Big alcohol is poised to expand into Africa. Why this is bad news for health

The alcohol industry is doing exactly what the tobacco industry did several decades ago to ensure growth and increase profits: expanding into Africa as an underdeveloped market. As a result, exposure to alcohol in African countries is expected to increase in the next few years. With it comes alcohol-related health and social problems.

Strategy hints coming out of the US$ 103 billion merger between SAB Miller and AB InBev provide a good reference point. The merged entity’s strategy clearly shows that Africa will be a critical driver for growth. Competitors like Pernod Ricard and Diageo are not far behind.

The alcohol industry is under pressure and needs to develop new sources of growth and profits. Markets in the developed world are under threat as a result of saturation. This is coupled with the fact that only a limited numbers of new drinkers are entering the market each year due to low population growth rates.

The expansion into developing economies comes as warnings about the harm that alcohol causes are gaining traction. As a result several countries have revised their guidelines on alcohol consumption. In the UK for example, there’s a move to regulate the sale and marketing of alcoholic drinks. And in Scotland a minimum price for alcohol is about to be introduced.

As a result the alcohol industry is targeting less regulated but more affluent low and middle income countries. Africa is becoming a key focus.

Studies show this is bad news for the continent. Alcohol is a risk factor for non-communicable diseases such as liver cirrhosis, heart disease and a range of common cancers of the breast, throat and mouth. Alcohol also interacts with other health challenges such as HIV, road traffic accidents, violence – including domestic violence – and mental health.

Alcohol use in Africa

Sub-Saharan Africa provides particularly fertile ground for growing market share due to the high proportion of the population in many countries who don’t yet consume alcohol (especially among females), the high youth population in most countries, and the growth in GDP in certain countries. Low advertising costs, weak regulation, high-intensity consumption of beer in these markets make for an ideal environment for global brands.

The dangers of alcohol are well documented. Across the globe, more than 3.3 million people die from harmful use of alcohol each year. More than 20% of deaths from liver cirrhosis, certain cancers of the mouth and throat, interpersonal violence and self-harm are due to alcohol use.

Alcohol is responsible for more than 7% of all deaths globally and it was the 9th leading risk factor for death and disability globally in 2015, up from tenth place in 2005 and eleventh in 1990. In the southern sub-Saharan Africa region alcohol ranked fifth as a risk factor for death and disability. With rising alcohol exposure, the extent to which alcohol contributes to various negative health outcomes are expected to also increase.

Using tobacco tactics

The global alcohol industry’s new focus in low and middle income countries mirrors the moves made by big tobacco companies in penetrating these markets.
Transnational tobacco corporations have succeeded in driving up smoking in African markets through aggressive marketing strategies. Their strategy included disguising marketing as corporate social responsibility programmes.

Alcohol firms are using the same strategy. Under the guise of corporate social responsibility they have run campaigns to promote “responsible” and “moderate” drinking.

Alcohol companies also position themselves as being committed to promoting the consumption of lower alcohol products. For example AB InBev’s campaign, called Global Smart Drinking Goals, states that its objective is to:

Ensure no- or lower-alcohol beer products represent at least 20% of AB InBev’s global beer volume by the end of 2025.

This may appear to be a positive message, but research on similar strategies suggests otherwise. It indicates that this is unlikely to be about substituting regular beer products for lower alcohol beverages. Rather the aim is to increase the overall size of the beer market through an expanded range of products.

Alcohol companies have also developed low-cost, entry-level products aimed at attracting new consumers, citing the greater safety of commercially produced products over homebrews.

An example is the introduction of commercially manufactured ‘Chibuku Shake Shake’ beer by SABMiller in Zambia. It’s based on a locally brewed traditional sorghum beer but is marketed as offering more consistent quality and safer than the home-brew variant.

The promotion of brewers products as safer alternatives forms part of a wider corporate social responsibility agenda aimed at highlighting the positive social impact that companies are having. A good example is Diageo’s water sanitation project.

Another strategy used successfully by tobacco companies as well as alcohol companies is government partnerships.

These have become an effective avenue through which the industry influences and limits regulation. For example, national alcohol policy documents from four sub-Saharan countries (Lesotho, Botswana, Malawi and Uganda) have been found to be identical and reflecting the alcohol industry’s preferred policy wording.

As the global alcohol industry moves to expand across the continent, more research, policy and public attention needs to be paid to industry practices and governance mechanisms to help understand and prevent the negative impact this will have on the population’s health. Industry expansion into African markets will be sold as being progressive, as providing new jobs, access to safer and healthier alcohol products. Perhaps nearer to the truth would be to describe this as David Jernigan, the leading health academic who has analysed the impact of alcohol and its marketing did, labelling it “Thirsting for Markets” and as possibly even as part of the recolonisation of Africa.

Karen Hofman, Program Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, University of the Witwatersrand and Charles Parry, Director of the Alcohol, Tobacco & Oher Drug Research Unit, South African Medical Research Council

This article was originally published on The Conversation.

How to talk to children about terrorism

Distressing events like the recent terrorist attack in Manchester affect us all in different ways. While adults often have enough life experience to be able to take a long-term perspective towards such disasters, children can face different challenges.

When a child has directly experienced extremely distressing events, or witnessed them through the news and social media, it is entirely normal for them to experience much higher levels of distress than usual.

Depending upon the impact of the trauma, the age of the child, and the supportive relationships they have prior to the traumatic event, their distress may be shown in all sorts of ways. This can include aches and pains, sleeplessness, nightmares, bed-wetting, becoming very snappy or withdrawn, or not wanting to be separated from their parent(s).

But there are lots of strategies that can help young people who are struggling after traumatic events.

Ask questions

Although the natural response is often to want to protect and shield children from the reality of terrorism, it is not a helpful goal long-term. It is also just about impossible to achieve – young people today are exposed to anxiety provoking information like never before.

So rather than shielding children from inevitable stressors, we need to focus on arming them with balanced information, compassion, hope and the chance to develop their resilience.

Incomplete stories and uncertainties can add to children’s worries, but a common worry for adults is how much to say and what gaps to fill in. In such instances, asking open questions about what a child has heard or understood can be helpful.

“How” and “what” questions, such as “how are you feeling about what you saw or heard?” or “what have your friends said about what happened?” can help in gaining insight into the story that the child is trying to establish and understand.

Point out the heroes

Showing children how people are actively trying to help and support people in need is a great way to frame horror with heroes. While older children will be able to process and understand many of the details and implications of tragedy that surround traumatic attacks and events, younger children just don’t have the life experience or developmental mechanisms to process such details.

Remind children that real life heros don’t wear capes. Instead, point out that the heroes in this story are the people in paramedic uniforms or theatre scrubs. They are the passersby, the people who offered help, taxi rides, cups of tea and a bed for the night when people were stranded after the attack.

Not only does this give a new focus to the story but it also highlights familiar cultural narratives – of heros and villains or goodies and baddies – that children can connect with. Such approaches have also been shown to enhance children’s confidence, sense of bravery, ability to problem solve and develop their moral compass.

Use drawings to help

If children are able to name and express what they are feeling, they are more likely to be able to talk about their thoughts and feelings and experience the benefits of connecting emotionally with others.

Don’t assume children know they can share their feelings. Always offer explicit permission for all emotions, especially emotions they may feel concerned about voicing, such as anger and sadness.

One way to do this might be to get out the pens and pencils and physically draw out emotions as characters, or consider how they feel in the body. For instance, “anxious” might feel like a hot head, sweaty hands and fast heart.

Keep things simple

Adults tend to use particular words around trauma, such as “awful”, “horrific”, or “terrible”. But these words don’t translate with much meaning for children.

If possible, it is helpful to break these terms down and use language that holds more meaning for children and connect with emotions they may be feeling or noticing in others, such as sad, worrying, frightening, kind or brave.

You can also try to reduce some of the anxious uncertainty by giving those responsible a name and explaining that they are a small group of people who make bad choices. This not only gives the perpetrators an identity for the child – which helps contain the idea of faceless “baddies” – but also helps to disqualify some of the unhelpful stories they may here from others.

Make time for hugs

Children only feel as safe as they are led to believe they are by the adults around them. So being able to reassure young people that they are safe, loved and cared for can make all the difference.

Research has shown that loving environments at home are hugely protective to the emotional well-being of children. Teenagers in particular benefit enormously if they have positive friendships that support them emotionally.

Relationships actually operate on a physiological level in the body, as well as an emotional one. Cuddles and emotional connection, sooth and calm down a child’s threat system by releasing feel-good hormones such as oxytocin – also known as the “cuddle” or “love” hormone.

You can find more information about how to talk to children after a traumatic event here

Sarah Parry, Senior Lecturer in Clinical and Counselling Psychology, Manchester Metropolitan University and Jez Oldfield, Senior Lecturer in Psychology, Manchester Metropolitan University

This article was originally published on The Conversation.

5 books you should read to know more about the Holy Spirit

The approach to Pentecost is a great time to reflect more on the gift of the Holy Spirit and the role it plays in our individual lives.

The amazing blessing available for every Christian is the gift of the Holy Spirit, but we can sometimes forget He's there, feel confused about His purpose, or limit His power.  

It's helpful to look to the words of our Lord Jesus Christ himself, who on the night He was to be executed explained to His disciples that He would send the Advocate to be with them.  He also explained exactly what this Advocate would do to help them.

In John 14:16-17 it says, "And I will ask the Father and he will give you another advocate to help you and be with you for ever - the Spirit of truth. The world cannot accept him, because it neither sees him nor knows him.  But you know him, for he lives with you and will be in you." (NIV)

Then in John 14:26, we read: "But the Advocate, the Holy Spirit, whom the Father will send in my name, will teach you all things and will remind you of everything I have said to you." (NIV).

Acts 2 describes the Holy Spirit coming down upon the believers in a powerful way on the day of Pentecost.  Here it is described as "tongues of fire" coming down to rest on each person.  The result is that each of them was filled with the Holy Spirit and "began to speak in other tongues as the Spirit enabled them".

Further down the chapter, Peter explains that the prophesy in Joel of God's Spirit enabling people to prophesy and see visions has now been fulfilled with the coming of Christ.

These few passages paint an amazing picture of the power of God's Holy Spirit and its empowering of His people.  And yet, the truth is, for many of us, the Holy Spirit can still feel like something of a mystery.  And for some believers, He can even arouse suspicion.

Yet the Holy Spirit is an essential part of the Trinity and so it's essential we get to know Him personally in our own walk of faith and experience Him for ourselves - and that means in our hearts, not just our heads.

If you don't know where to start, then here are some great books that will explain more about the nature of the Holy Spirit and the radical way in which He can transform your personal relationship with God.

'How to be Filled with the Holy Spirit' by A.W.Tozer
This book draws on sermons preached by Tozer at his church in Chicago and seeks to explain who the Holy Spirit is and how to be filled with Him. But it's much more than an explainer.  This book will challenge readers to reflect on how much they really desire to be filled by God's Holy Spirit.
Here's a taster: "He is indivisible from the Father and the Son, so that if you were to be suddenly transferred to heaven itself you wouldn't be any closer to God than you are now, for God is already here."

'The Mystery Of The Holy Spirit' by R.C.Sproul
This is another popular title and well respected in evangelical circles.  It's not only theologically sound, but Sproul manages to communicate the Person of the Holy Spirit in ways that can be easily grasped and applied by believers in their personal walk of faith.  His writing is also beautifully descriptive at points: "The Holy Spirit fills what is empty.  He conquers the void.  When His work is finished, the once lonely universe is teeming with a plethora of flora and fauna.  The barren wasteland becomes a pulsating arena of life."

'40 Days with the Holy Spirit' by R.T. Kendall
If you are looking for something that is very applicable to your Christian walk, give this book a try.  Similar to daily devotionals that you might use in your quiet times, this is divided into daily readings with space for journalling so that readers can take down their experiences of the Holy Spirit during their prayer times.  The emphasis of this book is a personal encounter with the Holy Spirit and it would suit anyone looking for a resource to enhance their prayer time.

'The God I Never Knew' By Robert Morris
In this book, Morris, the founder of Gateway Church in Texas - the home of worship artist Kari Jobe - seeks to remove the mystery of the Holy Spirit and clarify what He promises to do in the believer's life:
· Dwell within you
· Be your helper
· Guide you into all truth
· Comfort you
· Pray for you
· Show you things to come
· Never leave you

'Forgotten God: Reversing Our Tragic Neglect of the Holy Spirit' by Francis Chan
Another popular title and an Amazon #1 Best Seller with a 5 star rating, the 'Crazy Love' author pours his heart and soul into painting a picture of the Holy Spirit that is deeply personal - a Helper who intimately knows us and wants to help form us into witnesses for Christ.  As the title of the book suggests, Chan is writing from the perspective that the Holy Spirit has been neglected in the Church for far too long, with disastrous results, and the same may be said of our own personal faith lives.
Source

Protest after health care worker stabbed to death

Deputy police minister promises mobile station outside Gugulethu Community Health Centre at KTC Day Hospital

By Buziwe Nocuze
25 May 2017

Workers from the local clinic together with community members march to Gugulethu police station to hand over a memorandum. Photo: Buziwe Nocuze

Protesters gathered outside the Gugulethu Community Health Centre at KTC Day Hospital on Wednesday in response to the murder of a health worker. Workers from the clinic together with community members then marched to Gugulethu police station to hand over a memorandum.
The event was organised by the Treatment Action Campaign (TAC).

This comes after a porter, Andile Magama, died after he was stabbed on his way home outside the clinic.

Ncediswa Ngcobondwana, an activist with the TAC, told the crowd, “You know this is not the first time that something like this happened. Now, we are afraid, and we want help from the police and also from the community.”

“We are not feeling safe so we want the visibility of the police next to the clinic everyday. If that can happen, we believe incidents like these won’t happen again,” she said.

Resident Thembile Makana said, “How many people do we want to see dead before we report these criminals? Why are we hiding them while we can identify them? Let’s unite and fight these criminals.”

The memorandum was received by the Deputy Minister of Police Bongani Mkongi at Gugulethu police station who promised that by next week there would be a mobile station at the clinic.

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Published originally on GroundUp .

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Study: cannabis may reduce crack use

A medical cannabis grower.
Shivanshu Pandev/flickr, CC BY-SA

North America is in the midst of a drug overdose disaster. In British Columbia, Canada, where nearly 1,000 people died of overdose in 2016, officials have declared a public health emergency.

While over-prescription of painkillers and contamination of the illegal opioid supply by fentanyl, a potent synthetic analgesic, are at the heart of the problem, opioid users are not the only ones at risk. Public health officials in BC are warning that fentanyl has been detected in many drugs circulating on the illicit market, including crack cocaine.



The possibility of opioid overdose is an unusual new threat for people who use crack, which is a stimulant. Its consumption, either through smoking or injection, is not necessarily deadly.

If misused, though, crack can certainly cause health harms, including cuts and burns from unsafe pipes. Sharing pipes can also transmit infectious diseases such as HIV and hepatitis C. In the long run, frequent and heavy crack consumption may contribute to psychological and neurological complications.

Despite the estimated 14 to 21 million cocaine users worldwide, the majority of whom live in Brazil and the United States, scientists have yet to find an effective medical treatment for helping people who wish to decrease problematic use of the drug.

Cannabis-assisted treatment

Now Canadian scientists are working on an unconventional substitution for it.

Research done by the BC Centre on Substance Use in Vancouver shows that using cannabis may enable people to consume less crack. Could marijuana become to crack what methadone is to heroin – a legal, safe and effective substitute drug that reduces cravings and other negative impacts of problematic drug use?

Between 2012 and 2015, our team surveyed more than 100 crack cocaine users in the city’s Downtown Eastside and Downtown South neighbourhoods. These are poor areas where crack is common among people who use drugs. We found that people who intentionally used cannabis to control their crack use showed a marked decline in crack consumption, with the proportion of people reporting daily use dropping from 35% to less than 20%.

Data for this study, which was recently presented at the Harm Reduction Conference in Montreal, were drawn from three open and ongoing prospective cohorts of more than 2,000 people who consume drugs (not necessarily just stimulants). They were the Vancouver Injection Drug Users Study (VIDUS); the AIDS Care Cohort to Evaluate exposure to Survival Services (ACCESS); and the At-Risk Youth Study (ARYS).

We used harmonised procedures for recruitment, follow-up and data collection. Individuals in these cohorts were recruited through snowball sampling and extensive street outreach in the Downtown Eastside and Downtown South areas.

Vancouver’s Downtown Eastside has a history of innovative harm reduction responses to drug use.
Emma Kate Jackson/flickr, CC BY

First, we asked participants if they had substituted one drug for another in order to control or slow down their consumption. A total of 122 participants (49 from VIDUS, 51 from ACCESS, and 22 from ARYS) reported that they had done so at least once in the last six months. These were the subjects included in our analysis, contributing to a total of 620 interviews over three years.

When we analysed these participants’ crack use histories over time, a pattern emerged: significant increases in cannabis use during periods when they reported they were using it as a crack substitute, followed by decline in the frequency of crack use afterwards.

Self-medication

Our findings are in line with a smaller case-series study in Brazil that followed 25 treatment-seeking individuals with problematic crack use who reported using marijuana to reduce cocaine-related craving symptoms. Over a nine-month follow-up period in that study, conducted by Eliseu Labigalini Jr, 68% of participants had stopped using crack.

As in our study, in Brazil cannabis use peaked during the first three months of follow-up, with only occasional use of cannabis reported in the six months after that.

Qualitative studies in Jamaica and Brazil also indicate that crack users frequently self-medicate with cannabis to reduce cravings and other undesirable effects of crack.

Other research has shown that long-term cannabis dependence might increase cocaine cravings and risk of relapse. Rather than contradict findings from Canada, Brazil and Jamaica, these discrepancies suggest that patterns of cannabis use and dependence, and the timing of self-medication with cannabis, may play a role in individual outcomes.

Building on the finding from this preliminary study, the BC Centre on Substance Use is planning more research to confirm whether using cannabis might be an effective strategy for people seeking to reduce their use of crack or other stimulants, either as harm reduction or as treatment.

Canada’s recent move to legalise and regulate marijuana should facilitate this work. For decades, stigma and prohibition have blocked rigorous scientific evaluation of cannabis. Now these obstacles are beginning to disappear, enabling our team to better understand and unlock the therapeutic potential of cannabinoids.

M-J Milloy, is a Research Scientist with the BC Centre on Substance Use and Assistant Professor in the Division of AIDS, UBC Department of Medicine , University of British Columbia and M. Eugenia Socias, Postdoctoral Fellow and clinician-scientist with the BC Centre on Substance Use and UBC Faculty of Medicine, University of British Columbia

This article was originally published on The Conversation.