Visualizing the massive toll of an abused drug seldom in the headlines

--Fotopedia

The legalization of marijuana in Washington and Colorado has been big news around the country and the world.

These laws have spawned concerns that they could encourage more youths to use marijuana and lead to increased frequency of impaired driving. On the other hand, civil rights activists have endorsed marijuana legalization, noting that the law-enforcement approach has largely failed to make a dent in the drug abuse problem and that minorities are imprisoned more often than whites as a result of the prohibition of marijuana.

What about the impact of a drug that causes much greater health loss?

According to the Global Burden of Disease Study, alcohol was the fifth-highest risk factor for early death and disability worldwide in 2010. The screen grab below shows how alcohol ranked higher than high body mass index (an indicator of overweight and obesity), childhood underweight, and sedentary lifestyles (physical inactivity).

AlcoholGBDAlcoholGBD2

Delving into the country level, the next screen grab shows how alcohol ranks highest as a risk factor in many Latin American countries such as Guatemala (1), Ecuador (1), and Brazil (3); in African countries including Namibia (1), South Africa (1), Botswana (1), Gabon (1), and Uganda (1); and in many Eastern European countries, particularly Russia (1).

Ranking of alcohol use as a risk factor for premature death and disability, 2010

AlcoholGBD3How exactly is alcohol wreaking havoc on people’s health? To be clear, moderate amounts of alcohol can have a protective effect against conditions such as heart disease. Too much alcohol, however, can cut lives short and cause disability in a variety of ways. The effects of harmful alcohol use range from damaging people’s livers and resulting in cirrhosis, to increasing the likelihood of car crashes and homicides. Also, excessive alcohol use can actually cut lives short by causing cardiovascular disease.

The harms of alcohol exhibit different patterns among regions. In Central Latin America (see screen grab below), alcohol (represented by the dark shading) is linked to alcohol use disorders (defined as a condition where a person’s drinking leads to distress or harm), cirrhosis, road injuries, and violence. A previous Humanosphere post explored how the mayor of Cali, Colombia, issued alcohol regulations to prevent gun violence in his city. In Central Latin America, alcohol was linked to 25% of healthy years lost from violence.

Premature death and disability linked to alcohol by cause in Central Latin America, 2010

AlcoholGBD4Note: The size of each box represents the percentage of total disease burden due to a particular disease or injury. The dark shading represents the percentage of premature death and disability attributable to alcohol for a given disease or injury.

In Southern sub-Saharan Africa, the majority of the burden associated with alcohol was associated with injuries, as shown in the next screen grab. Very little alcohol burden was tied to non-communicable diseases such as cirrhosis and alcohol use disorders. Alcohol contributed to 45% and 43% of early death and disability from violence and road injuries, respectively. And 44% of healthy years lost from unintentional injuries from mechanical forces (which includes situations where a person accidentally shoots him- or herself or another person with a firearm, for example) were also linked to alcohol.

Premature death and disability linked to alcohol by cause in Southern sub-Saharan Africa, 2010

AlcoholGBD5Note: The size of each box represents the percentage of total disease burden due to a particular disease or injury. The dark shading represents the percentage of premature death and disability attributable to alcohol for a given disease or injury.

In Eastern Europe (see screen grab below), alcohol accounts for a large portion of healthy years lost from road injuries, self-harm (primarily suicides), violence, and other injuries, as well as non-communicable diseases. A marked difference from other regions is that a large percentage of premature death and disability from ischemic heart disease (40%) is linked to alcohol in this region of the world. This finding may be surprising to some given the fact that moderate drinking can protect people from cardiovascular diseases.

I asked Dr. Mohsen Naghavi, a co-author of the Global Burden of Disease study, to shed light on this finding.

“We know that binge drinking, which is common in Eastern European countries, can cause death from ischemic heart disease,” said Dr. Naghavi. “Death and disability from ischemic heart disease is also linked to poor quality alcohol. After the collapse of the Soviet Union, many people in former Soviet states started brewing lower-quality alcohol at home.”

Premature death and disability linked to alcohol by cause in Eastern Europe, 2010

AlcoholGBD6 Note: The size of each box represents the percentage of total disease burden due to a particular disease or injury. The dark shading represents the percentage of premature death and disability attributable to alcohol for a given disease or injury.

These findings underscore the importance of tackling harmful alcohol use globally. Visualizing the different ways that alcohol impacts people’s health across regions also highlights how data can help policymakers choose approaches for combatting harmful alcohol use that make the most sense for their region. These approaches range from enforcement of drunk driving laws to alcohol taxes and programs to screen and treat alcoholics and discourage binge drinking.

Katie Leach-Kemon, a weekly contributor of global health visual information posts for Humanosphere, is a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.