, "Addiction is no respecter of persons. Any of us here and our family members is a potential victim. If we don't push for this bill to pass, the future is a blick one. Research shows that young people are more prone to making risky choices as opposed to healthy ones," said Elwa.

Penalties 

Among other penalties, a fine of sh40 million or a three-year jail term has been proposed as sanctions for anyone found selling alcoholic drinks to a person under eighteen years of age. 

In addition, a person who sells alcoholic drinks without displaying health warning messages in a conspicuous place at his or her business premises commits an offence and is liable, on conviction, to a fine not exceeding sh20m or imprisonment for a period not exceeding ten years, or both.