title: Alcohol and public health in Africa: can we prevent alcohol-related harm from increasing?
abstract: OBJECTIVE
  According to the World Health Organization (WHO), the total amount of alcohol consumed in the African region is expected to increase due to the growth of new alcohol consumers, especially young people and women. With the changing alcohol environment, increases in the alcohol-attributable burden of disease are inevitable. To our knowledge, there has not been a comprehensive analysis of the factors that could be driving those increases. The objective of this study was to examine the evidence from peer reviewed literature regarding the factors that could be instrumental in this process, in order to inform strategic policy-related decisions.
  
  
  METHODS
  A narrative review was conducted using a thematic analysis approach. We searched papers published between January 2000 and July 2014 in PubMed, the WHO's Global Health Library and African Journals Online.
  
  
  RESULTS
  Our analysis identified seven factors (demographics, rapid urbanization, economic development, increased availability, corporate targeting, weak policy infrastructure and trade agreements) which are potentially tied to changes in alcohol consumption in Africa. Driven largely by globalization, a potential convergence of these various factors is likely to be associated with continued growth in alcohol consumption and alcohol-related morbidity and mortality.
  
  
  CONCLUSIONS
  To address the emerging risk factors associated with increased alcohol consumption, African governments need to take a more active role in protecting the public's health. In particular, important strategic shifts are needed to increase implementation of intersectoral strategies, community involvement in the policy dialogue, health services re-orientation and better regulation of the alcohol beverage industry.
authors.affiliation: Instituto de Higiene e Medica Tropical & GHTM, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Carina
authors.initials: C
authors.lastname: Ferreira-Borges
authors.affiliation: Instituto de Higiene e Medica Tropical & GHTM, Universidade Nova de Lisboa, Lisboa, Portugal.
authors.forename: Sonia
authors.initials: S
authors.lastname: Dias
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Babor
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Marissa B
authors.initials: MB
authors.lastname: Esser
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.|Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
authors.forename: Charles D H
authors.initials: CD
authors.lastname: Parry
mesh_terms: D000349:Africa / Q000453:epidemiology; D000428:Alcohol Drinking / Q000191:economics / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000517:prevention & control*; D003132:Commerce / Q000191:economics; D017281:Cost of Illness; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D011634:Public Health / Q000379:methods*; D012307:Risk Factors
keywords: Africa; alcohol availability; alcohol consumption; alcohol policies; alcohol problems; economic development; emerging markets