Fiocruz study: alcohol consumption costs Brazil R$18 billion a year and causes 12 deaths an hour

The consumption of alcoholic beverages represented a cost to Brazil of around R$18.8 billion (US$ 3.27 billion) in 2019. This is the conclusion of the study Estimação dos custos diretos e indiretos atribuíveis ao consumo do álcool no Brasil [Estimating the direct and indirect costs attributable to alcohol consumption in Brazil], carried out by Fiocruz Brasília under the leadership of researcher Eduardo Nilson from the Food, Nutrition and Culture Program (Palin), at the request of the organizations Vital Strategies and ACT Promoção da Saúde as part of the RESET Álcool initiative.

Of this total, R$1.1 billion (US$ 190 million) refers to direct federal costs with hospitalizations and outpatient procedures in the Brazilian Unified Health System (SUS). The indirect costs attributable to alcohol consumption, on the other hand, amounted to R$17.7 billion (US$ 3.08 billion) and include productivity losses due to premature mortality, sick leaves and early retirement resulting from diseases associated with alcohol consumption, loss of working days due to hospitalization and social security ill leave. Among the indirect estimates is the social security cost, which reached R$47.2 million (US$ 8.22 million) in 2019. Of the total, 78% (R$37 million) was spent on men, while 22% was spent on women (R$10.2 million).

The survey used estimates of alcohol-attributable deaths made by the World Health Organization as a basis and took into account a total of 104,800 deaths in 2019 in Brazil, which means an average of 12 deaths per hour. Men are the main victims and accounted for 86% of deaths, almost half of which were due to cardiovascular diseases, accidents and violence. Among women, who accounted for 14% of fatalities, the harmful effects of alcohol led to cardiovascular disease and various types of cancer in more than 60% of cases.

"We can conclude from the study that alcohol consumption in Brazil has a significant impact on the health and well-being of the population and, consequently, is very costly to the public purse. In this scenario, the need to adopt measures such as a selective tax on alcoholic beverages is clear. This is one of the actions recommended by the World Health Organization to reduce alcohol consumption and, consequently, its negative impact. By reducing consumption, we can save lives and reduce the social impacts of alcohol, saving billions of Reais every year," says Pedro de Paula, executive director of Vital Strategies.

The cost to the SUS of hospitalizing women for alcohol-related problems accounts for 20% of the total, which is much lower than the cost for men. This is because the prevalence of alcohol consumption among women is lower, according to the National Health Survey (PNS 2019), in which around 31% of those surveyed reported having consumed alcohol in the 30 days before the survey, while the percentage of men is 63%.

Another reason is that women are more likely to seek out health services and carry out self-care, such as routine examinations. This means that they can be treated before more serious health complications occur. "When men go to the health service, their health may already be much more compromised, which leads to more hospitalizations," says Eduardo Nilson, the Fiocruz researcher responsible for the study.

When it comes to costs related to outpatient care attributable to alcohol consumption, the difference between men and women drops significantly, with 51.6% of costs relating to men. "This confirms that women seek care earlier than men: they are responsible for almost half of outpatient visits, even though the prevalence of alcohol consumption among them is lower," explains Nilson. In terms of age group, the highest incidence of outpatient care is among people aged between 40 and 60, with 55% of costs relating to women and 47.1% to men.

Although currently the greatest costs resulting from alcohol consumption are related to men, who historically have always drunk more, data from Vigitel shows that between 2006 and 2023, the occurrence of episodes of abusive alcohol consumption (four or more drinks on the same occasion) almost doubled among women. The upward trend in consumption among them is also confirmed by the 2019 PeNSE (National School Health Survey), which shows that while 60% of male adolescents had tried alcohol before the age of 17, 67% of girls had done so in the same period.

"This behavioral change is a warning sign of an upward trend in the number of people consuming alcohol in Brazil, driven by the consumption of women and, consequently, its impact on health and costs to the public purse. We need to take a very careful look at the female population in order to curb this growth stimulated by cultural changes and the beverage industry's own efforts to make their products more unisex," says Luciana Sardinha, Deputy Director of Chronic Non-Communicable Diseases at Vital Strategies.

Indirect costs

When it comes to indirect costs, the study shows that there is also a predominance of impacts on the male population. The indirect economic impacts of alcohol consumption are vast and multifaceted. According to Fiocruz Brasilia researcher Eduardo Nilson, there are significant implications for productivity and the workforce, resulting in absenteeism, presenteeism (when workers show up for work but show a drop in productivity), accidents at work and preventable premature deaths. Additionally, drinking alcohol is associated with an increase in criminal behavior, including domestic violence, crime and traffic incidents.

Methodology

The study Estimação dos custos diretos e indiretos atribuíveis ao consumo do álcool no Brasil [Estimating the direct and indirect costs attributable to alcohol consumption in Brazil] was based on a comparative risk analysis methodology that estimates the fractions attributable to an exposure (risk or protective factor) concerning health outcomes directly caused by this exposure. Diseases and deaths associated with alcohol consumption were considered, with a dose-response relationship between the amount of alcohol consumed and the relative risk of the outcomes based on meta-analyses published and used by the Global Burden of Disease (GBD) study and the World Health Organization. Together with the prevalence of alcohol consumption for each sex and age group, the attributable burden for each disease was estimated, according to the range of alcohol consumption, which was then applied to the costs per disease.

Information on direct costs was obtained from public databases such as health information systems and population survey reports and microdata from the Brazilian Institute of Geography and Statistics (IBGE). The direct costs attributable to alcohol consumption included information from the SUS using data on hospital admissions (Hospital Information System – SIH/SUS) and outpatient procedures (Outpatient Information System – SIA/SUS), broken down by type of disease attributable to alcohol consumption, sex and age.

"It should be noted that the study adopted a conservative approach, since it is based exclusively on official data from public sources, such as SUS data and IBGE population surveys, and at the federal level, considering federal spending and not including supplementary funding by states and municipalities. The survey also does not take into account the costs of the private health network, nor the total economic losses to society. So, although almost 19 billion Reais a year is already an extremely significant figure, the actual cost of alcohol consumption for Brazilian society is probably even much higher," says Eduardo Nilson, the researcher responsible for the study.

Campaign reinforces messages about the harmful effects of alcohol

The second phase of the advertising campaign for the RESET Álcool program is being launched. The initiative aims to raise awareness among legislators and society about the harmful effects of alcohol on health and social well-being, and to discuss excise duty on alcoholic beverages as part of the tax reform.

Promoted by Vital Strategies and ACT Promoção da Saúde, the campaign entitled Quer uma dose de realidade? [Want a dose of reality?] will run in São Paulo, Rio de Janeiro and strategic locations in Brasília for 30 days. It will be present on digital media such as Facebook, and Instagram, as well as websites and news portals. Broadcasts on closed TV channels, radio and billboards are also planned. The Moringa agency is responsible for the creative development of the entire campaign.

The images are strong and the messages contain data on the negative impacts of alcohol on the health and lives of Brazilians. A hotsite supports the campaign and presents data from research and studies showing the damage that alcohol causes to the health and lives of Brazilians.

Vital Strategies is a global health organization present in more than 80 countries that works with governments and civil society to design and implement strategies and policies to tackle some of the world's biggest public health challenges. ACT Promoção da Saúde, a non-governmental organization, works to develop and defend public policies to combat chronic non-communicable diseases.