- Indian women are more aligned with home-brewed alcohol
- Emerged as a great health challenge
- Alcohol may increase the risk of cancer and coronary heart disease
- Unrecorded and Surrogate alcohol are most hazardous
Alcohol consumption has been rising steadily in India and has emerged as a leading public health challenge. According to the most recent estimates alcohol consumption accounts for 3.5% of the deaths in India in 2015 (IHME, 2015). Per capita alcohol consumption is very high among drinkers, indicating a greater prevalence of high-frequency and high-volume drinking pattern among drinkers. India ranks first in the WHO South East Asia region for total per capita consumption of pure alcohol among drinkers. Drinkers consumed on average 28.7 L of pure alcohol per capita per year in India, while drinkers in Australia, USA, and Germany consumed approximately 15 L of pure alcohol per year.
A study conducted by Kaushalendra Kumar, Santosh Kumar and Anil Kumar Singh drew data from five Indian states to estimate the prevalence of alcohol consumption and further explore the socio-demographic factors associated with alcohol consumption. Primary data was collected by Morsel Research and Development Private Limited and funded by International Alliance for Responsible Drinking (IARD).
The household survey findings revealed that around two-fifths (38.6%) of respondents were current drinkers, with 35.4% in the rural areas and 44.5% in the urban areas. The percentage of adults consuming alcohol daily or almost daily was 9.6%, which was 7.6% in rural area and 13.4% in the urban area. More than one-fifth (21.7%) of current drinkers were heavy drinkers, and prevalence of heavy drinking increased with age and. One-tenth of the current drinkers were heavy episodic drinkers in urban areas compared with only 6.9% in rural areas.
Results showed that age, gender, education, income, caste, and rural residence were significantly associated with alcohol consumption. There was a significant education and income gradient in alcohol consumption. Drinkers with higher education were more likely to consume recorded alcohol but less likely to consume country liquor and home-brewed alcohol compared to less educated drinkers. Higher income was positively associated with consumption of recorded alcohol and country liquor but negatively associated with consumption of home-brewed alcoholic beverages.
The above graphs reveal the drinkers’ status and beverages’ type by gender of the respondents. Compared to males, females were less likely to be current or daily drinkers. Only 1.2% of the female respondents were identified as daily drinkers. Among current drinkers, females were more likely to be heavy drinkers (22.8%) than males (10.9%). In terms of beverage type, male drinkers were more likely to consume distilled spirits (48.2%) and country liquor (32.2%) than female drinkers. Homebrewed alcoholic beverages were common among female drinkers (61.8%) than male drinkers (26.1%). Consumption o homebrewed wine was six times more prevalent among female drinkers (20%) than male drinkers (3.4%).
The WHO too reported approximately 15 L of pure alcohol was consumed per year by Indians. Male alcohol consumers were more likely to be high-volume drinkers than female consumers (32.1 L vs. 10.6 L) in India. Preference for hard liquors and distilled spirits were reported to be the main contributor to such high consumption levels of pure alcohol among Indian drinkers. Distilled spirits, which have the highest alcohol by volume, accounted for more than 90% of the alcoholic beverages consumed in India. Furthermore, higher levels of alcohol consumption may increase the risk of non-communicable diseases such as cancer, coronary heart disease, and intentional injuries. The health risk attributed to increasing prevalence of alcohol.
Unrecorded Alcohol Consumption
Alcohol produced outside the formal channel of the government system is termed as unrecorded alcohol. However, the WHO 2014 report on alcohol and health, which is recognized as the best available estimate, found that share of unrecorded alcohol could be as high as 50% in India. Country liquor industrially produced illicit alcohol, and home-brewed alcohol are the most common categories of unrecorded alcohol in India. Compared to recorded alcohol consumption, data on unrecorded alcohol are not easily available and are harder to obtain because they are not part of the formal tax or sales system. Furthermore, the majority of the countries do not gather information on consumption of unrecorded alcohol and therefore estimates of unrecorded alcohol consumption.
The widespread availability of unrecorded alcohol and lower price relative to recorded alcohol, it was further explored that the socio-demographic differential between recorded and unrecorded alcohol consumption in India. Specifically, the socio-demographic predictors of recorded alcohol, country liquor, and home-brewed alcohol were assessed in this study.
The consumption of unrecorded alcohol varied widely across states in the study, with West Bengal having the largest consumption of unrecorded alcohol, especially of home-brewed alcoholic beverages. Of the total per capita alcohol consumption, the percentage share of unrecorded alcohol consumption ranged from 8% in Maharashtra to 51% in West Bengal. Approximately one-third of the per capita consumption was unrecorded alcohol in Andhra Pradesh (29%) and Madhya Pradesh (31%).
Per capita consumption
Per capita alcohol consumption increased by 37.5% from 1.6 L to 2.2 L of recorded pure alcohol between 2003–05 and 2010–12 in India (WHO, 2014). Alcohol is reported the second most commonly used substance in India after tobacco.
The study findings revealed that the average per capita consumption of pure alcohol per year for the full sample was 4.4 L. However, among drinkers, per capita consumption of pure alcohol was 11.6 L per year. This is equivalent to 9.5 and 25.11 g of pure alcohol per day for the full sample and current drinkers only, respectively. The levels of alcohol consumption varied a lot across states. The highest level of alcohol consumption occurred in Kerala (13.6 L), while Andhra Pradesh had the lowest level of alcohol consumption (pure alcohol) among drinkers (9.1 L). The per capita consumption of recorded alcohol (distilled spirits, beer, and wine) was 3.2 L of pure alcohol, while consumption of country liquor and homebrewed alcoholic beverages was 1.6 and 0.9 L of pure alcohol in the full sample, respectively.
Drinkers with higher education were more likely to consume recorded alcohol but less likely to consume country liquor and home-brewed alcohol compared to less educated drinkers. Higher income was positively associated with consumption of recorded alcohol and country liquor but negatively associated with consumption of home-brewed alcoholic beverages.
Higher levels of alcohol consumption may increase the risk of non-communicable diseases such as cancer, coronary heart disease, and intentional injuries. The health risk attributed to increasing prevalence of alcohol consumption in India is further exacerbated by consumption of unrecorded alcohol, illicit liquor, surrogate alcohol, and other hazardous drinking behaviour.