Alcohol consumption in India: A rising burden and a fractured response

Abstract

Issues To review the burden of alcohol use in India, examine current policy initiatives and programs specific to India and provide a roadmap for future actions. Approach A literature search was undertaken to review available published research papers, unpublished reports and anecdotal media information in the period 2000–2020 to assess the burden and pattern of alcohol use and appraise alcohol control policies in India. Key Findings The per‐capita alcohol consumption among individuals aged 15+ years was 5.7 L, which increased over time. Prevalence of alcohol use varied across states with considerable impact on the nation. Regulatory policies and alcohol control programs vary across Indian states, with poor enforcement and implementation. Taxation and pricing policies are revenue oriented. Policies are needed to address the aggressive and innovative marketing strategies of the alcohol industry. The system for regular monitoring of alcohol burden and conducting alcohol policy analysis needs strengthening. Implications Alcohol use and its public health impact would continue to increase in India in the absence of effective policy and programs; the country may not achieve its stated goal of relative reduction of alcohol use prevalence by 10% by 2025. Conclusion The prevailing alcohol control policies and programs in India have been less than fully effective in controlling the burden of alcohol use and its associated impact. There is a need for comprehensive, evidence‐based and consensus‐driven national alcohol control policy to appropriately guide and support the Indian states in regulating alcohol and reducing the associated burden. Effective implementations of such policies are central to its success.

Heterogeneity in trends of alcohol use around the world: Do policies make a difference?

“…• Asian countries and regions show increases in GDP purchasing power parity per capita from 1990 onwards; these are most pronounced in China, which started with the lowest GDP (see Figure 1). In China [10], India [2,10] and the Southeast Asian Region [6,10], alcohol use per capita showed similarly increasing trends. • Sub-Saharan Africa changed the least in terms of wealth and in terms of average alcohol use [4].…”

“…In keeping with the economic theory cited above, the trends of GDP in this figure parallel the trends in alcohol use described in the papers (see Figure 2), albeit with some important differences: Asian countries and regions show increases in GDP purchasing power parity per capita from 1990 onwards; these are most pronounced in China, which started with the lowest GDP (see Figure 1). In China [10], India [2,10] and the Southeast Asian Region [6,10], alcohol use per capita showed similarly increasing trends. Sub‐Saharan Africa changed the least in terms of wealth and in terms of average alcohol use [4]. In Latin America and the Caribbean, after a marked increase in the 1990s, wealth has been stagnating since 2015 and this has been mirrored by a slight decline in alcohol use [3].…”

“…However, there were large differences within regions or within many countries. Let us give a few examples: Gururaj and colleagues [2] report on three regions in India where less than 2.5% of the population are drinkers but also on two regions in which more than every third person consumes alcohol (Chhattisgarh, Tripura). Similarly, in Latin America and Africa, we find countries where very little alcohol is consumed and countries in which consumption is more than 50% above the global average [3,4].…”

“…In India, except for some changes during the COVID‐19 pandemic, which seem to be mainly driven by revenue generation purposes rather than public health considerations [2], regulatory policies and alcohol control programs have not been effective in slowing down the trend of increasing use across the country [but note the large variations across states/territories detailed above; 2]. Gururaj and his co‐authors also state that policies are needed to address the aggressive and innovative marketing strategies of the alcohol industry in India [2]. There are marked differences between Indian states (the key level of government for alcohol control), partly based on the implementation of different policies between the states.…”

“…In this issue of Drug and Alcohol Review, in a section entitled 'Alcohol trends and policies in the wider worldbeyond a Eurocentric view', four overview papers are presented [1][2][3][4], which describe regional trends in alcohol use, attributable harm and policy. These papers are part of an effort to expand the base of epidemiological data and policy experience beyond the high-income countries so that other areas of the world are represented.…”