Public health successes and missed opportunities

MONITORING ALCOHOL EXPOSURE
The key indicator for monitoring harmful alcohol consumption at the country and international level is adult (defined
as age 15 years and over) per capita consumption (18), which is a composite measure comprising mainly recorded and
unrecorded consumption. Recorded consumption refers to all alcoholic beverages that are officially registered by the
respective country where they are consumed, most commonly based on taxation (18–20). Unrecorded consumption is a
summary term for all non-registered products, which include the following main categories (21,22): legal but unrecorded
alcohol products (mostly homemade alcohol); alcohol products recorded outside the jurisdiction where they are consumed
(cross-border shopping); surrogate alcohol (non-beverage ethanol-based alcohol products not or not officially intended for
human consumption); and illegally produced or smuggled alcohol products intended for human consumption (including
illegal homemade alcohol). With respect to surrogate alcohol, sometimes products may not officially be intended for
human consumption, but in reality they are only declared as such to avoid the higher taxation of officially declared
alcoholic beverages. Ethanol-based medicinal tinctures or perfumes with fragrances would be one such example in the
Russian Federation (23,24).
Globally, unrecorded alcohol has constituted at least 20% of all alcohol consumed in the past decades, but with
high variability between countries and regions, and over time (25–27). The proportion of unrecorded to total alcohol
consumption is in general associated with economic wealth: the higher the wealth of a country (e.g. as measured by its
gross domestic product [GDP]), the lower the proportion of unrecorded alcohol to overall consumption (1,28). In addition to
recorded and unrecorded consumption, tourist consumption is subtracted for a small number of countries where tourists
consume a sizable share of the overall alcohol consumed (see (29) for definitions). For most countries, it is assumed that
tourist consumption is balanced by the consumption of inhabitants while spending time outside of their country.
The objective of this chapter is to describe the long-term adult per capita alcohol consumption 4 for all countries that are
part of the WHO European Region from 1990 onwards. This is the earliest year for which there are systematic estimates
of unrecorded consumption. In addition, it has been the goal to provide estimates of recorded versus unrecorded
consumption, and estimates of average consumption per drinker. While some regional trends are included, these will be
used only to illustrate trends for groups of countries with similar drinking levels or drinking patterns. The main emphasis
is on the country level.
Methods for estimating trends in alcohol exposure
DATA
The Global Information System on Alcohol and Health (GISAH) (29) has been used for estimates of adult per capita
consumption of alcohol, mostly derived from taxation, or production, import and export data (18,19).
Estimates of recorded adult per capita alcohol consumption exist as time series of yearly data since 1960 for all WHO
Member States; these data are regularly updated according to an algorithm based on the validity and reliability of sources
(18). For the year 2014, data on recorded adult per capita consumption for the minority of countries without available data
were estimated based on regressions of previous trends for this indicator.
For the time after 1990, there are estimates of unrecorded consumption for select years (1990; 2000; 2010–2014),
mostly assembled by the WHO Collaborating Centre for Mental Health and Addiction, Toronto within the WHO monitoring
system on alcohol (for methodology, see (28,30,31)) (see Box 1). The years in between the estimated years were imputed
based on linear interpolation between data points.
4
In the remaining text, adult per capita consumption or alcohol per capita consumption is used as total consumption. Sub-categories will be specified.
2