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The Dual Nature of Alcohol Use and Abuse in Mongolia: Reflections Through Policy

Authors:
  • UNICEF Mongolia

Abstract and Figures

Alcohol abuse has become recognized by numerous organizations in Mongolia as one of their primary public health challenges. Despite the crisis of alcohol abuse in Mongolia, the dominance of narcology in shaping the health system's response has allowed the alcohol industry to control the debate. The Mongolian population largely interprets the World Health Organization's (WHO) "standard drink" as a consumption guideline rather than a measure of abuse. In addition, the focus on high levels of dependence, as defined by narcology, has allowed the WHO to officially write off the problem, stating that less than 1% of the adult population can be categorized as "alcoholics." As the government focuses on new policy-based approaches to the issue, the rhetoric undermines participation and support, while the industry finds new ways to learn from narcology in their efforts to grow. However, by reinvesting profits from alcohol and a public health-focused approach, solutions can be found.
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... For example, a recent survey determined that only a third of restaurant owners knew about the policy. 13 Similarly, although there are regulations against the use and abuse of alcohol, 14,15 government spending on implementing the program remains very low. Some suggest that this is because 25% of the state budget comes from tax on alcohol sales. ...
... Some suggest that this is because 25% of the state budget comes from tax on alcohol sales. 15 Additional attempts have been made, but accountability is not clear. In December 2011, the president passed the "Together for Alcohol Free Mongolia" campaign, calling for a ban on alcoholic beverages at work-related celebrations and for civil servants to be involved in reducing alcohol consumption and following alcoholrelated regulations. ...
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Objectives: We tested the efficacy of a 6-session, evidence-based health promotion intervention aimed at reducing noncommunicable disease (NCD) risk behaviors. Methods: Two hundred male and female factory workers in Ulaanbaatar, Mongolia were randomly assigned to groups receiving either the health promotion intervention or a time-matched financial literacy control intervention. Results: The health promotion intervention increased daily fruit and vegetable intake and physical activity, increased readiness for NCD risk behavior reduction and health promotion knowledge, and reduced the number of daily alcoholic drinks and diabetes symptoms 3 months after the intervention. Conclusions: The findings support the efficacy of the intervention to reduce risk behaviors associated with NCDs. Dissemination of the intervention may improve productivity, reduce costs of health services, and better the quality of life for Mongolians.
... In 2011, WHO estimated that one in twenty Mongolian men had a diagnosable Alcohol-Use Disorder, while acknowledging that up to two-thirds of national alcohol consumption remains unrecorded a [1,8]. Alcohol has a strong presence in Mongolian culture, predating, but exacerbated by Soviet rule [10] . In rural regions , families have been making traditional Mongol Arkhi or fermented horse milk liquor for many generations – and continue to do so today. ...
... Contrasting the rural and urban settings, alcohol consumption was higher among urban dwellers, with up to twice as many drinkers as compared to the rural population. This finding could support previous research suggesting that high alcohol intake is linked to social and epidemiological transition processes, such as urbanisation [10]. It could be inferred that as Mongolians become wealthier, more urbanized and have continuous access to alcohol, consumption rises. ...
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Background Non-communicable diseases (NCDs) are now the leading causes of mortality in Mongolia, and diabetes, in particular, is a growing public health threat. Mongolia is a nation undergoing rapid and widespread epidemiological transition and urbanisation: a process that is expected to continue in coming decades and is likely to increase the diabetes burden. To better inform policy and public-health responses to the impact of the growth in NCDs, a national NCD Knowledge, Attitudes and Practices survey was implemented in Mongolia in 2010; a section of which focused on diabetes. Methods This survey was a nationally-representative, household-based questionnaire conducted by field-workers. Households were selected using a multi-stage, cluster sampling technique, with one participant (aged 15–64) selected from each of the 3540 households. Questions explored demographic and administrative parameters, as well as knowledge attitudes and practices around NCDs and their risk factors. Results This research suggests low levels of diabetes-related health knowledge in Mongolia. Up to fifty percent of Mongolian sub-populations, and one in five of the total population, had never heard the term diabetes prior to surveying. This research also highlights a high level of misunderstanding around the symptomatology and natural progression of diabetes; for example, one-third of Mongolians were unaware that the disease could be prevented through lifestyle changes. Further, this study suggests that a low proportion of Mongolians have received counseling or health education about diabetes, with lowest access to such services for the urban poor and least educated sub-populations. Conclusions This research suggests a low prevalence of diabetes-related health-knowledge among Mongolians. In this light, health-education should be part of any national strategy on diabetes.
... In 2011, WHO estimated that one in twenty Mongolian men had a diagnosable Alcohol-Use Disorder, while acknowledging that up to two-thirds of national alcohol consumption remains unrecorded a [1,8]. Alcohol has a strong presence in Mongolian culture, predating, but exacerbated by Soviet rule [10] . In rural regions , families have been making traditional Mongol Arkhi or fermented horse milk liquor for many generations – and continue to do so today. ...
... Contrasting the rural and urban settings, alcohol consumption was higher among urban dwellers, with up to twice as many drinkers as compared to the rural population. This finding could support previous research suggesting that high alcohol intake is linked to social and epidemiological transition processes, such as urbanisation [10]. It could be inferred that as Mongolians become wealthier, more urbanized and have continuous access to alcohol, consumption rises. ...
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Full-text available
Background The leading cause of mortality in Mongolia is Non-Communicable Disease. Alcohol is recognised by the World Health Organization as one of the four major disease drivers and so, in order to better understand and triangulate recent national burden-of-disease surveys and to inform policy responses to alcohol consumption in Mongolia, a national Knowledge, Attitudes and Practices survey was conducted. Focusing on Non-Communicable Diseases and their risk factors, this publication explores the alcohol-related findings of this national survey. Methods A door-to-door, household-based questionnaire was conducted on 3450 people from across Mongolia. Participants were recruited using a multi-stage random cluster sampling technique, and eligibility was granted to permanent residents of households who were aged between 15 and 64 years. A nationally representative sample size was calculated, based on methodologies aligned with the WHO STEPwise approach to Surveillance. Results Approximately 50% of males and 30% of females were found to be current drinkers of alcohol. Moreover, nine in ten respondents agreed that heavy episodic drinking of alcohol is common among Mongolians, and the harms of daily alcohol consumption were generally perceived to be high. Indeed, 90% of respondents regarded daily alcohol consumption as either ‘harmful’ or ‘very harmful’. Interestingly, morning drinking, suggestive of problematic drinking, was highest in rural men and was associated with lower-levels of education and unemployment. Conclusion This research suggests that Mongolia faces an epidemiological challenge in addressing the burden of alcohol use and related problems. Males, rural populations and those aged 25-34 years exhibited the highest levels of risky drinking practices, while urban populations exhibit higher levels of general alcohol consumption. These findings suggest a focus and context for public health measures addressing alcohol-related harm in Mongolia.
... Binge drinking can occur when men consume 5 or more drinks or women consume 4 or more drinks in about 2 h. (Alcoholism 2004) In Mongolia, the population aged 15 to 69 years consumes on average 9.3 standard drinks per social occasion, indicating that binge drinking is a key public health challenge in this country (Armstrong and Tsogtbaatar 2010). The prevalence of heavy episodic drinking was found to be 27.9% in men, 5.3% in women, and 16.4% in both genders overall, according to the 2016 national statistics (WHO 2018). ...
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This study aimed to explore the risk factors for alcohol use during pregnancy in Mongolia, wherein high-risk alcohol use is prevalent. We analyzed nationwide data from the Gender-Based Violence (GBV) Survey of Mongolia conducted in 2017. We conducted an analysis restricted to 2714 women who had given birth within 5 years of the survey and who had responded to questions about their health-related behaviors during pregnancy. We assessed the association between alcohol use during pregnancy and pregnancy-related factors, including maternal age, educational attainment, history of abortion, smoking during pregnancy, unintended pregnancy, prior experience of sexual and physical violence, physical violence during pregnancy, and current binge drinking while also considering their residential region. Alcohol use during pregnancy was reported in 5.4% of the participating women. Unintended pregnancy for women (OR = 1.95, 95% confidence interval [CI]: 1.60, 2.38), abortion history (1.89, 95% CI: 1.60, 2.24), smoking during pregnancy (8.30, 95% CI: 6.60, 10.43), physical violence during pregnancy (2.22, 95% CI: 1.75, 2.81), and being a binge drinker (6.05, 95% CI: 3.63, 10.10) were associated with higher odds of alcohol use during pregnancy. Associations with maternal age, marital status, higher education, or multiparity were not evident. Our finding provides knowledge of risk factors for alcohol drinking among pregnant women and evidence for another harm of gender-based violence. This would contribute to the development of effective strategies for preventing antenatal exposure to alcohol in Mongolia.
... In the previous decade, Mongolia's alcohol sector has grown at an unprecedented rate. The affordability and broad availability of alcohol, a favorable sales environment, strong brand marketing, and its influence on public attitude about alcohol may all contribute to Mongolia's high prevalence of alcoholism [24]. Therefore, multisectoral cooperation will be essential to tackle alcoholism; efforts could include enforcement of alcoholism prevention laws, policy regulation of the alcohol market (increasing the excise tax on alcohol, improving the implementation and enforcement of the law against alcoholism), promotion of public movements aimed at reducing alcohol consumption, abating underlying causes of heavy alcoholism, i.e., unemployment and poverty, and education of children about excessive alcohol use and health risks. ...
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Background Over the past few decades, economic, political, and social changes have directly and indirectly affected the health of the Mongolian population. To date, no comprehensive analysis has been conducted on the burden of diseases in this country. Thus, we aimed to describe the leading causes of death and disabling conditions and their trends between 1990 and 2019 in the Mongolian population. Methods We used the data from the Global Burden of Disease (GBD) 2019 study. In the current study, we examined life expectancy at birth, healthy life expectancy, the 20 leading causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted-life-years (DALYs), and the contribution of major risk factors to DALYs in Mongolia. Findings The life expectancy at birth in Mongolia has gradually increased since 1995 and reached 63.8 years for men and 72.7 for women in 2019. The highest increase in the age-standardised death rate between 1990 and 2019 occurred in alcohol use disorders (628.6%; 95% UI 10.0–1109.6) among men, and in liver cancer (129.1%; UI 65.3–222.4) among women. Ischaemic heart disease and stroke showed the highest rates of death, YLLs, and DALYs among both men and women. In 2019, the highest age-standardised rates of DALYs were attributable to high systolic blood pressure and dietary risks. Interpretation Although Mongolia saw substantial improvements across many communicable diseases, maternal and neonatal disorders, and under-5 mortality between 1990 and 2019, non-communicable diseases remained leading causes of mortality. The mortality from the most preventable causes such as injury, alcohol use, and dietary risks remain substantially high, suggesting that individual and social efforts are needed to tackle these diseases. Our analyses will support the development of policy priorities and action plans in multiple sectors to improve the overall health of the Mongolian population. Funding Bill & Melinda Gates Foundation.
... According to Article 5.3 of the Law on Anti-Alcoholism in Mongolia, alcohol labels on bottles, packages, and parcels must contain the trademark, brand name, national standard, composition, alcohol content, type, manufacturing place and date, a health warning, and standard concentration. 29 In most countries, labels of alcoholic beverages include warning messages such as "excessive consumption of alcohol is harmful to health" (most South American countries), "not to be sold to anyone under the drinking age", or "not for sale to persons under the age of 18 years". 30 Among countries that have implemented programs to reduce alcohol use and alcoholrelated harm, Belarus and Peru appear to be highly successful. ...
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Background: This study aimed to examine alcohol consumption among Mongolian adolescents and youth, as well as their awareness and attitudes toward alcohol-related consequences. Methods: We analyzed cross-sectional data collected from students in secondary schools, colleges, and universities in Ulaanbaatar, Mongolia, using descriptive analysis methods. Findings: More than half of respondents had tried alcohol in the past, and 15.9% of high school students and 58.8% of university students had consumed alcohol in the last month (P = 0.0001). In total, 70.0% of respondents celebrated holidays with alcohol, 23.4% had economic problems due to alcohol consumption, 7.8% had health problems 1-2 times in the last 30 days, and roughly 36.0% had negative attitudes toward alcohol. Approximately, 15.0% of adolescents and young people had an insufficient understanding of anti-alcohol measures and laws. Conclusion: Our findings suggest that Mongolian adolescents and youth have a high level of alcohol consumption and insufficient awareness and attitude regarding alcohol-related harm.
... 18,19,26 High alcohol consumption and alcohol abuse with its related problems is the one of the primary public health challenges in the country today. 27 The diagnosis of liver cancer in Mongolia is poor due to a shortage of liver pathologists, radiologists and skilled technicians, as well as a low number of highquality ultrasonography machines. 19 Even for those who are diagnosed, current treatment options are very limited and expensive, largely relying on out-of-pocket payments due to insufficient government funding. ...
Article
Mongolia has a high burden from noncommunicable diseases, with cancer now the second leading cause of mortality. Given the paucity of situation analyses from the country, this study reports cancer data based on new cases 2008-12 from the National Cancer Registry of Mongolia covering the entire population (2.87 million). 21 564 new cancer cases were diagnosed over the 5-year period, with a slight predominance of cases (52%) in men. Liver cancer was the leading cancer site in both sexes (ASRs of 114.7 and 74.6 per 100 000 males and females), and responsible for almost two-fifths of all cancer diagnoses, followed by cancers of stomach, lung and oesophagus in men, and cervix, stomach and oesophagus in women. The cumulative risk of incidence for all cancers (27.7% and 20.8% in men and women, respectively) positions Mongolia above China (20.2% and 13.3%), below the U.S. (34.1% and 28.5%) and similar to Russia (26.1% and 19.1%). These figures shed light on the considerable magnitude of cancer in the country and the large fraction of cancers that can be prevented by lifestyle modifications and vaccine implementation. An expansion of activities of the cancer registry and the continued development of research are necessary steps in support of national cancer control planning in Mongolia. This article is protected by copyright. All rights reserved.
... Mongolia is known internationally for high levels of alcohol consumption among men. 15 Women traditionally disapprove of male drinking, since they are often the victims of its negative consequences, 16 which may explain why so few women in our study consume alcohol or, possibly, why they were less likely to report it. The STEPS Survey conducted 5 years before our data collection found that 57%, or over twice the percentage in our study, reported consuming alcohol in the past year. ...
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Mongolia has experienced vast migration from rural to urban areas since the 1950s. We hypothesized that women migrating to Ulaanbaatar, the capital, would differ in factors related to future chronic disease risk compared with women who were born in Ulaanbaatar. Premenopausal mothers (aged <44 years) of children attending two schools (one in the city centre and one in the outskirts) in Ulaanbaatar were recruited for the study. During April and May 2009, 420 women were interviewed about migration, reproductive history and lifestyle factors and anthropometric measurements were taken. Women born in (n = 178) and outside (n = 242) Ulaanbaatar were similar in education and marital status, but the latter appeared to have a more traditional lifestyle including being more likely to have lived as a nomadic herder (22.3% vs 5.6%; p<0.001) and to currently live in a traditional yurt or ger (40.1% vs 29.2%). Ever-use of hormonal contraception was more common in women born outside Ulaanbaatar (52.1% vs 38.2%; p = 0.005) and their age at first live birth was older (26.0% vs 20.8% for ≥25 vs <25 years). Although the number of pregnancies was similar, the number of live births was greater for those born outside Ulaanbaatar (p = 0.002). Women born in Ulaanbaatar were more likely to have smoked cigarettes (24.7% vs 11.2%; p<0.001). Women born outside Ulaanbaatar were more likely to consume the traditional meat and dairy diet. Rural migrants to Mongolia's capital have retained a traditional lifestyle in some, but not all, respects. Internal migrant populations may provide the opportunity to assess the effect of changes in isolated risk factors for subsequent chronic disease.
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Christianity has had a long and often turbulent history in Mongolia. When socialism crumbled finally, in 1990, there were no more than 20 Christians in the whole nation. Today, there are up to 100,000 adherents, 90 per cent of whom are Protestant evangelical. Prominent Mongolian Christian leader, Purevdorj Jamsran, suggests that there are three distinct periods in this development: formation (1991–1995); growth and transition (1996–2005); and identity (2006–present). Through analysing primary and secondary materials, conducting three field trips to gather oral interviews and using a Pentecostal case study, I explore these three periods. I argue that Protestant evangelicalism exploded onto the scene assisted by political upheaval, international allure, youthful enthusiasm and the use of mass media. Growth and transition progressed via contextualisation, ecumenical unity and community engagement. Finally, a sense of identity was established through accelerated maturation processes.
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