How Unregulated Alcohol Harms Public Health In Uganda

Jinja, Uganda, draws tourists who want to see the reputed source of the Nile River, and thrill-seekers looking for white-water rafting, four-wheeling and other adventure sports.

But just outside this town surrounded by lush green hills lies a sprawling, open-air alcohol distilling operation that most visitors will never see.

Monica Swahn, a professor at the School of Public Health, recently led a group of study abroad students past vats of bubbling brown liquid, sludgy runoff, enormous piles of firewood and rusted metal drums producing moonshine destined for sale in the slums of the capital city of Kampala.



“It was several years ago that I was there my very first time,” Swahn says of the distillery. “It’s just something I don’t think anybody can prepare you for in words… It’s so sad. The smells are so strong.

Men chop wood and tend the fires, many wearing rubber work boots to protect their feet from toxic runoff. Many woman also work at the illegal distillery, and children, many of them barefoot, run in and around the operations, breathing fumes and sometimes getting burned on hot barrels. Workers report that equipment explodes about once a month, often causing severe injury to people who don’t have money for medical treatment.

To Swahn, this operation is a microcosm of the harm that alcohol abuse is causing in the East African nation of Uganda, where unregulated production and unfettered marketing feed one of the highest rates of alcohol consumption in the world. Uganda has one of the youngest populations on Earth and high rates of HIV/AIDS. Direct marketing (including free samples) and sales of alcohol to underage youth is not uncommon. Some legal operators package high-proof alcohol in small plastic bags, creating more affordable portions for sale to the poor.

Swahn has traveled to Uganda regularly since 2011 to conduct research into alcohol marketing and its relationship to gender-based violence, unsafe sex and HIV/AIDS transmission. In May, she co-led a study abroad program focused on those public health challenges.

Dr. Monica Swahn

Dr. Monica Swahn

She wanted the group of masters and Ph.D. students to see first-hand the challenges of trying to address complex public health problems that are compounded by poverty and the limited resources in a developing country. Walking carefully across makeshift bridges at the distillery, eyes stinging from the fumes, she noted that the operation had grown by 25 to 30 percent in size since she last visited.

In Uganda, alcohol abuse is generally viewed as an individual’s problem, a character flaw. But slowly, researchers are taking interest in how it affects public health. Government leaders are just starting to consider how it hinders economic development.

Swahn was recently selected for a Fulbright Fellowship that will allow her to continue her work through 2018. Makerere University in Kampala will host Swahn, and she will assist the School of Public Health there in the creation of a research center focused on alcohol and drug abuse issues.

Conducting locally-based research, and improving coordination between researchers, local government agencies, and non-governmental agencies will take time. But the approach holds promise. After all, in the U.S., it took years for society to view alcohol abuse as a treatable illness and a public health concern.

“There’s hope,” Swahn says.

Video and story by Anna Varela.