Cutting alcohol consumption in middle-income countries
WHO reports show that more than 3 million people died from alcohol-related illness in 2016, yet low-cost interventions to measure how much people drink can lead to major reductions in heavy consumption. The EU-funded SCALA project promises significant results by introducing some of these techniques in Latin America.
© mrfotos_fotolia #6781649 , source: fotolia.com 2019
People whose alcohol consumption is tracked are likely to drink less, according to research from high-income countries. But is this also the case in middle-income countries, where alcohol poses a significantly higher health risk?
The EU-funded SCALA project sets out to answer this question, while also examining how to encourage health care professionals to track alcohol consumption in the first place. The initiative measures the drinking habits of 180 000 patients, in Mexico, Colombia, Bolivia and Peru, where alcohol is one of the leading risk factors for morbidity and premature death.
Its not just about proving the hypotheses, says SCALA project coordinator Peter Anderson of Universiteit Maastricht in the Netherlands. Setting up the infrastructure to encourage practitioners to measure and treat alcohol consumption counts as a result on its own. He adds that once the project is completed, practitioners will have treated as many as 9 000 heavy drinkers.
Simplifying the process
Anderson hopes that the project can be scaled up across Latin America and beyond as part of global measures against alcohol-related diseases. Statistics from the Global Burden of Disease Study recorded 63.5 million cases of alcohol use disorder (AUD) in 2015, causing 137 500 deaths, and 6.3 million years lived with disability.
Interventions can quickly produce results to improve patient outcomes. The Organisation for Economic Co-operation and Development (OECD) estimates that increasing to 30 % the proportion of eligible patients receiving advice and treatment for heavy drinking could lead to a fall in the harmful use of alcohol by as much as 10-15 % in OECD countries, with reductions in the annual incidence of AUD of 5-14 %.
Given the scale of the problem, health care providers in middle-income countries know that if they help cut alcohol intake among their patients, theyll have to deal with fewer recurring problems. However, Anderson says that limited resources and punishing schedules can limit their ability to take on new projects.
Referred for further treatment
The key is to simplify the process, he says. We make sure that there is a questionnaire in every consulting room, with a simple three-question test. We also offer a one-pager that doctors can give to patients with alcohol problems. If health care providers see that drinking is not decreasing, they can refer the patient for further treatment.
Given the strong correlation between heavy drinking and some mental disorders, SCALA also aims to identify patients at risk from conditions such as depression. The process is the same, says Anderson. Health-care providers offer a questionnaire, people with a raised score receive a brochure, and those with a very high score are referred for further assessment and treatment.
Anderson is satisfied with the uptake so far, but says his team werent quite expecting the influence that political changes would have on their work. When a new government comes in, youll find changes right down to the level of a director in a local health centre. If this happens, we start the whole process again in convincing people to come on board.
With the support infrastructure in place, SCALA will start providing interim reports on the projects results. And while Anderson is keen to see similar initiatives in poorer countries benefit from the projects outcomes, he emphasises the importance of a scaled approach.
We are making everything publicly available. During the last year of the project we will mobilise a range of networks of health professionals, healthy cities and WHO to try to ensure widespread scale-up of our strategy and programme throughout primary health care services in Latin America.