Indonesia’s ban on alcohol could come with its own health risks

The Indonesian House of Representatives plans to draft a bill that will criminalise the activities of producing, selling and buying, distributing, drinking and storing alcoholic beverages.

However, a total prohibition of alcohol as drafted in the bill (November 2020 draft) is highly problematic. Recently, the country’s parliament has changed the name of the bill from “prohibition” into “regulation” of alcohol and it is part of this year’s list of priority legislation.

Public health risks

A total alcohol restriction could bring its own serious risk since more people could experience ill health or could die from methanol poisoning, a common consequence of the production of illicit and informally produced alcohol that does not meet quality and safety standards.

Doctors Without Borders and Oslo University have been tracking global data on methanol poisoning. They have monitored over 70 countries, including India, Iran, Libya and Indonesia, where difficult access to alcohol results in frequent incidents caused by illicit and informally produced alcohol.

Some data demonstrate how in places where alcohol is prohibited or seen as controversial, there are higher incidents of methanol poisoning due to low awareness on the danger of making bootleg alcohol.

Often, due to taboo and stigma, those experiencing methanol poisonings do not immediately seek help for fear of criminalisation and stigma.

A total ban on alcohol would also increase incidents of alcohol smuggling and bribery. Any monitoring strategy for such trade would cause the country’s government more problems than the legal trade currently does.

If alcohol is not fully prohibited, those who consume alcohol can have access to better quality alcohol that is safe to consume. Simultaneously, the government could implement computerised tracking of illegal alcohol by identifying suppliers and monitor the trade.

We also need to note that if the bill is passed without an effective medical and psychological strategy, the Government might put those with alcohol dependency at serious risk of harm from alcohol withdrawal symptoms.

Weighing negatives

There is no denying that that alcohol consumption can harm our health.

The WHO categorised alcohol as one of the leading causes of cancer, alcoholic liver diseases and, if consumed by pregnant women, could result in foetal alcohol syndrome.

Alcohol can also be socially and economically damaging. Countries with high alcohol consumption see more interpersonal violence and drunk-driving incidents.

Public health goals should reduce health risks from alcohol consumption that result from overdosing, protecting the health of children and vulnerable people, and helping people overcome addictions and avoid unhealthy behaviours.

At the same time, they should minimise intrusive measures and avoid excessive criminal punishments.

It is important to note that alcohol consumption is not a common lifestyle in Indonesia, the world’s largest Muslim-majority country. Data from Indonesia’s Health Ministry shows that alcohol consumption in Indonesia is at a low rate of 3.3% in 2018.

Compared to the extremely high tobacco use and the lack of regulation around unhealthy food and sugar-sweetened beverages, health damage caused by alcohol consumption in Indonesia is very low, as monitored by WHO’s Global Information System on Alcohol and Health.

Strong regulation needed

Rather than a total ban on alcohol, the Indonesian Government should implement stronger alcohol regulations based on the WHO’s guidelines and recommendations through the 2010 Global Strategy to Reduce the Harmful Use of Alcohol.

The guidelines offer detailed options on domestic policies and strategies, such as restricting advertising and marketing, banning alcohol sponsorship in sports and cultural events, and reducing the risk of consumption of illicit and informally produced alcohol.

Some of these interventions include restricting the age of alcohol consumption and requiring suppliers or direct sellers to have trade licenses has already been regulated.

The government could widen its interventions to include:

1. Giving sanctions to sellers as well as any adult individuals who give alcohol to minors,
2. Widen requirements to obtain trade license to online sellers,
3. Mandate pictorial warnings on alcohol packaging and advertisements - currently mandatory pictorial warnings only apply to cigarette packaging,
4. Instruct current license holders and applicants to take mandatory lessons on social responsibility and health awareness of alcohol use, as regulated in many European countries,
5. Expand the prohibition of alcohol advertising and promotion to digital media,
6. Regulate the maximum blood alcohol concentration of drivers in transport regulation with stronger punishments to those who are drink-driving. The transport police should be equipped with breathalysers to allow them to monitor these levels.

Whilst so far Article 283 of the Transport Act 2009 regulates criminal punishments on those who drive in a situation where they cannot fully concentrate, the Government can enact driving bans ranging from several years to lifetime bans to those who drive or cause accidents under the influence of alcohol. At the moment, there is no regulation yet on maximum blood alcohol concentration.

On the community level, the government could implement a health strategy by giving health officers and community leaders training on counselling and medical help and providing more accessible detoxification and rehabilitation programmes for those with alcohol dependency.

Evidence-based regulations

Excessive use of alcohol is harmful.

However, the government should protect the population’s health by implementing evidence-based, cost-effective regulations by putting forward awareness and education on the adverse health and social consequences of alcohol use and avoiding excessive criminalisation.

Citta Widagdo is a Doctoral Researcher in Public Health Law at the University of Birmingham.

This article first appeared on The Conversation.