If you asked the average global health professional to name the countries where alcohol caused the most health problems, what would they say?
Most likely, “Eastern Europe.”
This answer is only partially correct. Twelve sub-Saharan African nations were among the 20 countries with the highest rates of healthy years lost to alcohol use in 2013 (see Figure 1). Healthy years lost include all the years lost when people die early or suffer from disability. Countries from across the African continent appear toward the top of this list. Two southern African countries, Lesotho and Namibia, are among the top five countries with the highest levels of early death and disability from alcohol use.
Figure 1 also shows how the rankings of countries have changed over time. In 1990, Rwanda, Burundi and Uganda were among the five countries with the most early death and disability from alcohol use. By 2013, these three countries dropped to ranks 17, 9 and 12, respectively, while Lesotho and Namibia moved up to ranks 2 and 4, respectively, from their 1990 rankings of 46 and 218.
When you compare regions according to the rates of early death and disability from alcohol, Southern sub-Saharan Africa ranks second, just behind Eastern Europe. Western, central, and eastern sub-Saharan Africa rank fourth, fifth and sixth, respectively, behind central Asia.
In southern Africa, alcohol use is the third-leading risk factor for early death and disability just after unsafe sex, which accounts for the lion’s share of early death and disability in this region, and childhood undernutrition. In this region, alcohol use causes more early death and disability than unsafe water and inadequate breastfeeding. In southern Africa, a substantial amount of the early death and disability linked to alcohol use comes from people driving drunk or committing violent acts or suicide while under the influence. Alcohol use is also linked to early death and disability from tuberculosis.
Given these findings, it is encouraging to see that a target under Sustainable Development Goal 3 specifically focuses on alcohol use, aiming to “strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.” Going forward, it will be important to watch how governments and development partners in sub-Saharan African countries, particularly in southern Africa, address this global health threat.