ABSTRACT
A primary issue in the development of alcohol policy is the degree to which ideas developed in Western nations are applicable in developing world contexts. Related to this debate is a further issue: namely, the contrast between a focus on the amount of alcohol consumed in different societies and a focus on the patterns of consumption in these cultural settings. Despite these issues' central importance, they remain relatively unexamined in the public health and alcohology fields.
“Dry” versus “wet” as a cultural distinction. Dwight Heath spoke about the concept of dry cultures, in which little alcohol is consumed overall but in which, when people do drink, they tend to get drunk (e.g., Scandinavian countries). This is not necessarily the case in all dry societies. However, the “dry” model of alcohol use highlights the point that it is not only how much one drinks, but also how one drinks that is important—that is, the importance of patterns of drinking and not just consumption. Once again, the issue of social context in defining how alcohol is used moves to the forefront. Likewise, in defining problems, one needs to examine who is doing the defining. Someone in a given social context may accept its drinking patterns and find them rewarding, even if they are viewed as excessive from outside.
Poverty versus pleasure. David Macdonald spoke about use of alcohol in marginalized, impoverished groups. He proposed that alcohol is used to reduce pain rather than to induce pleasure in such settings. Macdonald hypothesized a direct relationship between poverty and excessive use of alcohol. Thus, he surmised, pleasure in relation to alcohol consumption is very specific to cultural context. Following on Macdonald's comments, Louise Nadeau spoke about Canada's Royal Commission on Aboriginal Peoples. The commission had few recommendations on alcohol per se. This was correct, in her view, because alcohol abuse was dwarfed by other problems. Natives themselves saw the issue of autonomy, not alcohol, as primary.
The French context: industry and public health collaboration. Jean-Paul David reported on an initiative in France, supported by wine manufacturers, to market wine from a public health perspective. This partnership between public health and manufacturers led in August 1993 to the adoption by the International Wine Organization of its San Francisco Resolution, which was in keeping with the European Regional Office of the World Health Organization's Alcohol Action Plan. The objectives of the European plan against alcoholism include (a) reinforcing practices in the production and distribution sectors that favor the prevention of harm linked to alcohol, (b) creating environments favorable to health that reinforce the motivation and the capacity of the individual to avoid dangerous drinking practices, and (c) encouraging public support of moderate drinking practices through education programs. Some of the elements in the French initiative include, on the industry side, after-sales service and professional training to ensure that alcohol is consumed sensibly leading to as few harms as possible. This is paralleled by education focusing on both the psychological (the needs of the individual) and the physiological (the metabolism of alcohol). The program also engages the entire social context of the individual (for example, looking at the synergy between school and family), part of a larger conception of the individual drinker as a complete human being. In this larger human context, discontents within a society may hinder the satisfactory pursuit of the pleasure principle (perhaps by leading to excessive consumption).
