Introduction
Punjab is a state in northern India comprised of a mainly Punjabi-speaking Sikh minority Population. Due to these differences in religion and language, there exists a culture in Punjab which has its unique challenges and problems. One of these problems the state faces is the high rates of alcohol use and abuse, especially in rural villages. Data collected from multiple studies paint a clear picture that Punjab has higher rates of mental morbidity than the national average with alcohol use disorder being the biggest problem. These rates of alcohol use disorder rise even higher when we focus on areas in rural Punjab. Alcohol abuse is an important issue to highlight in rural Punjab because alcohol use disorder is a mental illness that significantly impacts physical health. It has been reported that worldwide there are an estimated 2.9 million deaths each year due to substance use disorders with alcohol use disorder contributing to 2.7 million of these deaths (Nadkarni et al., 2016). It has also been shown that alcohol abuse is a risk factor for cardiovascular diseases, cancers, chronic respiratory diseases and diabetes (World Health Organization, 2015). It is clear the impact that alcohol use disorder can have on public health and why it is important to investigate this problem in Punjab. As we investigate rates of alcohol abuse in Punjab and specifically rural communities in the state, we will find that they are higher than the national average due to a lack of education and other mental illnesses.
Discussion
When looking at Punjab it is clear that the state has higher than national average rates of mental morbidity. According to Chavan et al. (2018), it has been reported that the mental morbidity rate in Punjab is 13.42% while the national average for India is 10.6%. When we start looking at just rural Punjab we find that this number increases to 15% (Chavan et al, 2018). When looking at these numbers we see that Punjab has higher than national average rates of mental morbidity and this problem intensifies in the rural areas of the state. Looking at rates of mental morbidity across the state it has been found that the highest rate of any mental morbidity is alcohol abuse at 7.9% (Chavan et al. 2018). In a separate study, researchers surveyed 15 villages in the Jalandhar district of Punjab and the results showed that the most common substance abused in the villages was alcohol at 41% (Sharma et al, 2017). Even though this survey was conducted in a very localized region in the state and the number may not be generalized for all villages, it is still concerning to see alcohol being abused at such a high rate. In a study conducted by Avasthi et al. (2018), it was found that the lifetime dependence on alcohol in Punjab was 12.15% and when looking at just Men the rate rises to 22.66%. According to these rates, it has been estimated that 2.4 million people in Punjab have a lifetime dependence on alcohol Avasthi et al. (2018). In this same study, it has also been reported that when we look at the rural population of Punjab there is a higher prevalence of substance use and dependence compared to cities. Looking at all these studies together there emerges a clear picture that Punjab and specifically rural Punjab has a public health problem with alcohol abuse which needs to be addressed.
Seeing these numbers is concerning but to address this problem we need to understand what factors cause alcohol use disorder and which of these factors are present in rural Punjab. In Research conducted by Miller et al. (2010), it was found that hazardous alcohol use is more common among rural and remote communities relative to urban communities. This study shows that this problem is not just occurring in Rural areas in Punjab but is a common theme among rural communities. When looking at the risk factors for hazardous alcohol use and alcohol-related harm in rural and remote communities it was found that having less relative education, having friends and family who drink, having a mental illness, and having a history of arrest or incarceration are all risk factors (Friesen et al. 2022). In a separate study done by Kim et al. (2010), it was found that in the rural population not having an education increased the odds of alcoholism in rural men. When we look at these risk factors it is important to see which of these are manifesting in rural Punjab to combat the problem of alcoholism. There was research done by Kaur (2017), which investigated the quality of education in elementary schools in rural Punjab. This study found that the mean academic score was below 40%, which the researcher described as “dismal”. Kaur (2017) concluded that the learning outcomes and the quality of education in elementary schools in rural Punjab were poor. In research done by Pushkarna (2017), it was found that literacy rates for rural Punjab were 9% less than in Urban Punjab and Punjab as a whole had lower literacy rates than the national average. As mentioned earlier it has also been observed that the mental morbidity in rural Punjab is 15% which is higher than the national average of 10.6% (Chavan et al. 2018). Taking all this information together it can be seen that poor education and higher rates of mental morbidity in rural Punjab are contributing to the high rates of alcohol abuse.
According to the studies discussed in this paper it can be said that lower levels of Education and higher rates of mental morbidity among the rural population in Punjab may be the cause of the high rates of alcohol abuse. Therefore, a potential solution may be increasing education and providing mental health support in rural Punjab. Another potential solution to this problem may be screening and brief intervention. It was found that when lay counsellors delivered brief treatment to harmful drinkers in India there were positive and sustained effects on remission and abstinence (Nadkarni et al. 2022). According to Nadkarni et al. (2022), this solution is also cost-effective, which makes the solution even more viable for rural areas of Punjab. It has been shown that brief advice and early intervention is an effective strategy that has evidence from multiple countries and a range of healthcare settings (Anderson et al. 2009).
Conclusion
According to data collected by multiple studies, it can be shown that Punjab has an alcohol abuse problem, and that problem intensifies in rural areas of Punjab. It can be seen that lower quality of education, illiteracy and higher mental morbidity are risk factors present in rural Punjab for alcohol abuse. This problem is something that needs to be addressed as it is a public health concern. Protentional solutions to this can be targeting the risk factors or using a brief intervention.
Recommendations
Potential solutions are talked about in the discussion.
Further research needs to be done in rural areas of Punjab to get a better idea of exact differences between rural and urban rates of alcohol abuse, education, and mental illnesses. It would also be beneficial to conduct research on incarceration rates in rural vs urban Punjab as this is also a risk factor for alcohol abuse.
References:
Chavan, B. S., Das, S., Garg, R., Puri, S., & Banavaram, A. A. (2018). Prevalence of mental disorders in Punjab: Findings from National Mental Health Survey. Indian journal of psychiatry, 60(1), 121–126. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_221_17
Sharma, B., Arora, A., Singh, K., Singh, H., & Kaur, P. (2017). Drug abuse: Uncovering the burden in rural Punjab. Journal of family medicine and primary care, 6(3), 558–562. https://doi.org/10.4103/2249-4863.222037
Avasthi, A. ( 1 ), Subodh, B. N. ( 1 ), Gupta, P. K. ( 2 ), Sidhu, B. S. ( 3 ), Gargi, P. D. ( 4 ), Sharma, A. ( 5 ), Basu, D. ( 6 ), Ghosh, A. ( 6 ), & Rani, P. ( 7 ). (2018). Epidemiology of substance use and dependence in the state of Punjab, India: Results of a household survey on a statewide representative sample. Asian Journal of Psychiatry, 33, 18-29–29. https://doi-org.login.ezproxy.library.ualberta.ca/10.1016/j.ajp.2018.02.017
Nadkarni, A., Weiss, H. A., Naik, A., Bhat, B., & Patel, V. (2016). The six-year outcome of alcohol use disorders in men: A population based study from India. Drug & Alcohol Dependence, 162, 107–115. https://doi-org.login.ezproxy.library.ualberta.ca/10.1016/j.drugalcdep.2016.02.039
Miller PG, Coomber K, Staiger P, Zinkiewicz L, & Toumbourou JW. (2010). Review of rural and regional alcohol research in Australia. Australian Journal of Rural Health, 18(3), 110–117. https://doi-org.login.ezproxy.library.ualberta.ca/10.1111/j.1440-1584.2010.01133.x
Erik Loewen Friesen, Ms., Jacob Bailey, Bhs., Sarah Hyett, Ms., Sina Sedighi, Bs., Mitchell Lennox de Snoo, Ms., Kenneth Williams, Ms., Rebecca Barry, Ms., Anders Erickson, Bs., Farid Foroutan, P., Peter Selby, P., Laura Rosella, P., & Paul Kurdyak, P. (2022). Hazardous alcohol use and alcohol-related harm in rural and remote communities: a scoping review. The Lancet Public Health, 7(2), e177–e187. https://doi-org.login.ezproxy.library.ualberta.ca/10.1016/S2468-2667(21)00159-6
Kim, J. M., Shin, I. S., Stewart, R., & Yoon, J. S. (2002). Alcoholism in older Korean men: prevalence, aetiology, and comorbidity with cognitive impairment and dementia in urban and rural communities. International journal of geriatric psychiatry, 17(9), 821-827.
KAUR, S. (2017). Quality of Rural Education at Elementary Level: Evidence from Punjab. Economic and Political Weekly, 52(5), 58–63. http://www.jstor.org/stable/44166150
Nadkarni, A., Bhatia, U., Bedendo, A., de Paula, T. C. S., de Andrade Tostes, J. G., Segura-Garcia, L., … & Andréasson, S. (2022). Brief interventions for alcohol use disorders in low-and middle-income countries: barriers and potential solutions. International Journal of Mental Health Systems, 16(1), 36.
Anderson P, Chisholm D, Fuhr DC, Anderson, P., Chisholm, D., & Fuhr, D. C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet, 373(9682), 2234–2246. https://doi-org.login.ezproxy.library.ualberta.ca/10.1016/S0140-6736(09)60744-3
Pushkarna, M. (2017). Literacy Patterns in Punjab: Rural-Urban Differentials. J. Human. Soc. Sci, 22(7), 32-39.
Author: Harsohail Parmar
Contact: info@savingpunjab.org
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