Toolkit for Assessing the Unrecorded Alcohol Market

What health outcomes are associated with the unrecorded market?

Previous research has suggested the existence of potential links between unrecorded alcohol consumption and certain negative health outcomes. The elevated health concerns associated with some types of unrecorded alcohol stem from the potential for compromised quality and the presence of contaminants as well as higher than acceptable levels of naturally occurring compounds (see What is the Composition and Safety of Unrecorded Products) compared to recorded alcohol. Health outcomes of particular concern include:

  • alcohol poisoning;
  • methanol poisoning; and
  • liver disease; and
  • liver cirrhosis.

The type of unrecorded product typically consumed will also inform which health outcomes should be examined. For example, in Sub-Saharan Africa, home-produced beer is brewed in iron pots or drums, resulting in high concentrations of iron in the beer itself. Consumption of these products has been linked with dietary iron overload, which may result in fibrosis or cirrhosis of the liver and potentially hepatocellular carcinoma (Kew & Asare, 2007).

The risks associated with unrecorded products vary among sub-segments of the unrecorded market, with counterfeit, non-conforming, and surrogate alcohol more likely to be associated with elevated health risks. Although its quality can vary greatly, home-produced alcohol is often artisanal in nature and of high quality. And unrecorded but genuine commercial and branded products, such as contraband and tax leakage alcohol, do not pose an elevated risk to human health relative to recorded products.

Official Statistics

Official health statistics on mortality and/or morbidity from alcohol-attributable health outcomes can be correlated with unrecorded alcohol consumption to examine the association between the two variables. However, the presence of an association between two variables does not provide conclusive evidence that one causes, or drives, the other; thus, alternative explanations may pose a problem for interpretation. For example, both higher unrecorded consumption and poorer health outcomes might be driven by a country’s income level.

Moreover, longitudinal data on unrecorded consumption is difficult to come by for the vast majority of countries/regions, as is comparable data for conducting a cross-sectional analysis across countries.

Population-Based Surveys

Items designed to screen for symptoms of methanol poisoning may be included in population-based surveys. This information, combined with data collected through questions addressing consumption of different types of alcohol products, may then be used to investigate the association between possible methanol poisoning and the consumption of certain unrecorded products (e.g., counterfeit or surrogate alcohol) in a geographical area. However, as with the health statistics approach to correlating unrecorded consumption and adverse health outcomes, any associations must be probed for alternative, third-variable explanations and presented with the appropriate caveats regarding possible confounding.