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| | Alcohol Drinking and Related Health Problems in China | | 2005-3-25 18:14:45 Mental Health Institute, Central South U Hao Wei M.D, Ph.D. |  Wei Hao1, Hanhui Chen1, Zhonghua Su2, Yilang Tang3
1. Mental Health Institute, Second Xiangya Hospital, Central South University
2. Jining Psychiatry Hospital, Jining Medical College
3. Beijing Anding Hospital, Capital University of Medical Sciences, Beijing
Corresponding to: Wei Hao MD., Ph.D.
Professor of Psychiatry
Mental Health Institute
Second Xiangya Hospital
Central South University
Renmin Middle Road 139#
Changsha, Hunan 410011
China
Email: weihao57@china.com or bmwhomhi@public.cs.hn.cn
China is a vast country, which holds 22% of the worlds population. Over recent decades there has been evidence of a striking increase in alcohol consumption and related problems in that country, with the potential for a major impact on world health.
As one of the oldest brewing countries in the world, there are many legends and tales that center on this theme in China. The research shows that the origin of alcohol in China was from the Shen Nong period of New Stone Age (approximately 7 000 years ago). At the end of the 18th and the early 19th centuries, beer, brandy, whisky, and vodka were introduced to China (Cochrane, 2003, Hao et al., 2000).
China is known as a country in which alcohol is an important aspect of the culture. Drinking is socially accepted and plays a significant part in major events of daily life such as the Spring Festival?, wedding ceremonies, birthday parties and so on. Ritual drinking in special events, such as thanking to God, ancestors, the heaven and the earth, still exists in some areas. While several customs remain, there are noticeable changes in the drinking behavior of the Chinese. The Chinese business world is becoming highly competitive, and in many cases drinking is seen as a necessary behavior for success. Some Chinese businessmen believe that drinking could ease their tension and facilitate social interactions. Furthermore, alcohol could also help to maintain good relations between supervisors and employees and among colleagues (Cochrane, et al. 2003, Hao & Young, 2000).
Chinese cultural norms encourage social drinking and discourage solitary drinking. Despite the custom of toasting (i.e. urging one another to drink, and being made to drink as a forfeit at a banquet) and the drinking game known as "wager", Chinese drinkers tend to remind themselves not to drink too much when with friends. Most social drinking takes place with a meal (Hao & Young., 2000).
A wide range of alcoholic beverages is consumed in China. These include "strong" distilled liquor (about 54% V/V ethanol), "less strong" liquor (32-44% ethanol), wine and yellow rice wine (12-18% ethanol) and beer (4-6% ethanol). Rice wine is produced from cereals in China, with ethanol content usually15-16%. Additionally medicinal liquor is produced which includes traditional herbs and is used to treat a variety of ailments including arthritis and sexual dysfunctions such as impotence, though there is little evidence published so far (Hao & Young, 2000).
The amount of alcoholic beverages produced and consumed in China is increasing steadily and China is now the second largest beer-producing country in the world (World Drink Trends, 1996). In 2001 the sale of beer accounted for 73.1% of total beverage alcohol sales in China, with spirits at 26.0%. However, spirits still constitute the major absolute alcohol consumption, with more than four times the amount of ethanol consumed as spirits than as beer in 2001 (China Statistic Bureau).
A 2001 WHO sponsored survey of 24,992 subjects across five sites in China showed an annual ethanol consumption of 4.5 liters (SD= 10.9) among adults aged 15 years and older (Hao et al, 2003). Based on WHO data the per capita alcohol consumption in pure alcohol for adults in China in 1970 was 1.03 liters, and rose to 5.17 liters in 1996 (WHO, 1999). This was still low compared with many industrialized countries: by comparison European alcohol consumption was 8.6 liters per capita in 2001(WHO, 2001).
In the above WHO sponsored study in general population aged 15 and above, the proportions of 3-month drinkers in the study were 63.8%, 18.3% and 43.8%, for males, females and the total sample, respectively, and those of 1-year drinkers were 74.9%, 38.8% and 59.0%, respectively. Both the 3-month and the 1-year drinking rates were higher in males than in females (P < 0.0001). Both 3-month and 1-year drinking rates increased with age, reached a peak at 41–50 years old in males and 36–40 years old in females and then declined. A majority (76.7%) of female drinkers and 33.8% of male drinkers had alcohol beverages once a week or less, while 26.1% of male drinkers and only 5.4% of female drinkers drank at least once a day (Hao et al. 2003). In men, distilled spirit is the primary beverage of choice, accounting for more than one third of all drinks consumed. Women report consuming more wine and beer than other beverages (Cochrane et al. 2003).
Drinking behavior in young people in China is a new concern and needs more attention. A survey conducted in a Beijing middle school showed that life-time drinking rates were 48.3% and 37.0% for boy and girl juniors students respectively, and 72.8% and 56.3% for boy and girl senior students respectively. 12.2% admitted that they had drunk experiences in the past one year (Xing et al., 2003).
Luo et al (2003) conducted a survey in 115 middle, high or technical schools in Shanghai (n=9308). The results showed that 45.7% of these students used alcoholic beverages in their life-time and 17.8% used alcoholic beverage (5.2% had drunk experiences) in 30 days preceding the survey.
Some studies targeted people with specific occupations, such as steel workers and mine workers (heavy physical laborers). A sampling report showed that daily drinking rates were 63.8% for steel workers (average 88g /day in pure alcohol for 9.65 years) and 52.2% for mine workers (100g/day in pure alcohol for 6.5 years) (Lu et al., 1999).
The alcohol related harm has not been systematically studied and reviewed. It was conservatively estimated by WHO for 1990 in China alcohol was responsible for 114 000 deaths, 2.118 million years of life lost and 4.854 million "disability adjusted" years of life lost (WHO, 2002).
In the earliest reported field survey of mental morbidity in China, Shen et al. surveyed 38,136 persons aged 15 and over from 12,000 households in 12 regions in the early 1980s ( Cochrane, 2003, Hao & Young, 2000). Only six cases (0.016%) could be diagnosed as alcohol dependent according to ICD-9 criteria. Since then China has undergone rapid social and economic change. In the above five-site study, the prevalence of current alcohol dependence was 6.625% in men and 0.200% in women (3.797% overall), and the 1-year morbidity from gastritis/ulcer in the whole sample was 7.9%, which associated nonlinearly to alcohol intake, and heart disease and cerebral infarction/cerebral hemorrhages showed V-shaped curve relationships (Hao et al., 2003).
It is difficult to ascertain to what extent differences in diagnosis rate, survey methodology, and reporting have impacted on this apparent dramatic increase in the prevalence of alcohol dependence. Nonetheless the rise in prevalence of alcohol dependence has paralleled similarly dramatic increases in commercial alcohol production (see above), and the substantial changes within Chins society.
While alcohol drinking is an integral part of Chinese culture, experts in the field have been alarmed at the rate of increase of consumption and related health problems. Population based prevention has not been developed, and early intervention techniques have not been routinely implemented. Health services response to alcohol related harm has traditionally focused on treatment of complications with little focus on the underlying alcohol use disorder per se (Hao, 1995). No publications were found on harm reduction or prevention programs. There are few published reports of current treatment methods for alcohol dependence in China. Facilities have been established for treatment of substance abuse, but there are not specific alcohol treatment centers (Cochrane, 2003, Hao & Young, 2000). Home detoxification has been relatively unexplored, and self-help organizations similar to alcoholics anonymous exist only in certain regions. Only one multi-center study on efficacy of naltrexone in reduction of relapse is being conducted.
Drinking driving caused a lot death in China (in 2001, the number of traffic accident cases in China were over 100,000 and 1/3 were related drinking driving). (Zhang et al., 2004). Chinese government issued the new version "Traffic Safety Law", which has taken effect from May 1, 2004. The penalties for drinking-driving include life-long license suspension and imprisonment. However, the criteria for drinking driving and drunken driving, and related procedure have not been clarified yet (Zhang et al., 2004).
Besides, there is another important issue which has not been addressed so far: China has not developed a comprehensive public health policy on alcohol. Access to alcohol has few restrictions and controls. There is no legal drinking age in China, alcohol is freely available in restaurants, supermarkets and other stores. Alcohol advertising is widespread, including on television, and appears to have been very successful for specific brand.
Considering the time lag between alcohol use and alcohol related chronic harm, it is likely that alcohol related disorders will increase even if the alcohol consumption do not continue to increase in China over the coming years and so the burden of ill health related to alcohol use is expected to grow. China should develop an alcohol policy to improve public health based on the experiences of other countries. The policy should be a harm reduction strategy, aiming to reduce health damage and stabilize the consumption of alcohol. This could be achieved through measures aimed at controlling overall alcohol consumption (a population-based approach), and specific measures targeted towards risk behaviors (a high-risk approach). Measures such as public awareness education, advertisement restriction, taxation, set a legal age for drinking, and drinking driving penalties would have a significant impact on the reduction of alcohol related problems.
China is now experiencing economic and political reform and the government needs to achieve a balance between economic development and public health, and between short- and long-term strategies. At the present stage, economic development is the focus of public and government attention. It will be a challenge to mount a population-based alcohol policy in China.
References
China Statistic Bureau. http://www.stats.gov.cn.
Cochrane J, Chen HH, Conigrave KM, and Hao W. Invited review, alcohol use in China. Alcohol & Alcoholism 38: 537-542, 2003.
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Hao W, Young D. Drinking pattern and problems in China (invited author) Journal of Substance Use. 5:71-78, 2000.
Hao W. Commentary: Alcohol use and public good, a Chinese view. Addiction, 90:1448-1450, 1995.
Lu XH, Yang QM, Wang LH, Liu UH. Drinking and drinking related health problems in steel and mine workers. Journal of Health Psychology 1999, 7:58-60.
Luo CY, Peng NN, Zhu W, Zhou YF, & Gao GD Risk behaviors of adolescents in Shanghai: Part III, smoking, drinking and addictive drug use. Chinese Journal of School Doctor 2003, 17: 401-404.
WHO. A summary of global status reports on Alcohol. WHO, 2001, Geneva.
WHO. Global Status Report on Alcohol, pp. 9–13. WHO, 1999, Geneva.
WHO. International guide for monitoring alcohol consumption and related harm. PP 5-6, WHO Geneva, 2002.
World Drink Trends. International beverage alcohol consumption and production trends. NTC Publications, Henley-on-Thames. 1996.
Xing Y, Ji CY, Yang XG, Ji H, Yang LP, Yu Y, & Zhang L. The prevalence of addictive behaviors among middle school students in Shijingshan, Beijing. Chinese Journal of School Doctor 2002, 16:684-686.
Zhang HX, Zhang XG, Deng ZH., Xie Na, Kong B, Huang SX, Liu KL. The issues of the drinking driving related BAC criteria and assessment procedure in China. Journal of Forensic Sciences 2004, (6) 36-38.
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Ministry of Health, (2003) No.013
ICP:No.040657