Indigenous populations around the world — whether Native Americans, Australian Aboriginals, or the basarwa of Southern Africa — are often considered to be at particular risk for harm from alcohol misuse. Heavy and abusive drinking patterns have been described among indigenous groups, and their impact in terms of harmful outcomes is particularly high.
Native Americans, for example, are reportedly five times more likely than other groups to die from alcohol-related causes including liver disease and road traffic crashes. In Alaska, fetal alcohol syndrome is found in 5.6 of every 1,000 live births among Native populations, compared with 1.5 per 1,000 live births in the US, overall.
Similarly, in Australia, the rate of health and social problems among Aboriginals is twice that among non-indigenous groups. Although, in reality, Aboriginals are more likely to abstain from drinking than other groups, among those who drink, rates of risky consumption are almost double those for non-Aboriginals.
Various explanations have been offered for the high impact of alcohol misuse and abuse on indigenous groups. Social exclusion and marginalization are important risk factors for poor health, as well as alcohol misuse. Indigenous people often live outside the mainstream of society, in poverty and without access to adequate health care and disease prevention. It has also been suggested that heavy drinking may be a mechanism for coping with stressors like unemployment, powerlessness, or low self-esteem.
Given the unique position of many indigenous groups in society, prevention requires a tailored approach. Education for young people that emphasize life skills and self esteem has shown promise in preventing later problems. Interventions that are integrated into general health services have also been applied, for example, screening for alcohol problems within general pre-natal care. Research also suggests that prevention and treatment that is sensitive to and respectful of indigenous culture may be a particularly useful approach.
Marjana Martinic works for the International Alliance for Responsible Drinking (IARD). Her work focuses on the development of policy approaches at the global, regional and national levels. She currently serves as scientific advisor to the European Commission, as part of the Alcohol and Health Forumâ€™s Science Group.