In this blog post, Kesavan Rajasekharan Nayar and his colleagues discuss the public health implications of excessive alcohol consumption on the people of Kerala, India. Alcoholism has a major share in the morbidity profile of the Kerala society; apart from serious emotional, familial and economic crises, it also leads to higher rates of suicides. This is a socio-epidemiological reality which cannot be ignored in future disease planning.

Alcohol consumption had been a favourite past-time of human societies since time immemorial. In India, references to alcoholic drinks could be found in Vedic texts which give indications of the prevailing drinking culture. It appears that a discriminatory social practice existed even with regard to alcohol consumption with higher castes having more rights than the lower castes. In tribal dominated states like Jharkhand, alcohol consumption is an accepted cultural practice. Due to its extreme social and economic consequences, it has been the focus of many social movements including extremist movements.¹

In recent times, the discriminatory practices have disappeared in states like Kerala where alcohol, especially hard spirits, is only sold through state-run outlets and is accessible to the masses. Such sales strategy is also being tried out in other states largely because of the huge revenue potential. It is ‘state-sponsored violence’ on human souls who want to unload the pains of life and hard labor after carrying them over their head for the whole day. When you watch the long and often boisterous crowds in front of such outlets one could see this written all over their faces. They all look the same everywhere in the state, with wrinkled parched faces and premature old age symptoms.

The sales of hard spirits and beer through such outlets contributed immensely to the state exchequer. In 2012-13, the sales of alcohol contributed a little more than 70 billion to the state revenue. This is by selling two and a half billion cases of hard liquor and one billion cases of beer through such government-run outlets. The sales almost doubled in a ten-year period from 2002-03 to 2012-13. Surveys show that more than 40 percent consumed alcohol previous to the survey period and there are no differences between the rural and urban population.³ A substantial number of people also consume up to three drinks per day almost daily. Highest prevalence was observed among the age group of 35-44.

It is now evident that alcoholism has a major share in the existing morbidity and mortality profile of Kerala and is an emerging public health problem in many states. Apart from socio-economic impacts, the compulsive habit causes serious emotional and familial crises including marital discords which sometimes also results in suicides.⁴ As a result, de-addiction of alcoholism is a major activity largely spearheaded by religious trusts. Alcohol consumption is also a major risk factor for many non-communicable diseases and such risk factors were widely prevalent across all socio-economic categories in Kerala.³ This coupled with physical inactivity, nutritional inadequacy and smoking result in a scenario of higher prevalence of diabetes, coronary heart disease and hypertension which could be indeed worrisome. Although the exact mortality profile is difficult to ascertain, informal figures and news reports indicate that one Indian dies every 96 minutes. The future disease planning cannot ignore this socio-epidemiological reality.

Kesavan Rajasekharan Nayar Ph.D

Global Institute of Public Health and Santhigiri Social Research Institute, Thiruvananthapuram, Kerala    

Lucy George M.Phil

Department of Bio-Sciences, Mar Athanasios College of Advanced Studies, Thiruvalla, Kerala

Lekha D. Bhat Ph.D

Department of Epidemiology and Public Health, Tamil Nadu Central University, Thiruvarur, Tamil Nadu

Anant Kumar Ph.D

Xavier Institute of Social Services, Ranchi, Jharkhand

Conflict of Interest: None declared

1. Shah, Alpa. Alcoholics Anonymous: the Maoist movement in Jharkhand, India. Modern Asian studies 2011; 45 (05):1095-1117.
2. National Institute of Medical Statistics, Indian Council of Medical Research (ICMR). 2009. IDSP Non-Communicable Disease Risk Factors Survey, Kerala, 2007-08. New Delhi: National Institute of Medical Statistics and Division of Non-Communicable Diseases, Indian Council of Medical Research.
3. Nishanth J H, Harish M Tharayil, Praveenlal Kuttichira. Analysis of patients admitted with alcohol dependence syndrome in a tertiary care hospital in a calendar year. Health Sciences 2014;1(3):JS001A.