Unrecorded alcohol: a threat to public health?

Abstract

Headlines such as this [1] appear in newspapers with certain regularity, more often than not referring to incidences and outbreaks in low-and middle-income parts of the world. These incendiary statements also often refer to death or fatal consequences through the usage of so-called 'unrecorded alcohol'. Unrecorded alcohol is a summary term for a number of categories not registered in the country where it was consumed. Four main categories can be distinguished (see [2], their Figure 1):i Illegally produced or smuggled alcohol products (including illegal homemade alcohol). ii Surrogate alcohol: non-beverage alcohol products not intended officially for human consumption, such as industrial alcohol, mouthwash or eau de cologne [3]. iii Alcohol products that are recorded, but not in the jurisdiction of consumption (e.g. cross-border shopping). iv Legal but unrecorded alcohol products (homemade or other).In 2000 30% of global alcohol consumption was estimated to be unrecorded [4,5], with a high proportion in low-income countries and in the former Soviet Union. These estimates, based usually upon expert opinion or surveys [6], carry substantial uncertainty [5][6][7] and have many open questions. Thus, the regional distribution of the four subcategories cannot be quantified. As most of the unrecorded alcohol consumption is in countries such as India, China, Brazil, Russia or in the African continent, category 3, including mainly cross-border shopping, is clearly not very relevant on a global level, but it may still constitute a sizeable portion in some parts of the world, such as the Nordic countries [8]. More important, however, are questions about whether there are substantial effects from unrecorded consumption on public health over and above the effect of ethanol alone. Table 1 shows an overview of potential components which could pose a public health threat, and the level of evidence. In considering this issue two main questions arise: (1) what is the evidence on causality for the links to health; and (2) what is the prevalence of additional harmful components in unrecorded alcohol around the world? POTENTIAL COMPONENTS OF UNRECORDED CONSUMPTION WHICH COULD POSE A PUBLIC HEALTH THREATTo date, neither of the questions has been answered conclusively. While it is beyond the scope of an editorial to review systematically the level of evidence by component, we will give some illustrations of the underlying problems using the example of a recent publication [9]. THE POLITICAL DIMENSION: THE INTERESTS OF THE ALCOHOL INDUSTRYGiven the global level of unrecorded consumption it is obvious that the alcohol industry, with the exception of cross-border trading or some minor categories, has a keen interest in its reduction. Thus, it is no surprise that the International Center for Alcohol Policies (ICAP), a notfor-profit organization funded by leading producers of beverage alcohol, has published repeatedly on unrecorded consumption and potential health problems [10]. In their most recent publication, Noncommercial Alcohol in Thr...

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