São Paulo, November 5, 2024 – Consumption of alcohol cost Brazil R$ 18.8 billion in 2019, according to a new study, “Estimation of Direct and Indirect Costs Attributable to Alcohol Consumption in Brazil“, commissioned by Vital Strategies, a global health organization that leads the RESET Alcohol initiative.
Of this total, R$ 1.1 billion is direct federal costs which include hospitalization and outpatient procedures to the Unified Health System (SUS). The indirect costs attributable to alcohol consumption, comprised R$ 17.7 billion and include productivity losses due to premature mortality and early retirement due to diseases associated with alcohol consumption, as well as loss of workdays due to hospitalizations and medical leaves covered by Social Security.
The costs to Social Security alone reached R$ 47.2 million in 2019, of which 78% (R$ 37 million) was spent on the male population, and 22% was spent on the female population (R$ 10.2 million).
The report was based on estimates of alcohol-attributable deaths by the World Health Organization and accounted for a total of 105 thousand deaths in 2019 in Brazil, resulting in an average of 12 deaths per hour.
Men are the main victims and represented 86% of deaths, of which almost half were due to cardiovascular diseases, accidents and violence. The 14% of deaths in women were related to cardiovascular diseases and cancer in more than 60% of the cases.
The study, commissioned by Vital Strategies, was carried out by researcher Eduardo Nilson, from the Oswaldo Cruz Foundation (Fiocruz), the Center for Epidemiological Research in Nutrition and Health of the University of São Paulo (Nupens/USP) and the Autonomous University of Chile.
“We can conclude from the study that alcohol use in Brazil has significant impacts on the health and well-being of the population and is, consequently, very costly to public finances. The need to adopt proven measures such as the selective tax on alcoholic beverages is clear. It is one of the measures recommended by the World Health Organization to reduce alcohol consumption and its negative impact. By reducing consumption, we can save lives and reduce the social impacts of alcohol, saving billions of reais every year,” said Pedro de Paula, Executive Director of Vital Strategies in Brazil.
The cost to SUS generated by the hospitalization of women for problems due to alcohol use represent 20% of the total, much lower than the costs for the male population. This is due to a lower prevalence of alcohol consumption in women, according to the National Health Survey (PNS 2019). The survey found about 31% of women interviewed reported having consumed alcohol in the 30 days prior to the survey, compared with 63% of men.
Another reason for the discrepancy is that women seek health services and perform self-care, such as routine check-ups, sooner and more often than men. This means that women are 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 hospitalization,” says Eduardo Nilson.
When it comes to costs related to laboratory 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 laboratory care costs, even though the prevalence of alcohol consumption is lower among them,” explains Nilson. Regarding the age group, the highest incidence in outpatient care occurs in people between 40 and 60 years old, with 55% of the costs among women and 47.1%, among men.
Although currently the highest costs arising from alcohol consumption are related to men, who have historically consumed more, Vigitel data shows that, between 2006 and 2023, the occurrence of episodes of binge drinking (four or more drinks on the same occasion for women) almost doubled.
The upward trend in consumption among girls 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 behavior brings a warning sign for an increase in the amount of alcohol users in Brazil in general and also for its impacts on health and costs to public finances. A very careful look at the female population is necessary to curb this growth driven by cultural changes and the alcohol industry’s own efforts to make its products more unisex in appeal,” said Luciana Sardinha, Deputy Director of Chronic Noncommunicable Diseases at Vital Strategies.
Indirect Costs
When it comes to indirect costs, the study shows that there is also a bigger impact on the male population.
The indirect economic impacts of alcohol use are vast and multifaceted. Eduardo Nilson, from FioCruz, pointed outthat there are significant implications on productivity and the workforce, resulting in absenteeism, presenteeism (when a worker attends work but has a drop in productivity), work accidents and preventable premature deaths. In addition, the intake of alcohol is associated with an increase in criminal behavior, including domestic violence, crimes, such as assault, and traffic crashes.
Methodology
The “Estimation of direct and indirect costs attributable to alcohol consumption in Brazil” report was based on a comparative risk analysis methodology that estimates the fractions attributable to an exposure (risk or protective factor) in relation to health outcomes directly caused by this exposure.
Diseases and deaths associated with alcohol consumption with a dose-response relationship between the amount of alcohol consumed and the relative risk of outcomes (extracted from meta-analyses published and used by the Global Burden of Disease (GBD) study and the World Health Organization) were considered. Alongside the prevalence of alcohol consumption for each sex and age group, the attributable burden for each disease, according to alcohol consumption range, was estimated and subsequently applied to the costs per disease.
Information on direct costs was obtained from public databases such as health information systems and reports and microdata from population surveys conducted by the Brazilian Institute of Geography and Statistics (IBGE). Direct costs attributable to alcohol consumption included SUS information obtained from data on hospitalizations (Hospital Information System – SIH/SUS) and outpatient procedures (Outpatient Information System – SIA/SUS), disaggregated by type of disease attributable to alcohol consumption, sex and age.
“It is important to note that the study adopted a conservative approach, since it is based exclusively on official data from public sources, such as SUS and IBGE data from population surveys, and was conducted at the federal level, considering federal expenditures and not including complements of costs by states and municipalities. The report also does not consider the costs of private health services. Therefore, although almost 19 billion reais per year is already an extremely significant figure, the real cost of alcohol consumption for Brazilian society is probably still much higher,” says Pedro de Paula, from Vital Strategies.
About Vital Strategies
Vital Strategies is a global health organization operating in more than 80 countries which works with governments and civil society to design and implement strategies and policies to address some of the world’s greatest public health challenges. Vital Strategies supports the design and implementation of evidence-based policies and practices to achieve significant impacts in combating alcohol consumption, chronic noncommunicable diseases, epidemics, gender-based violence, traffic injuries and other causes of illness, injury and death. The organization has offices in New York, São Paulo, Addis Ababa, Singapore, Jinan, New Delhi and Paris.
About ACT Promoção da Saúde
ACT Promoção da Saúde, a non-governmental organization, works to develop and advocate for public policies that combat chronic noncommunicable diseases. In this sense, it specifically supports tobacco and alcohol control, healthy eating and physical activity through advocacy actions, such as political advocacy, communication, mobilization, contact networks and research, among others.
RESET Alcohol – RESET Alcohol brings together governments, civil society, research organizations and global leaders in public health and alcohol policy to develop and implement evidence-based alcohol policies including raising taxes, regulating availability and restricting marketing. The initiative is led by Vital Strategies in collaboration with national partners in countries where RESET operates (in Brazil, ACT Promoção da Saúde and Universidade Católica de Brasília – UCB) and global technical partners that include the World Health Organization (WHO), Johns Hopkins University Tobacconomics Team, Global Alcohol Policy Alliance (GAPA), and Movendi International.
More information
Analítica Comunicação – Communication consultancy at Vital Strategies
Gabriela Scheinberg – gabi.scheinberg@analitica.inf.br – (11) 98111-9294
Raíza Dias – raiza.dias@analitica.inf.br – (11) 95272-3944
Wilma Loures – wilma.loures@analitica.inf.br – (11) 96324-6565
Mauricio Esposito – mauricio.esposito@analitica.inf.br – (11) 99915-7583
Erica Benute – erica.benute@analitica.inf.br – (11) 99185-7078