The States of Delhi, Karnataka, Haryana, Punjab, Tamil Nadu, Goa, and Kerala are or were mulling plans to allow the doorstep delivery of alcohol through platforms like Swiggy, BigBasket, and Zomato.
India has seen a steady rise in alcohol consumption. The recorded per capita consumption has increased from 1.6 litres in 2003-2005 to 2.2 litres in 2010, then to 5.5 litres in 2016-2018. With $52 billion in revenue, India is the sixth-largest alcohol market worldwide. According to a Ministry of Social Justice and Empowerment survey in 2019, there were about 16 crore alcohol users in India in the 10-75 year age group in 2018. About 5.7 crore frequently consumed alcohol leading to social or interpersonal problems and 2.9 crore were dependent users requiring therapeutic intervention.
Medically, the safe limit for alcohol consumption is zero millilitres. Alcohol use causes 3 lakh deaths in India every year.
Why doorstep delivery?
There are two main arguments in favour of doorstep delivery of alcohol. First, the excise taxes on alcohol sales can help generate revenue for Central and State governments. This in turn can be used for the public good.
Across States, taxes on alcohol sales can contribute up to a quarter of all revenue generated for governments.
Second, doorstep delivery can help reduce drunk-driving incidents and prevent road traffic crashes and injuries. In India, 6-48% of fatal road traffic fatalities are due to alcohol use. Reducing them is thus crucial.
A third argument is that doorstep deliveries may not threaten the safety of women consumers. There is some evidence from Kerala that shutting bars selling hard liquor reduced on-premise violence against women. Doorstep delivery options might have a similar effect, especially for women who live alone or with other women.
However, this argument is on a slippery slope: for the majority of India’s women, safety cannot be presumed because domestic violence related to alcohol use is rampant. So while doorstep delivery will help women access alcohol without having to deal with social stigma — a possible advantage in itself — whether it could reduce violence against them is suspect.
Arguments against doorstep delivery
Studies to date agree that for India, the costs due to alcohol use exceed economic benefits from alcohol sales.
Second, schemes with doorstep delivery of alcohol assume people will change their drinking and socialising behaviours in response to the new option. It is reasonable but requires concrete evidence. There is some evidence that the availability of alcohol on-demand can increase consumption, promote binge drinking, and lead to harms related to alcohol use.
Similarly, it is not straightforward to assume doorstep alcohol delivery can reduce drunk-driving. There are several other, evidence-based policies that can help deal with that issue as well, including sobriety checkpoints, stringent penalties for repeat offenders, capping drinks offered to people at bars, and increasing availability of public transport and other ride-share options.
Effects of alcohol consumption
Alcohol is a carcinogen and causes at least seven types of cancers through DNA damage and other pathways. Alcohol consumption also increases the risk of injuries, abuse of other substances, mental illnesses (including severe depression), fatal and non-fatal self-harm, diabetes mellitus, liver disease, diseases of the heart and blood vessels, and chronic kidney diseases. Along with health implications for the user, male alcohol misuse also increases the risk and severity of inter-partner violence.
Treatment of diseases and injuries due to alcohol consumption are expected to cost India more than Rs 3 lakh crore between 2011 and 2050. Adding productivity losses raises this to Rs 121.3 lakh crore. The revenue to governments from excise taxes will be only one-fifth of the financial losses.
Worldwide, the alcohol industry is known for intense lobbying including efforts worldwide to weaken health warning labels. The alcohol industry views LMICs as emerging markets. In India, the industry has been known to advocate against alcohol use reduction policies despite evidence of the policy’s effectiveness.
What can governments do?
Except for some national policies — including drunk driving laws and health warning labels — alcohol-use policies have been delegated to States, resulting in wide variation in policy framing and implementation. Doorstep delivery may also undermine the strategy to restrict alcohol availability as a way to mitigate alcohol-use harm. States will need to rethink and implement marketing and pricing policies for delivery platforms as a result.
The instruments available to State and Central governments allow them to mitigate harms due to alcohol use through cross-sectoral public health approaches. They include restricting the availability and marketing of alcohol, higher taxes, enforcement of drunk-driving laws, and higher investment in cost-beneficial psychosocial treatments of alcohol-use disorders.
So if doorstep delivery is to be offered, for example, States can change the trade-off for consumers from whether they should order in to whether they should drink at all — which they can achieve by setting higher prices and taxes. The revenue to the government from taxes could also be earmarked for government initiatives to care for those with mental health and substance-use issues.
In tandem, governments should work with their health departments and other organisations to monitor and evaluate the impact of doorstep delivery on alcohol consumption. Companies offering these services must share accurate data with the government to understand the health and economic burden impacts. The decision should be revised if the harms are evident.
Central and State governments need to rethink their approach to alcohol use. More uniform policy standards and better implementation grounded in public health over revenue generation are necessary.
Vid Karmarkar is the founder and CEO of Canseva Foundation. Parth Sharma is a community physician, researcher, and founding editor of Nivarana.org. Siddhesh Zadey is a co-founder of the nonprofit Association for Socially Applicable Research (ASAR) and a doctoral student in epidemiology at Columbia University.
