Opinion: Alcohol & Health, Overconsumption

Chinese Drinking Culture: Changing Norms Impact Public Health

Brewing alcohol in China dates back to the beginning of China’s 5,000-year history. Drinking alcohol was regarded as part of the elite culture. Only the upper class could consume alcohol regularly but they had to follow Confucian norms, which discouraged over consumption. The rest of the population could hardly afford alcohol, except for special situations, such as spring festival, wedding ceremonies and birthday parties.

Drinking behavior was often about more than just enjoying the alcoholic beverage itself. There was an old saying: “It is not a banquet without alcohol.” Alcohol was considered an important tool in social interaction and in traditional Chinese medicine, and it was often associated with the creation of works of art. For centuries, the general population admired drinking and longed to be associated with the elite class.

China’s economy has grown at an unbelievable rate in the past few decades, and so too has the production and consumption of alcohol. The prosperous economy has brought more social and economic activity. An increasing percentage of the population can afford to consume alcohol, and do so more regularly. But as Chinese culture has evolved and become influenced by other cultures, traditional Confucian norms have lost their impact with regard to imposing restrictions on drinking behavior.

Unlike in the West, heavy drinkers in China are older and, in many cases, drinking to advance their careers. People regale guests or important colleagues with alcohol to enhance the relationship, or they drink alcohol to promote business. In fact, some job advertisements are even known to list “good drinking capacity” as a required credential.

Research by the National Center for Chronic and Non-Communicable Disease Control and Prevention in China has found that 57 percent of male drinkers and 27 percent of female drinkers in China binge drink. The degrading social norms on drinking have already made trouble for public health practitioners, who try to control hazardous drinking. And the lack of regulations regarding access to alcohol often means people of any age can buy it. This cripples any effort to reduce the amount of heavy drinking, and public health agencies have been unable to do anything effective about it.

China needs to reverse this trend. We suggest persistently informing current and future generations about healthy drinking habits. No official drinking guidelines exist in China, so people do not know how to assess themselves for risk of alcoholism, nor how to determine what is low risk for them as an individual. As a first step, guidelines that describe the potential risks and benefits of drinking, and which outline self-assessment skills for identifying harmful or hazardous drinking, should be developed. If possible, the contents of these guidelines should be written into textbooks of elementary and secondary education. Mass media should then also take responsibility for guiding healthy drinking behavior.

Li Yichong, MPH, is an epidemiologist at the National Center for Chronic and Non-communicable Disease Control and Prevention, the People’s Republic of China. His research interests include alcohol epidemiology and modern survey methodology.

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