Dimensions of alcohol's harm to others and implications for policy and service in low- and middle-income countries, including a case study of Thailand

© 2019 Dr Orratai WaleewongThis thesis focuses on alcohol’s harm to others (HTO), the negative effects of alcohol consumption on other people around the drinker. Secondary analysis was undertaken using population survey data of five low- and middle-income countries (LMICs), including Thailand, Sri Lanka, India, Laos and Vietnam, which employed the WHO/ThaiHealth Research Protocol, aiming to understand situations of HTO in LMICs. This thesis found that harms from others’ drinking-related aggression, violence and misconduct are prevalent in the population at large of the five LMICs (50-73%); the most commonly reported harms: public disturbance and insult or harassment due to others’ drinking. More serious forms of HTO (assaults and traffic harms) were less commonly reported than public disturbance or harassment, but still stood out as substantial. When compared with high-income countries, these figures were much larger, in particular when calculated by per capita consumption or “harm per litre”. Variations in rates between demographics by harm type and by country are evident. Predominantly, men were more likely than women to experience harm from others’ drinking, especially traffic harm, whereas women were more likely to feel unsafe and afraid because of others’ drinking than men. Generally, young, people with less formal education, and those living in urban areas were most at risk of being harmed by others’ drinking. The analysis of Thai data revealed that people around drinkers also paid a high price for others’ drinking, with 21% of Thais experienced financial harms due to others’ drinking in the last year. The greater part of total costs was incurred as a result of property damaged due to others’ drinking. The poorer the family, the greater the financial burden. The more frequent the drinking pattern, the closer to the drinker, the greater the consequences reported. Those being harmed financially were more likely to perceive that they had been strongly negatively affected compared with those who did not experience any financial harm. Rates of seeking help due to others’ drinking were relatively low (7-20%). Affected people in most countries more commonly sought help from informal sources than from police or health services. There was no consistent pattern across countries for the relationships between demographics and seeking help for HTO. Where there were rural/urban differences, those living in a non-rural area sought help from the police more often than those living in a rural area. In conclusion, this thesis revealed a high prevalence of HTO and relatively low rates of help-seeking due to others’ drinking in the five Asian countries, and considerable costs to others around drinkers. These findings support the need for more efforts to strengthen alcohol policies in LMICs, particularly to address heavy drinking patterns, alongside the need for more available, accessible and improved social response services for those who need help. Alcohol policies should aim not only to reduce harms to drinkers, but also to limit harm to others. Additionally, this thesis points out gaps in knowledge and contributes to the improvement of routine data collection systems and research methodology in the HTO field