Alcohol and the Process of Economic Development: Contributions from Ethnographic Research Laura A

International Journal of Alcohol and Drug Research IJADR

The Official Journal of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol doi: 10.7895/ijadr.v1i1.38 IJADR, 2012, 1(1), 41 – 55 ISSN: 1925-7066 Alcohol and the process of economic development: Contributions from ethnographic research Laura A. Schmidt1 and Robin Room2–4

1 Philip R. Lee Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, School of Medicine, University of California, San Francisco, U.S.A. 2 School of Population Health, University of Melbourne, Australia 3 AER Centre for Alcohol Policy Research, Turning Point Alcohol & Drug Centre, Fitzroy, Victoria, Australia 4 Centre for Social Research on Alcohol & Drugs, Stockholm University, Sweden

ABSTRACT

Drawing on 33 ethnographic studies of drinking in low- and middle-income countries around the world, this paper describes common themes pertaining to economic development, alcohol consumption and related harms. Three crosscutting themes emerged that shed light on why alcohol consumption and problems tend to increase during periods of economic development. First, from the perspective of the global alcohol industry, developing countries often become viewed as emerging consumer markets. Commercially produced alcohol tends to gain a higher status than traditional locally produced beverages, replacing them as resources allow. Drinking and beverage choices thus both symbolize new social divisions and help create them. Second, economic relations change whereby women’s interests often lose ground as men’s drinking increases. Commercialization of production may mean that women lose control over what was traditionally a home-produced supply. Resources that once stayed in the family or community may be exported as commercial profits. Third, alcohol often becomes both a source and symbol of political tensions and class divisions. Governments may become dependent on commercial alcohol revenues and willing to tolerate high levels of alcohol-related harm. In response, social and cultural movements, often promulgated by women, spontaneously emerge from within developing societies to counterbalance elite interests in the alcohol trade and push against external market forces.

The relationships among alcohol consumption, the health of populations and economic development are global spread of NCDs has increased attention on how gaining greater currency in international discussions alcohol and other risk factors are affecting the health of of public health. Emerging evidence shows that today, developing nations (United Nations General Assem- non-communicable diseases (NCDs), such as heart bly, 2011). disease and cancer, are more prevalent than infectious As part of our service to the World Health diseases in low- and middle-income countries (Nara- Organization’s Commission on the Social Deter- yan, Ali, & Koplan, 2010). Along with tobacco and minants of Health, we considered these issues in a unhealthy diet, alcohol is one of the key controllable review of the worldwide epidemiological evidence risk factors in NCDs (Room, Rehm, & Parry, 2011). A on alcohol and inequality, with substantial atten- recent high-level meeting of the United Nations on the tion to developing or low-/middle-income societies (Schmidt, Mäkelä, Rehm, & Room, 2010). This

Correspondence: Dr. Laura A. Schmidt, 3333 California Street, Suite 265, San Francisco, CA 94118, U.S.A. E-mail: [email protected]

Acknowledgments: This work was conducted under the auspices of the World Health Organization’s Commission on the Social Determinants of Health, Priority Public Health Conditions Knowledge Network. We acknowledge the contributions of Pia Mäkelä, Jürgen Rehm and Dag Rekve to the collective work from which this paper has developed. The authors are grateful to the Alcohol Research Group Library for making its holdings and indexing of alcohol ethnographies available for this review. This paper was presented at the Thematic Meeting on Alcohol Epidemiology and Policy of the Kettil Bruun Society at Makerere University, Kampala, Uganda, November 15–18, 2010.

Keywords: economic development, non-communicable disease, globalization, substance abuse 42 Laura A. Schmidt & Robin Room

work, focusing on the quantitative epidemiological Background: The quantitative picture evidence, showed that alcohol plays an important, In our prior work on the social determinants of alcohol but complex, role in the health of developing socie- problems, we were tasked with assessing health ine- ties. That said, we observed a general tendency qualities related to alcohol, by which was meant differ- across societies for economic development to coin- ences in rates of illness and mortality between cide with increases in alcohol consumption and different populations and subpopulations, both be- related harms at the population level. Rising afflu- tween and within countries (see Blas & Sivisankara ence has many positive impacts on health, for ex- Kurup, 2010). Looking between countries, the main ample through improved sanitation and education. emphasis was on comparing richer and poorer coun- In addition, it increases disposable income, and tries using quantitative data from disease surveillance people often use that wealth to consume more systems and multi-site surveys. The differences be- alcohol, leading to increased rates of alcohol- tween rich and poor have also been a major focus of related harm. We also observed that the negative studies within countries, although some researchers impacts of alcohol tend to result in disproportion- have focused on other social differentiations, such as ate harms for the poorest of poor—those at the social marginality and gender (Braveman & Gruskin, lower end of emerging class hierarchies within 2003; Kawachi, Kennedy, & Wilkinson, 1999). low- and middle-income countries. People in We observed that alcohol plays two roles in poorer societies, but particularly the more socially health inequality. The first part of the burden is marginalized within those societies, are more from alcohol-specific diseases, which are wholly likely to drink to intoxication on any given drink- attributable to alcohol in global accounting of risk ing occasion, and tend to suffer more health and factors in the burden of disease. Alcohol depend- social effects from drinking than their more affluence and other alcohol use disorders count as dis- ent counterparts. eases in their own right, as do several others specific Therefore, while economic development may to alcohol in the International Classification of Dis- have many positive impacts on the health of popula- eases, such as alcoholic psychoses and alcoholic tions, our previous review of the epidemiological evi- gastritis. Second, alcohol is a risk factor for a wide dence on alcohol revealed a somewhat darker side of variety of disease categories and other harms that the story. It also revealed some of the limits of our are not specific to alcohol, including heart disease, current understanding of alcohol and development metabolic dysfunction and some cancers (Room, based on the quantitative evidence: while that evidence Babor, & Rehm, 2005). In assessments of the rela- can describe changes in alcohol-related indicators over tive contribution of different risk factors in recent time, and can allow one to compare differences be- years, alcohol has ranked no lower than fourth in tween more and less developed countries, it does not global accounting for the burden of disease (Ezzati shed much light on the mechanisms and processes by et al., 2002). which development leads to increases in alcohol con- The quantitative evidence suggests that ab- sumption and problems. stinence rates tend to be higher in developing socie- This motivated us to balance our quantitative ties, particularly in very poor societies, and that per- review with the present examination of qualitative capita alcohol consumption is generally higher in studies on developing societies. We reviewed richer than in poorer societies. Alcohol is responsi- selected ethnographic studies on alcohol in low- ble for a much larger fraction of the burden of dis- and middle-income developing societies conducted ease in richer than in poorer societies. This reflects since the mid-20th century, with an interest in not only the higher volume of drinking in richer extracting common themes that were missed by societies, but also the smaller set of important com- our quantitative review. Virtually all the studies peting risk factors that predispose people to poor located focused on a single society and most were health. It seems likely that rates of disease and prob- confined to a single locality within that society. But lems per liter of pure alcohol are generally higher in taken together, they pointed to several key insights poor countries, but this is not well measured. into alcohol’s role in economic development that In terms of other social differentiations, in were largely missed by our review of the epidemiol- most places men tend to be more likely than ogical evidence. women to drink, and to drink more than women. But there are great variations in the extent that

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 43 men’s and women’s drinking differs by degree of ist in orientation. Scientists attempt to derive “just affluence, both within and between countries at the facts” and purge from the data issues of social different stages of development. In general, levels of evaluation and morality. But alcoholic beverages drinking by men and women are closer together in have a dual nature. On the one hand, they are more affluent groups within a given society, and in physical commodities with effects on the body and richer societies compared to poorer ones. Patterns mind when ingested, as well as having interactions by age among adults appear to vary considerably with other substances, environmental and personal between societies, so that no generalization on this factors. On the other hand, alcoholic beverages are can be made. cultural artifacts and their use is highly charged Prospective data, where available, also point with symbolism. To use the word “champagne” to the adverse effects of development on alcohol carries strong connotations of celebration and lux- consumption and problems. Alcohol consumption ury in Westernized societies, even for people who levels have often risen in the process of economic have never had a sip. At the other end of the spec- development, particularly as people move out of trum, cultures where drinking is common tend to extreme poverty and destitution. However, there have a variety of labels for alcoholic beverages that continues to be a greater burden of ill health and are “demerit commodities,” to use the economists’ other harm for a given level of drinking in the poor- term—in English, such labels as “rotgut,” “plonk” est segments of a given population, and levels of and “red-eye” (Room, Mäkelä, Schmidt, & Rehm, harm are often observed to rise steeply in early 2006). stages of economic development. The positivist orientation of epidemiology tends to leave the current body of science agnostic Limits of the quantitative evidence on these value-laden, symbolic attributes. However, many of these associations are pertinent to under- What has been stated so far can be learned from quan- standing the connections between alcohol and ine- titative research fairly universally, since such data, in quality, and in relationships between the developing the form of population surveys and cause-of-death and developed worlds. Poor people who drink seem statistics, are increasingly available for poorer countries to be quite heavily stigmatized across the whole as well as wealthier ones. However, epidemiological range of societies (Room, Rehm, Trotter, Paglia, & research has several inherent limitations. A crucial one Üstün, 2001), as one Honduran ethnographic in- is that the preponderance of the alcohol produced and formant described: consumed in most developing societies is unrecorded by official statistics, either because it is brewed in the “Like if somebody that’s poor gets home, traded for in-kind goods and services, or illegally drunk, really drunk, they’ll go, ‘Oh distributed. Consequently, epidemiologists are de- look, there goes a fucking alcoholic pendent on self-report population surveys to systemati- wino, pachanguero,’ but if somebody cally measure and quantify alcohol consumption. Sales really rich gets drunk they’ll go ‘Oooh’ and tax records in these societies are grossly incom- [in a comical tone]. It’ll be like, fun, plete, and survey-based reports are frequently limited you know: ‘Look at the doctor, he got a to particular regions and subject to reporting bias. By little bit drunk.’” (Pine, 2008, p. 95) contrast, in more affluent societies, it is possible to go considerably further on the basis of quantitative data. Ethnographic studies often provide vivid por- Here, survey data are more abundant, and sales re- trayals of the changing values and moral categories cords more accurate and comprehensive as to what is associated with different forms of alcohol over the actually produced and consumed. course of economic development. This can be im- The existing quantitative literature is also portant for understanding how consumption, prob- generally much less helpful on issues of change lems and incentives to drink change during over time, and the interplay of alcohol and processes development, and how the burden of social stigma- of economic development. This is a problem of tization and marginalization may become spread costs and logistics. It is costly and challenging to across classes and other social groups. conduct population-based surveys in developing societies given the need to cover large rural areas, much less to do them repeatedly over time. The basis for this essay A final limitation results from the fact that We confined our coverage of the literature to major the epidemiological literature is, by design, positiv- ethnographic studies that explicitly focused on alcohol

–––––– IJADR 1(1) ––––––

44 Laura A. Schmidt & Robin Room in the context of developing societies, and that were time, and talking with people of all published since the mid-20th century. Many of these ages and groups. (Eber, 1995, p. 8) studies cannot easily be found through databases of articles or even through search engines. So to locate studies we drew primarily on the holdings of the Alco- Common themes hol Research Group Library in Emeryville, California, one of the largest collections of alcohol research stud- We report on common themes that emerged across ies in the world, as well as on personal networks. In the 33 ethnographies reviewed for this study. These total, we reviewed 33 ethnographies from different pertain to: (1) the effects of changing alcohol availability parts of the world, including India (N = 5), Africa (in- with the emergence of economic development and cluding South Africa) (N = 7), South Asia (N = 1), Cen- consumerism, (2) changing economic relations linked tral and South America (N = 6), Aboriginal to alcohol production and distribution, and (3) political communities in Australia (N = 3), Papua New Guinea and class tensions around alcohol in the context of (N = 2), Native American communities in the United development. Changing relationships and tensions States (N = 3), and Indonesia, Polynesia and Microne- between men and women comprised another theme sia (N = 6). Our selection of studies privileged those that cut across all three of the above. that followed groups and localities for a considerable period of time, yielding invaluable information of the Developing societies as consumer markets changing dynamics of alcohol and development, and A central theme in many of the studies we reviewed we made sure to cover different world regions. The involved how, in an increasingly globalized world, primary goal was to extract a few common themes that developing societies represent the major remaining illustrated the new kinds of evidence that existing eth- untapped markets for corporations in the business of nographic studies could contribute to the quantitative producing and distributing alcohol. The impulse to evidence, to the point of analytic saturation. turn colonies into markets emerged in the 19th cen- We focused our search on studies carried out tury, so by the mid-20th century, the beginning of the since the mid-20th century for two reasons. First, period we are considering, production facilities for these studies are likely to be more relevant to to- western-style alcoholic beverages had been established day’s discussions around health inequality and eco- in many developing countries across the globe (see nomic development because they are relatively Jernigan, 1997). Many of our ethnographic studies contemporary. Second, the pre-1960 tradition of reveal how economic development leads to the emer- anthropological writing had a tendency to underplay gence of a cash economy in which alcohol takes its the harms associated with alcohol—partly because place as a commodity, becomes commercialized, and of ethnographers’ functionalist leanings and partly becomes more widely available in new, often more due to the fact that these, mostly male, anthropolo- concentrated, forms. Some show in vivid terms how gists often lacked access to the groups most ag- the harm associated with increased alcohol availability grieved about drinking, such as women (Room, is seldom borne evenly across groups within the popu- 1984). In the words of Christine Eber, who studied lations of developing societies. Emerging elite and gender and drinking among the native pendranas of middle class groups typically have better access to for- a highland Maya town, eign brands of alcohol, which often become symbols of

their more modern outlook and cosmopolitan identity Listening to pendranas tell me about (Butler, 2006). Those who are less well off often seek problem drinking and then later ana- these new forms of alcohol as symbols of social status, lyzing what they told me, I came to be- sometimes to the detriment of their health and eco- lieve that drinking has probably always nomic well-being (Grossman, 1982). been more problematic . . . than seems In fieldwork by Martha Macintyre, we find a apparent from the ethnohistorical re- contemporary microcosm of these dynamics as they cord. Staying only one year in a com- are unfolding among Lihirians in the province of munity and talking mostly to men, New Ireland in Papua New Guinea. In this case, the anthropologists are not able to get engine of economic development has been the re- much past normative drinking, which cent entry of a foreign mining corporation into the in most societies isn’t problematic for island economy. Macintyre’s work includes a careful most of the population. To learn more comparative analysis of how the mining industry is about deviations from norms it takes

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 45 affecting four different villages on the island. In- nothing. Before we were equal, now we depth studies of these villages show a direct correla- are at the bottom. That’s what the tion between the perceived negative impacts of mine has done for us.” (Macintyre, drinking—adverse effects on family life, sexual of- 1999, p. 46) fences and deteriorating relations between women Suggested in this account is a self-reinforcing dynamic and men—and the village’s physical proximity to that is observed in many of the societies studied: the mine. Her work further documents that alcohol emerging elite and middle classes with newfound consumption is more common in areas close to the disposable income form a consumer market for for- mine because of increased availability—in Macin- eign alcohol products. Foreign alcohol products thus tyre’s words, “because there is more money avail- emerge as symbols of a better life, thereby increasing able and because these people have better access to their commercial value and further expanding the liquor outlets” (Macintyre, 2005). Development has consumer market. As Elizabeth Colson and Thayer also brought the emergence of a social class hierar- Scudder conclude from their fieldwork in Zambia, chy to New Ireland where there was little social dif- “thirst seems to grow as more men and women attain ferentiation before. Alcohol use and problems are a cash income, and as brewers and distillers expand directly implicated in the island’s growing problems their operations” (Colson & Scudder, 1988, p. 1). with class inequality. In the words of a 35-year-old Moreover, as foreign drinking practices are introduced Lihirian man: and alcohol distributors appeal to new markets, drinking often becomes acceptable in a wider range of “At the top now are all the white men groups within the population. While historically, alco- who live in the best houses and all hol consumption had been proscribed for women in drive cars and have a club. . . . Then most of the societies studied, with development often there are the relocatees [who were paid comes the emergence of a new class of educated for their land] who all have big houses women who take up drinking as a symbol of gender and cars and businesses and they have equality and independence (Benegal, Nayak, Murthy, compensation money to spend. Now Chandra, & Gururaj, 2005). they are all greedy troublemakers who Across the different societies studied, young do not share their money with others, adult men often form the group that seems the even their own clan and family. They most ready to embrace new drinking practices in- throw away their money and then just troduced from the outside. Christine Toren’s con- ask [the mining corporation] for more. temporary ethnography of villagers on the island of They all drink too much. Gau in Fiji describes how consumption of European brands of beer has supplanted traditional kava (a Then there are the employees at the traditional mildly psychoactive, non-alcoholic drink) mine who have regular wages and can as the preferred beverage among young men buy things like rice and tinned meat (Toren, 1994). As one female informant described for their families, but they are not very the change in drinking and the accompanying pub- rich. . . . They spend too much of their lic problems, money on beer. . . . These men are ru- ining the place, making their wives “Today, all the young men want to be work in the gardens and not giving Europeans. They’re always going off . . . them money for food and . . . just to drink beer until they’re drunk. throwing their money away on drink. When they return here they make a lot of unpleasant noise, fight each other At the bottom are the villagers like us and I don’t know what else. It looks who were promised that Lihirians bad, it is not respectful, they neglect would all benefit, and now we just [the reputation of] the village.” (Toren, watch as all the promises are broken. 1994, p. 157) Here we have no water supply, no money, no road, no cars, no boats. We Toren’s work highlights how changes in al- can no longer afford to buy things at cohol availability and consumption can give rise to the supermarket. . . . That’s Lihir now, deeper divisions within developing societies. In the a few with plenty, the village people, case of Gau, western modes of drinking have di-

–––––– IJADR 1(1) ––––––

46 Laura A. Schmidt & Robin Room vided young people and elders in the community by while in the cantina and violence introducing a set of cultural contradictions that now against themselves when they go frame daily life: “inside” versus “outside” the com- home. They try to come between the munity, kava versus European beer, the “ritualized” combatants, as a group, in the cantina versus “haphazard” use of psychoactive substances, and only hope there will be others to and “dignified behavior” versus “rowdiness and defend them when they are home. fighting.” Helplessly, they watch their house- Colson and Scudder (1988) note similar ten- hold’s disposable income sliding down sions in Zambia, where villagers in the Gwembe their husbands’ throats. (Butler, 2006, District have come to measure social worth in terms p. 183–184) of urban fashions, including a preference for the more “sophisticated” drinking of imported beer in A related theme involves economic conse- beer halls and bottle shops, rather than in home- quences for the poor who seek increased status by steads. The consequences of this cultural shift in drinking new brands of foreign alcohol. Colson and the status of alcohol have included across-the-board Scudder (1988), for example, document a growing changes in most aspects of drinking: an increase in proportion of wages over time earned by men in the the volume of alcohol consumption per occasion, in Gwembe District, Zambia, that is diverted from the frequency of drinking per week, in reasons for households for the purchase of bottled beer. Simi- drinking and in alcohol-related problems: larly, in a study of the socioeconomic impact of drinking in Karnataka, India, a group of ethnogra- The frequency of purely social drink- phers found that per-capita expenditures on food, ing has . . . increased, first among men health and education were substantially lower in and more recently among women. So households where men drank, compared to non- has the amount of drunkenness, with drinking households (Thimmaiah & Sharma, 1978). associated violence. . . . The changes in From reading the reports of these ethnogra- behavior can be summed up by saying phers, it seems almost inevitable that when foreign- that drinking among men has in- produced alcohol takes on elite status, there will be creased substantially with respect to a concomitant degradation in the status of other, both the amount consumed on any more traditional, forms of alcohol. Abeyansinghe’s one occasion and the frequency of (2002) study of drinking in Sri Lanka dramatically drinking. . . . Whereas in the past most illustrates the symbolic roles that different forms of drinking was well grounded in either alcohol have come to play in defining social groups. ritual or labour activities, drinking has In this highly stratified caste society, if and what now become an activity on its own— one drinks has become a central signifier of social drinking for drinking’s sake. (Colson & status. Middle-class people, such as government Scudder, 1988, p. 15–16) workers, traders and taxi drivers, drink the local beverages arrack and toddy, but avoid even coming In most of these ethnographic studies, dif- into contact with the widespread illicit form of alco- ferentiations and tensions emerged between gender hol, Kasippu. As the researchers observe, a “class groups around drinking. Poor women often lose by barrier” keeps the middle class from drinking their men’s drinking, not only in terms of the man’s Kasippu, not to mention the fact that this beverage is drunken comportment, but also in terms of the often adulterated with toxic substances to give it resources available for family life. Butler (2006) “more kick”: describes the scene in the local taverns in rural Ecuador: The middle class of Sri Lankan society in particular evince attitudes of am- The young wives in cantinas gather up bivalence and bigotry towards alcohol. their husbands’ watches, ponchos, and This is particularly evident in such hats, because these are easily lost or ideas as the fact that any drinking is stolen when their husbands are drunk, bad within the class and any form of then sit on the edge of the room and excessive and uncontrolled drinking wait. They fear drunken violence be- such as of illicit liquor (popularly tween their husbands and other men known as Kasippu) is acceptable

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 47

among the poor. (Abeyansinghe, 2002, [men’s] self-esteem” brought about by social change p. 13) (Colson & Scudder, 1988, p. 16). Silberschmidt describes similar changes in men’s drinking in In this highly polarized context, Kasippu drinkers, who rural Kenya: are largely poor, slum-dwelling, day laborers, form a marginalized subculture defined by “social stigma and Men are faced with a new life situation guilt.” They are physically and socially “isolated from that many are not able to cope with, the rest of drinking culture” by wholly separate modes and they have not found other ways of of alcohol manufacture, transport, distribution, sales acquiring new roles from which they and drinking venues. What the ethnographers thus can get a feeling of self-respect and describe are “two drinking worlds [that] seem to have a self-reliance . . . . In their frustrated parallel existence” but seldom intersect—moralized situation, alcohol seems to be an es- social worlds that justify social exclusion by blaming cape. Besides, when they go to bars— marginalized groups on the basis of their drinking. men mostly drink together with other Tragically, those who are marginalized often internal- men and not alone—they meet with ize the blame, as Abeyansignhe’s interviews of slum- other men in the same situation as dwelling Kasippu drinkers show: themselves, and they get some social contact. (Silberschmidt, 1990) These besotted people who have got trapped into a life long addiction real- Pine (2008), however, has a different inter- ize this only too well. “This is our pretation of the cultural association of violence and [karma]” and “I have only a few years the drinking of the poor in her study of Honduras. to live” are some of the remarks made This is a society with what she describes as a history by them. (Abeyansinghe, 2002, p. 91) of structural and institutionalized violence. In such a context, the culture’s linking of violence with the Last, we found some tensions and diver- intoxication of poor men becomes a way of indi- gences in these ethnographic accounts concerning vidualizing the social interpretation, and diverting the reasons why alcohol appears to have such a det- attention away from structural and institutional rimental impact in many of the developing societies determinants of socioeconomic inequality. Still, studied. Many of these ethnographers tend to argue Pine acknowledges an objective reality in the link, that increases in alcohol-related harm are largely remarking that “drinking is one way to perform a driven by the wider availability of alcohol in more rebellion against structured oppression,” although concentrated forms. But often implicit in their first- the “retributive violence that [drunks] are best able hand accounts is a sense that other forces contrib- to take part in is against those closest to them— ute to the harm caused by alcohol, involving the their families, other drunks, and other people from acute social stresses that come with the involuntary their social milieu” (Pine, 2008, p. 96). resettlement of communities, political frustrations and the demoralization of men. Changing economic relations linked to Particularly where men have traditionally alcohol production and distribution held great power and authority within their communities, the political and social-structural changes A second theme in the ethnographies we reviewed that come with development often bring new, un- involves how alcohol can exacerbate economic inequal- familiar roles that afford less respect and status. ity and contribute to impoverishment. In the emerging Increased drinking among men and alcohol-related cash economies of the developing world, the produc- violence may be expressions of this demoralization tion and sale of alcohol represent a substantial poten- and loss of control. Thus, in Colson and Scudder’s tial source of revenue. Depending on how the account of Zambian society between the 1950s and production and distribution of this commodity unfolds 1980s, the combined pressures of guerrilla warfare, locally, it can have significant impacts on the popula- a massive population resettlement program and tion. Some of our ethnographers were able to see up economic decline seemed connected to the rise in close, and document, economic mechanisms at the drinking among men, and particularly to dramatic local level that link alcohol with growing inequality. In increases in alcohol-related violence toward some of the studies reviewed, changes in alcohol pro- women—expressions of the “numerous insults to duction and distribution resulted in the impoverish-

–––––– IJADR 1(1) ––––––

48 Laura A. Schmidt & Robin Room ment of particular groups within the community, such compete. They further document the significant as women. In others, it led to more widespread com- adverse consequences that this had for the local munity impoverishment following the corruption of economy. As local women lost the beer franchise, local officials or their neglect of community need. they lost their primary source of independent in- In many of the societies studied, it was tradi- come. According to Colson and Scudder’s account- tionally the business of women to produce indige- ing of household expenditures, profits from beer nous forms of alcohol for bartering, work parties sales had been critical to sustaining life in the vil- and ceremonial uses. With development, it was lage: overall, one-fourth of profits from home- observed that outsiders often colonized the produc- brewed beer sales went to purchasing food for fami- tion and sale of alcohol, thus upsetting traditional lies, whereas 21% went to transportation and 16% to economic and gender relations within the society. clothing (Colson & Scudder, 1988, p. 93). Women’s Multinational firms, often in partnership with local beer profits not only supported day-to-day survival entrepreneurs or politicians, might gradually take throughout Africa, but also helped create the possi- over a larger share of the market for alcohol, often bility of upward mobility for young people. Thus in in the form of heavily promoted western-style lager a study of young college-bound woman at the Uni- beer (see Jernigan, 1997). While this dynamic is versity of Dar es Salaam, one woman noted, “I found in many societies (e.g., Eber, 1995; Maula, would not stand here had it not been for my 1997), one of the most detailed accounts is provided mother’s brewing” (Beckman, 1988, p. 39). in Colson and Scudder’s (1988) study of the Colson and Scudder further describe how Gwembe District in Zambia, which went through the shift in beer production had adverse conse- important changes in alcohol distribution channels quences for the distribution of wealth in the com- and drinking practices during the lengthy study, munity. In the 1950s, women’s production and conducted between the 1950s and the 1980s. distribution of beer had helped redistribute wealth Prior to 1950, local women in the Gwembe between the sexes, thereby empowering women. District produced only small amounts of low- When men used wages earned in the local mines potency traditional beer for the purposes of rituals and fisheries to purchase home-brewed beer from and work parties. Beer-brewing technology was local women, they not only helped to redistribute simple, intensive labor was required and the beer income from men to women, but they also kept would not remain potable for long, which meant wealth circulating through the local economy. To that it was rare to produce beer in excess of what the extent that men spent increasingly large propor- was immediately needed. Due to limited means of tions of their cash earnings on alcohol in private storage and transport, little alcohol traveled far from and government-owned taverns, wealth migrated the point of production, and all that was made was outside the village. Colson and Scudder’s case study typically consumed quickly. shows how African women lost doubly when they After 1950, with the development of local lost the beer brewing franchise—they lost both in fishing and mining industries, and the emergence terms of the market moving away from them, and of a cash economy, beer brewing increasingly be- in terms of their own empowerment vis à vis men— came a commercial industry. By the 1960s and including their ability to control the level of the 1970s, domestic brewing became a major source of men’s drinking by their control of the supply. village income for the women who served as brew- In addition to such changes in gender rela- ers. Metal drums were now available for women to tions, the ethnographies we analyzed described brew larger quantities of beer in return for cash more general changes in economic relations be- payments from men. Over time, however, local tween the populations and their local governments. women brewers faced new competition from politi- In many of the societies studied, development and cally connected men who opened beer halls and commercialization led local governments to become taverns to sell commercially produced beer, trucked more dependent upon the excise taxes, tariffs, li- in from the capital city on the new roads. Initially, censing fees and profits generated from sales of home brews were sold for about half the price of alcohol. Where governments became dependent on commercially produced ones, thus allowing women these revenue streams, they commonly faced the brewers to remain competitive. challenge of negotiating two competing interests. Colson and Scudder report that by the For revenue purposes, government officials devel- 1980s, urban breweries and numerous local bottle oped an interest in maintaining high levels of alco- shops had rendered the women brewers unable to hol consumption in the community. Yet, in their

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 49 roles of protectors of the public health, these same women, traffic crashes, homicides and injuries (Mar- officials had an interest in reducing consumption to shall & Marshall, 1990). The problems appear to have control alcohol-related harm (see Mäkelä & Viikari, peaked in the late 1970s, when drunken gangs of 1977). Growing harm and health inequality was a Moen men began threatening an all-out “war” with consequence when government officials privileged drinking gangs from a neighboring island. Even this the former over the latter interest. extreme degree of public disruption, however, seemed The just-discussed study of Zambia’s chang- to be tolerated by local officials. Change only became ing beer industry was one such case. Even as rising possible when local women organized a popular alcohol consumption and problems became a sig- movement for prohibition and persisted with their nificant source of public disturbance in the organized resistance over several years. Moen is one Gwembe District, Colson and Scudder describe a case where alcohol prohibition appears to have suc- municipal government that did little to establish cessfully reduced problems in the community, at least formal controls on the distribution of alcohol. This in the Marshalls’ assessment. Under prohibition, was attributable to the fact that “the main producers Moen came to tolerate a vigorous black market in alco- of alcoholic beverages [were] parastatal enterprises, hol production and speakeasies, generating income for and the income from licensing and the profits of local elites. However, because drinking was officially their own taverns [was] a major source of income illegal, most drinking is clandestine and thus distur- for municipal and rural councils” (Colson & Scud- bances occur in settings where others would be able to der, 1988, p. 19). The irony of this situation was not intervene before someone was seriously hurt (Marshall lost on the local people: & Marshall, 1990). The case of Moen shows that, while govern- The government, despite its occasional ments dependent on alcohol revenues may be will- pronouncements encouraging sobri- ing to tolerate high levels of alcohol-related harm, ety, profited from its involvement in local communities may not. Jarratt and Zwar (1989) the liquor trade, a fact well recognized describe a similar situation among Aboriginal Aus- by rural people as they listened to visit- tralians, but one in which events unfolded some- ing officials address local gatherings what differently. In the late 1980s, elders in on the evils of excessive drinking. (Col- Queensland’s Aboriginal communities began to son & Scudder, 1988, p. 58) push for the reintroduction of old paternalistic laws controlling alcohol. Paradoxically, the plea came In a very different part of the world, two eth- when revenue from the profits of alcohol sales were nographers report similar tensions for local govern- relieving heavy financial burdens on the local gov- ment officials invested in the alcohol trade. ernment, as well as underwriting the development of Throughout the 1970s, 1980s and 1990s, Mac and needed community services and public works. The Leslie Marshall made repeated returns to the town of issues at stake were complex. On the one hand, Jar- Moen in Chuuk, Federated States of Micronesia. As ratt and Zwar interviewed local health clinic directors elsewhere in Micronesia, Moen had no indigenous who argued that “access to these canteens—and sly drinking tradition. The introduction of alcohol by grog [illegal alcohol] brought into the communities— whalers and traders in the late 19th century was sud- [was] simply allowing Aborigines to destroy them- den and rapid, and concentrated forms of alcohol selves.” On the other hand, spokespeople for public conspired with cultural patterns to produce a consid- affairs argued that the elders’ plan for prohibition erable degree of violence, explosive drinking and would lead to a “‘really bad situation, [since] it would public disorder (Marshall & Marshall, 1975, 1976). be highly desirable that people drink as much as pos- Moen was also a place where the municipal govern- sible so they could have plenty of money to do public ment became deeply dependent upon revenues from works [in the communities]. And we all regret and alcohol taxation, licensing and a government-run lament that this is the case.’” Likewise, McKnight alcohol monopoly, as well as being invested in build- (2002) documented, on the one hand, the devastation ing a market for tourism, with alcohol viewed as a associated with drinking in the Aboriginal commu- necessary commodity for attracting foreigners. nity on Mornington Island in northwest Queensland The Marshalls observed that, over time, the and, on the other hand, the dependence of the local volatility of drinking in Moen became a pronounced government on revenue from alcohol sales in the source of public disruption, as evidenced by remarka- community canteen. In such circumstances, there bly high rates of alcohol-related violence against were moves in many Aboriginal communities in

–––––– IJADR 1(1) ––––––

50 Laura A. Schmidt & Robin Room

Australia to impose restrictions on alcohol availability hibition movements coming from both directions, as (e.g., Wright, 1997). in communities throughout Micronesia: The changes in alcohol distribution described in the ethnographies are part of more gen- Throughout Oceania, prohibition was eral processes of economic development, applicable one of the first laws colonial govern- also to other items of mass consumption. But alco- ments enacted. With independence hol is a special commodity both in its potential movements leading to self-government harm to health and its dependence-producing prop- following World War II, de- erties. Concentration of alcohol production into a prohibition—ushering in the “right to smaller number of enterprises can allow govern- drink”—was a common change, often ments in developing countries to exercise more made even before the end of colonial control over the market and to raise taxes. Higher rule. Given this background and the alcohol taxes, by suppressing consumption, can symbolic value of drinking as a sign of contribute to public health as well as to government equality, it is surprising and somewhat revenues. However, to the extent the new producers ironic to discover recent instances and distributors succeed at “growing the market” where islanders themselves have re- with advertising and other promotion, rates of alco- imposed prohibition. (Marshall & Mar- hol problems will very likely rise. And the new shall, 1990, p. 7) methods of production and distribution of alcoholic beverages usually contribute to increased consump- South Africa has a long history of colonial tion, since more alcohol, and more concentrated domination involving alcohol that, as observed by forms of it, can be made available. These trends, as contemporary ethnographers (e.g., La Hausse, suggested by the Zambian case, may have particu- 1988), has had a significant societal impact. Espe- larly adverse effects on the social situation of cially in the wine-producing regions of South Africa, women. colonials used alcohol as payment for African labor over generations, largely because it reduced labor Alcohol as source and symbol of political costs and allowed farmers to extract more effort tensions and conflict from workers. In the 300-year-old wine farming industry on the Western Cape, the “tot system” pro- The ethnographies we reviewed underscore alcohol’s vided laborers with regular wine rations throughout dual nature in the context of development: it comes to the day. The tot system had significant benefits for serve as both a source and symbol of inequality. As a farm owners: wine rations were taken directly out of consumer product, alcohol is linked to wealth for those cash wages, thereby reducing labor costs, especially who control its production and distribution. As a status since the wine given to workers tended to be poor symbol, specific brands and patterns of alcohol con- quality. Moreover, as workers became increasingly sumption help societies sort the poor from the afflu- dependent on drink, they were less inclined to leave ent, and the marginalized from the mainstream. Given the employer; the promise of daily rations appeared this, it should come as little surprise that a number of to have made workers more willingly accept harsh the ethnographies reviewed described the eruption of conditions. political conflicts surrounding alcohol. Some of these With the growth of cities in the first half of the movements to prohibit drinking (especially by the 20th century, efforts to control South African drinking poor) came “from above,” as in cases where foreigners took the form of government-owned beer halls— and elite groups used alcohol prohibition to control known by Africans as “drinking in the cage.” The first indigenous populations or to create a sober workforce municipal beer hall was established in Durban, and of wage laborers. Other social movements around the sale of beer to Africans became the primary source alcohol, however, emerged “from below,” as indige- of revenue for funding local police and prison-like nous groups came to see the use of alcohol as a tool of barracks to house workers. When it became apparent elite domination—as a symbol of the elite’s ability to that home-brewed beer produced by local women un- quell political uprising by “anesthetizing” the popula- dercut the rationing system, and also competed with tion (Fahey & Manian, 2005; La Hausse, 1988). In beer hall sales, the Durban town council established some of the societies represented, the political history licensing laws and began police raids on women brew- was punctuated by the repeated back-and-forth of pro- ers, along with their aggressive prosecution in the courts.

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 51

In the 1930s and 1940s, resentment toward the population would be better able to govern itself beer hall system erupted in an organized boycott spon- (Dorschner, 1983). In revolutionary Chile of the 1970s, sored by the black workers’ labor union. The results of prior to the military coup, the “alcohol problem” be- the beer hall boycott were profound for white authori- came viewed as a “political problem” tied to its ten- ties, with municipal budgets sustaining heavy financial dency to inhibit social and political participation losses. Eventually, the authorities softened their stance (Weinstein, 1976). Here, excessive drinking became on alcohol controls. But beer halls again became the defined as a force that alienated workers from the his- stage for political action in the late 1950s and the torical task of perceiving and analyzing their social 1960s, this time by the Women’s League of the Afri- situation, and joining in action to change the society: can National Congress (ANC), which sought to defend South African women’s ownership of the home- We stand before an ideological strug- brewing industry. In 1959, ANC women attacked Dur- gle, on the threshold of the develop- ban beer halls with sticks, fought with police, and ul- ment of a new culture, expressed in timately set one beer hall on fire. As one activist changes in power relations. Workers explained, “‘Our real grievance over the beer halls was are becoming the country’s leading that the home-brewing of this traditional drink of the class. In order to reach that aim they people is not allowed, [while] the Corporation [local must realize all their potential. Exces- government] turns it into a revenue-making commod- sive social or addictive use of alcohol ity’” (La Hausse, 1988, p. 63). As the ANC leader, Al- limits productivity, the possibilities for bert Luthuli, later reiterated, “‘The beer hall has ideological advance, the attainment of become for us a symbol of legal robbery by whites’” (La power, and the capacity to incorporate Hausse, 1988, p. 1). women in the process of social change. Other movements for alcohol control “from This concept can be summarized with above” occurred in many other parts of the developing the help of a slogan that begins to be world throughout the late 19th and early 20th century, heard in some working class commu- reflecting the efforts of missionaries and temperance nities: “Alcoholism is opposed to the workers in European colonial empires to reform both revolutionary process.” (Weinstein, imperial practices and the subject populations. Thus 1976, p. 76) the first international treaty to control a psychoactive substance was the agreement between the colonial Within these political conflicts, drinking powers in 1899 to ban sales of “trade spirits” to in- practices often come to serve as symbols of tensions digenous Africans in most of Africa (Room, 2008). that arise when indigenous societies confront the From a mixture of motives, in the course of the 19th radically different cultures of outsiders. Christine century the settler societies in Australia, New Zealand, Eber (1995) presents a fascinating case in which Canada and the United States prohibited the sale of alcohol came to take on multiple meanings among alcohol to the indigenous populations. A more recent highland villagers in Chiapas, Mexico. These mean- manifestation of such an impulse was the Australian ings reflect underlying political tensions around federal “intervention” in the Northern Territory in changing gender roles, the encounter with evangeli- 2007, which included new restrictions on alcohol sales cal Protestantism, and the ongoing revolt against in remote indigenous communities (Australian In- the national government, all which became symbol- digenous Doctors’ Association & Centre for Health ized in choices about drinking. Eber observes that Equity Training, Research and Evaluation, 2010). women in the mountains of Chiapas continue to In terms of grassroots movements, several of this day to sell native chicha, a fermented sugar cane the ethnographies reviewed describe popular move- drink, out of their homes. However, use of rum or ments for alcohol prohibition “from below” (e.g., Mar- aguardiente—translated as “burning water”—also shall & Marshall, 1990). In such cases, alcohol often has a long, albeit ambivalent, place in the cultural serves a symbolic function by defining the clash be- order of the native pedranos. On the one hand, rum tween classes and status groups, as well as the need for has been integrated into religious rituals as “holy a sober populace that can fight for greater equality and water.” In Eber’s analysis, this has served as a way defend tradition. In the context of India’s struggle for of symbolically negotiating the dangerous and pow- independence, Mohandas Gandhi pressed for the in- erful presence of European outsiders in their home- clusion of alcohol prohibition as a plank in the Con- land. But rum still remains a symbol of the historic gress Party platform on the grounds that a sober encounter with Europeans in the 1500s, when it

–––––– IJADR 1(1) ––––––

52 Laura A. Schmidt & Robin Room served as “a tool of domination”—for many money coming into the family will now pedranos, rum is believed to be a Satanic influence be used for education, food, clothing, (Eber, 1995, p. 32). and small household appliances. . . . These cultural contradictions in Chiapas For Protestants, the hope is that alco- came to a political head in 1946, when government hol will not take one dime away from officials established a monopoly on the lucrative these household expenses. (Butler, rum trade. Local pedranos responded with organized 2006, p. 388) resistance, including a boycott of the town market and violence that led to a series of murders of pur- ported informants or “witches.” The “Rum War” Discussion was resolved in 1954 when representatives of the indigenous community argued in defense of access We reviewed 33 ethnographic studies on alcohol in to rum on religious grounds—as “holy water.” This developing societies, covering a diversity of societies story continues to unfold in the context of current from different regions of the world. Despite such wide battles over independence in Chiapas. For many in variation, their accounts of alcohol and development the Chiapas villages, Eber (2001) reports, alcohol shared some important commonalities. Three com- and its attendant problems have come to be seen as mon themes involved the harms that accompany the a core issue, and as a symbol of political and eco- commercialization of alcohol in developing countries, nomic domination, resulting in calls for local prohi- changing economic relations around alcohol produc- bition. tion and distribution, and alcohol as an issue and arena Butler’s (2006) ethnography of poor Otava- for political conflict. Across studies, we observed a lan (Quichua-speaking) communities in Ecuador similar sequencing and generic process that helps emphasizes the power struggle with mestizos, Span- account for why alcohol consumption and alcohol- ish speakers who ran the cantinas in the towns and attributable harm tend to increase during the course of controlled the local supply of spirits. The cantinas in economic development. Through this process, eco- town were seen by the Otavalan women as a kind of nomic inequality between countries (i.e., between trap where unlimited alcohol supply and unlimited more and less developed countries) appears to beget credit would keep men and even some, usually economic and health inequality within countries. older, women drinking beyond their physical, emo- Growing inequality within developing countries often tional and financial capacity (Butler, 2006). appears to occur across gender lines, and between Over the years, three separate groups of out- emerging elite, middle and lower classes. siders argued to whoever would listen in the Otava- The general progression seems to start with lan communities that a social change was needed to the commodification of alcohol as societies enter steer the community away from a situation of grow- the global economy and become “emerging mar- ing “drunken dissipation”—groups including evan- kets” to outside commercial producers. Commodifi- gelical Protestants; Catequistas, from the Latin cation increases the availability, consumption and, American liberation-theology movement among therefore, the harmful consequences of drinking Catholics; and sympathetic government functionar- within the population. The burden of harm, how- ies. Little changed until there was a devastating ever, is seldom borne evenly across groups within earthquake in 1987. This was taken as a sign from the population. Emerging elite and middle-class God that change was needed, and Butler describes groups typically have better access to foreign brands in some detail the sobering of the community and of alcohol, which become symbols of their status its cultural rituals that followed. Women today in and more cosmopolitan identity—as one informant the community, she writes, in Toren’s (1994) study of Fiji put it, “‘Today, all the young men want to be Europeans.’” Those who are have a greater expectation that they can less well off may seek these new forms of alcohol as form productive relationships with symbols of social status, but often to the detriment their husbands. . . . It is with a visible of their own health and economic standing. Finally, relief that women report and promul- those marginalized at the very bottom of the emerg- gate the new views about drinking. For ing class structure tend to drink highly stigmatized Catholics, a few binges are manage- local products. In Sri Lanka, for example, the act of able, even pleasurable, if kept relatively drinking Kasippu signifies that one is poor, a slum- short-lived, but the vast majority of dweller and to blame for one’s personal misfortune.

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 53

Commodification also means that the sym- cash economy, they often lose the ability to regulate bolic nature of alcohol takes on a life of its own. themselves. These popular movements voice the Drinking and beverage choices, therefore, both need for action at national and sub-national levels to symbolize new social divisions and help to create protect public health and order interests, to provide them. Governments may become dependent on a shield from the most deleterious aspects of the commercial alcohol revenues and willing to tolerate globalized commercial promotion of alcohol, and to high levels of alcohol-related harm. In response, support community self-regulation. social and cultural movements, often promulgated by women, emerge spontaneously from within developing societies to counterbalance elite interests Implications in the alcohol trade and to push against external market forces. Studies in Chiapas, South Africa, In international health, ethnographic research is often Fiji, Papua New Guinea, India and native commu- confined to the roles of hypothesis generation and nities of Ecuador underscored the importance of measuring cross-cultural applicability—to produce resistance tactics and indigenous political resources findings only later validated through quantitative in mitigating the adverse effects of alcohol on popu- means. We tend to view this body of work as a series of lation health. In all cases, political struggles cap- rich, but isolated, snapshots of particular people, in a tured the dual nature of alcohol, both as a source particular place and time. However, the common and symbol of inequality and class conflict. In addi- threads observed across the developing societies in this tion, changing relationships, and tensions, between review may encourage us to think about the ethno- men and women were themes that cut across most graphic record as its own coherent body of scientific of the ethnographies we reviewed. Women’s inter- evidence—as well as a declining resource as more low- ests often lose ground as men’s drinking increases and middle-income countries cross the epidemiologi- in the context of development. Commercialization cal transition to become part of the developed world. of production may also mean that women lose con- Reframing the ethnographic record as a co- trol over what was traditionally a home-produced herent body of research on a par with quantitative supply. Many of the developing societies we studied studies opens up possibilities for more systematic shared long-standing traditions of home production cross-cultural secondary analyses to inform policy- by women—traditions that helped balance a gen- making and practices in international health. We dered distribution of wealth. As countries entered can expect that in many other areas of public health, the global economy, local markets were often colo- besides alcohol, there already exist reasonably large, nized and women’s independent source of wealth well-developed ethnographic records to be mined. dried up. The declining wealth and independence of More systematic studies of these data sources could women often took place within a context in which suggest ways to better understand the dynamics of the status of men was under threat as well. In stud- developing countries. Even more important, they ies of Fiji, Chuuk, Zambia and Papua New Guinea, could suggest better ways to intervene on behalf of development left local men dislocated from their producing health equality within and between coun- former political and economic statuses, producing tries. After all, the field of public health has its own role strain. Among other things, increased drinking dual nature: it is part science and part politics. The and alcohol-related violence among men seemed a ethnographic record is unique in its capacity to by-product of their growing sense of demoralization speak to both sides of the duality—both as a scien- and loss of control. tific investigation, and as a rich fund of symbols and Historically, alcohol has provided many co- imagery around which to build political coalitions lonial governments with a means to control and and motivate change. dominate indigenous populations, as well as a way to extract more in the way of labor and taxes from local populations. It is only natural, then, that for- References eign sources of alcohol have become symbolically tied to struggles against foreign incursion in many Abeyansinghe, R. (2002). Illicit alcohol: Drinking parts of the developing world. Cases of alcohol boy- culture in Colombo—A study of alcohol consump- cotts and spontaneous prohibition movements tion among the urban poor in a South Asian capi- “from below” underscore the fact that, as tribal and tal. Colombo, Sri Lanka: Vijitha Yapa village societies are incorporated into the globalized Publications.

–––––– IJADR 1(1) ––––––

54 Laura A. Schmidt & Robin Room

Australian Indigenous Doctors’ Association & Grossman, L. (1982). Beer drinking and subsis- Centre for Health Equity Training, Research tence production in a highland village. In M. and Evaluation. (2010). Health impact Marshall (Ed.), Through a glass darkly: Beer and assessment of the Northern Territory emergency modernization in Papua New Guinea (pp. 59– response. Canberra, Australia: Australian 72). Boroko, Papua New Guinea: Institute for Indigenous Doctors’ Association. Retrieved Applied Social and Economic Research. from http://www.aida.org.au/ Jarratt, P., & Zwar, D. (1989). Dreamtime or geno- viewpublications.aspx?id=3 cide? The Bulletin (Sydney, Australia), 1 No- Beckman, V. (1988). Alcohol: Another trap for Af- vember, 44–48. rica. Örebro, Sweden: Libris. Jernigan, D. (1997). Country profile on alcohol in Benegal, V., Nayak, M., Murthy, P., Chandra, P., & Zimbabwe. In L. Riley & M. Marshall (Eds.), Gururaj, G. (2005). Women and alcohol use in Alcohol and public health in eight developing India. In I. S. Obot & R. Room (Eds.) Alcohol, countries (pp. 157–175). Geneva, Switzerland: gender and drinking problems: Perspectives from Substance Abuse Department, World Health low and middle income countries (pp. 89–123). Organization. Geneva, Switzerland: Department of Mental Kawachi, I., Kennedy, B. P., & Wilkinson, R. G. Health and Substance Abuse, World Health (Eds.). (1999). The society and population health Organization. reader: Income inequality and health (Vol. 1). Blas, E., & Sivasankara Kurup, A., (Eds.) (2010). New York, U.S.A.: New Press. Equity, social determinants and public health pro- La Hausse, P. B. (1988). Brewers, beerhalls and boy- grammes. Geneva, Switzerland: World Health cotts: A history of liquor in South Africa. Johan- Organization. Retrieved from nesburg, South Africa: Ravan Press. http://www.who.int/social_determinants/en/ Macintyre, M. (1999). Social and economic impact Braveman, P., & Gruskin, S. (2003). Defining eq- study, Lihir 1998. Melbourne, Australia: Char- uity in health. Journal of Epidemiology and lotte Allen and Associates. Community Health, 57, 254–258. Macintyre, M. (2005, November). “Mi laikim spak Butler, B. Y. (2006). Holy intoxication to drunken tasol” [I just want to get drunk]: Alcohol consump- dissipation: Alcohol among Quichua speakers in tion patterns in Lihir 1995–2005. Paper pre- Otavalo, Ecuador. Albuquerque, U.S.A.: Uni- sented at the meeting of Dangerous versity of New Mexico Press. Consumptions III, University of Melbourne. Colson, E., & Scudder, T. (1988). For prayer and Mäkelä, K., & Viikari, M. (1977). Notes on alcohol profit: The ritual, economic, and social importance and the state. Acta Sociologica, 20, 155–179. of beer in Gwembe District, Zambia, 1950–1982. Marshall, M., & Marshall, L. B. (1975). Opening Stanford, U.S.A.: Stanford University Press. Pandora's bottle: Reconstructing Micronesians’ Dorschner, J. P. (1983). Alcohol consumption in a early contacts with alcoholic beverages. Journal village in North India (Vol. 1). Ann Arbor, of the Polynesian Society, 84, 441–465. U.S.A.: UMI Research Press. Marshall, M., & Marshall, L. B. (1976). Holy and Eber, C. (1995). Women and alcohol in a highland unholy spirits. Journal of Pacific History, 11, 135– Maya town: Water of hope, water of sorrow. Aus- 166. tin, U.S.A.: University of Texas Press. Marshall, M., & Marshall, L. B. (1990). Silent voices Eber, C. (2001). “Take my water”: Liberation speak: Women and prohibition in Truk. Belmont, through prohibition in San Pedro Chenalho, U.S.A.: Wadsworth. Chiapas, Mexico. Social Science & Medicine, 53, Maula, J. (1997). Small-scale production of food and 251–262. traditional alcoholic beverages in Benin and Tan- Ezzati, M., Lopez, A .D., Rodgers, A., Vander zania: Implications for the promotion of female Horn, S., Murray, C. J. L., & Comparative Risk entrepreneurship. Helsinki, Finland: Finnish Assessment Collaborating Group. (2002). Se- Foundation for Alcohol Studies. lected major risk factors and global and re- McKnight, D. (2002). From hunting to drinking: gional burden of disease. Lancet, 360, 1347– The devastating effects of alcohol on an Australian 1360. Aboriginal community. New York, U.S.A.: Rout- Fahey, D. M., & Manian, P. (2005). Poverty and ledge. purification: The politics of Gandhi’s campaign Narayan, K. M. V., Ali, M. K., & Koplan, J. P. for prohibition. The Historian, 67, 489–506. (2010). Global noncommunicable diseases—

–––––– IJADR 1(1) ––––––

Alcohol and the process of economic development 55

Where worlds meet. New England Journal of United Nations General Assembly (2011). Political Medicine, 363, 1996–1198. declaration of the high-level meeting of the Assem- Pine, A. (2008). Working hard, drinking hard: On bly on the Prevention and Control of Non- violence and survival in Honduras. Berkeley, communicable Diseases. 66th Session, Agenda U.S.A.: University of California Press. Item 117. New York, U.S.A.: United Nations. Room, R. (1984). Alcohol and ethnography: A case Weinstein, L. (1976). Alcoholism as a political of problem deflation? Current Anthropology, 25, problem in Chile. Mental Health & Society, 3, 169–191. 72–76. Room, R. (2008). “Justly anxious respecting the Wright, A. (1997). Grog war. Broome, Australia: moral and material consequences.” The prolif- Magabala Books Aboriginal Corporation. eration of international control regimes for psychoactive substances. Social History of Alco- hol and Drugs, 22, 6–21. Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. Lancet, 365, 519–530. Room, R., Mäkelä, P., Schmidt, L., & Rehm, J. (2006). Alcohol, health disparities and development. Expert committee meeting. Geneva, Switzerland: World Health Organization. Room, R., Rehm, J., & Parry, C. (2011). Alcohol and NCDs: Time for a serious international public health effort. Addiction, 106, 1547–1548. Room, R., Rehm, J., Trotter, R. T., Paglia, A. & Üstün, T. B. (2001). Cross-cultural views on stigma, valuation, parity and societal attitudes towards disability. In T. B. Üstün, S. Chatterji, J. Rehm, S. Saxena, J. E. Bickenbach, R. T. Trotter, & R. Room (Eds). Disability and culture: Universalism and diversity (pp. 247–291). Seat- tle, U.S.A.: Hofgrebe & Huber. Schmidt, L., Mäkelä, P., Rehm, J., & Room, R. (2010). Alcohol: Equity and social determinants. In E. Blas & A. Sivasankara Kurup (Eds.), Equity, social determinants and public health programmes (pp. 11–29). Geneva, Swit- zerland: World Health Organization. Retrieved from http://www.who.int/social_determinants/en/ Silberschmidt, M. (1990). The interaction between changing male and female roles and alcohol problems in rural Kenya: Observations from a field study in Kisii District. In J. Maula, M. Lindblad, & C. Tigerstedt (Eds.), Alcohol in developing countries (pp. 134–150). (NAD Publica- tion 18). Helsinki, Finland: Nordic Council for Alcohol and Drug Research. Thimmaiah, G., & Sharma, J. V. M. (1978). Socio- economic impact of drinking in Karnataka. Calcutta, India: Institute of Social Studies. Toren, C. (1994). Drinker as chief or rebel: Kava and alcohol in Fiji. In M. McDonald (Ed.), Gen- der, drink and drugs (pp. 153–173). Oxford, U.K.: Berg.

–––––– IJADR 1(1) ––––––