Tuesday, May 23, 2017

Alcohol in Mongolia

This is a challenging post to write, because it is a complex issue. I think the best way to handle this is to discuss the media and data before moving into the realm of personal experience.
Media evidence in the form of reports and studies is conflicting. The World Health Organization released its last report on alcohol in Mongolia in 2013. It found that, on average, adults ages 15+ consumed 6.9 liters of alcohol each year. 70% of these liters were in the form of spirits (vodka).  27% of the adult population reported heavy episodic drinking and 6.4% reported alcohol related disorders. Based on this data alone, Mongolia’s alcohol problem is significantly less than a number of countries including the US, Japan, Canada, South Korea, and Russia with a whopping 15.1 liters consumption per person.

This doesn’t seem so bad until you start looking between the lines. According to an NPR report from 2009, Mongolia had one store selling alcohol for every 270 people, thus leading the world in alcohol availability.  I can vouch for this, since you can purchase hard alcohol in almost every food store in our city, even small neighborhood shops. Prices for 750 ml of Vodka can range between $3-10 making it very affordable.

A second disturbing statistic is the rate of liver cancer deaths (63.2/100,000 people each year). This is twice as high as Mozambique, the runner up. There are a number of factors that can affect this rate, and alcohol may not be the primary cause, but there is generally a correlation between liver cancer and alcohol use.

In March of this year, a personal idol of mine, the Dalai Lama told John Oliver that he has been promoting the drinking of airag (fermented mare’s milk) in Mongolia as an alternative to hard liquor, thus leading to a decline in the rates of alcohol use in Mongolia. While it is true that airag has a much lower alcohol concentration, it is not as easy to come by in its off season. It is likely that the decrease in alcohol use in Mongolia over the past few decades is related to the economy improving until about 2013. Since the boom of 2013, the Mongolian economy has been getting weaker.

The data, aside from liver cancer and availability, is actually not too bad in comparison with a number of other countries including the US, but it is still a significant public health problem in Mongolia.

That captures the data. Now let’s tackle the issue from personal experience, alcohol is something that Sally and I have encountered a lot in our service. Often, teachers’ celebrations or social events involve drinking large amounts of alcohol usually in the form of shots of vodka. Drinking is such an important part of social events that it often seems disrespectful to refuse.  Mongolians love to toast and share a bottle of vodka with friends.

Over the course of my service, I have begun to recognize the signs of alcohol dependency among some of the men that I know, and wisdom has taught me to avoid drinking with them, because it would never end.  Service in Mongolia also means that you develop a lot of ways to avoid getting drunk at an event where the social pressure is to binge. These methods can be anything from tossing the shot over your shoulder to pretending to drink.

PC service in Mongolia means that you become accustom to being approached by drunks on the streets who are emboldened by their condition. Usually it is just harmless curiosity, but it is something that many volunteers deal with on a day-to-day basis. When I started my service, I would stop and have conversations out of respect for the older men, but now I don’t engage often to the point of quickly skipping around them before they can reach me to shake my hand.

Alcohol and the effects of alcohol are everywhere, even in the States, but in a culture where alcohol plays such a key role in important parties and events, it does seem like this is more of a public health issues than the data would suggest. Part of the reason is that there is a general lack of understanding of healthy drinking habits in Mongolia. If a bottle of vodka makes an appearance at a social event, then the entire bottle will be drunk. Usually there is another bottle hidden out of sight. The dangers of binging that has been drilled into the heads of American youth are not as widely discussed here, and moderation in drinking is not the norm among those that do drink.

In addition to poor drinking practices, the economy of Mongolia is not fairing as well as it did in 2013. The continual decline of the tugrik and issues with unemployment lead to an increase in dependence on alcohol.

However, the country recognizes that it has a problem with alcohol and a number of public incentives have been put into place to reduce drinking habits. Drunks are also viewed unfavorably in Mongolia, but there is still a woeful lack of treatment centers for people with addiction. A large percentage of the Mongolian population does not drink, and an additional percentage only drink in social settings. The issue is that these settings are often binge situations.

So to close out a delicate post, I would finish by saying that Mongolia is improving on this issue, but it is still a big enough part of society that PCVs in Mongolia will encounter alcohol issues on a regular basis.


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