ICAP REVIEW 3 Noncommercial Alcohol in Three Regions An Overview of Terms ICAP Reviews, issued periodically since 2005, are A significant portion of alcohol produced, sold, and con- independently authored and peer reviewed publica- sumed around the world is not reflected in official statis- tions providing an overview of a given topic; they seek tics. This issue of ICAP Reviews focuses on the prevalence a broad, international readership and are distributed in of some such beverages—termed here “noncommercial hard copy and electronically via the ICAP website. alcohol”—in three regions: Sub-Saharan Africa, central Disclaimer: The opinions expressed in this ICAP Review are those of and eastern Europe, and southern Asia. the individual authors and do not necessarily reflect the views of the International Center for Alcohol Policies or its sponsoring compa- We target a subsection of what WHO calls “unrecorded nies. The papers presented here have undergone external peer alcohol.” i Addressed in this Review are traditional drinks review; the final text reflects the judgment of the individual authors. produced, whether legally or illegally, for home consump- tion or limited local trade, as well as unregistered and counterfeit products. Also included is the consumption of of official per capita consumption figures in describing a range of nonbeverage or “surrogate” alcohols (derived actual drinking behavior and informing policy. from medicinal compounds, automobile products, and cosmetics), a relatively widespread phenomenon in some Existing studies have focused on noncommercial alco- areas, particularly among problem drinkers in the lowest hol from either a global or a country-level perspective. socioeconomic brackets. Drinks made illicitly are at times However, global research paints too broad a picture, adulterated by such liquids, for example, to increase obscuring key trends and issues. On the other hand, alcohol concentration. country-level work may be too narrow in scope because many of the factors associated with noncommercial “Noncommercial alcohol” is defined in this ICAP alcohol consumption are not bounded by national Review as traditional drinks produced for home borders and thus cannot be addressed without looking at consumption or limited local trade, unregistered country clusters. This ICAP Review explores the topic from and counterfeit products, and nonbeverage—or a regional perspective, aiming to provide a comprehen- surrogate—alcohols. sive yet sufficiently detailed account of the actual alcohol consumption and information useful to policy-makers. Parts of this Review report on “unrecorded alcohol” when This publication builds on ICAP’s existing work: the 2004 assessing results of studies that have used the broader book Moonshine Markets (1), which looked at the pat- WHO term, but the bulk of the discussion focuses on terns of “local alcohol” production and consumption in noncommercial beverages, as defined above. six countries (Brazil, India, Mexico, Russia, Tanzania, and Zambia); and the ICAP Blue Book, which gives a brief, Because it is not taxed, regulated, or recorded, little is international overview of noncommercial alcohol. known about noncommercial alcohol, its production, consumption, and related outcomes. Although the pro- The three papers below were each written by a regional duction of many noncommercial beverages meets high expert, familiar with local research and able to discern quality standards (1), much of what is included under regional trends. Each paper provides a literature review this heading may be contaminated and toxic. The latter of published work and introduces new data, recently category poses a threat to public health—particularly in obtained by the authors. Possible targeted interven- developing and transition countries—but the magnitude tions, appropriate for local and regional conditions, are of the problem is unclear. Moreover, lack of data about then proposed. An effort was made to retain the unique noncommercial alcohol contributes to the limitations style, structure, and emphasis of each paper, so as to give the reader a better idea of the issues surrounding i WHO’s term “unrecorded alcohol” mainly covers the following: home noncommercial alcohol in the three regions. Thus, the production (licit/illicit), travelers’ imports and cross-border shopping, only commentary in this review accompanies the paper smuggling, surrogate alcohol, tourist consumption, and beverages with alcohol content below the legal definition of alcohol (37, p. 15). on Sub-Saharan Africa to underscore some of that paper’s ICAP REVIEW 3 Noncommercial Alcohol in Three Regions | 2 key proposals, as seen from the perspective of another regional expert. The paper on central and eastern Europe Table of Contents compares the noncommercial alcohol markets in coun- Noncommercial Alcohol in Sub-Saharan Africa. .3 tries of that region to their Western neighbors. And the Prof. Moruf Adelekan paper on southern Asia focuses on one popular noncom- mercial beverage, kasippu, and the regulatory develop- Noncommercial Alcohol in Sub-Saharan Africa: ments that have surrounded it in Sri Lanka. Which Way Now?A Commentary . 15 Prof. David M. Ndetei It is hoped that this ICAP Review will contribute to a better understanding of the informal alcohol sector, Noncommercial Alcohol in Central and identifying available local and international research Eastern Europe. .17 and highlighting areas for further work. The dearth of Dr. Yu. E. Razvodovsky basic data on noncommercial alcohol in many countries is a clear obstacle to quality international analysis; ICAP Noncommercial Alcohol in Southern Asia: hopes to help bridge this gap as it prepares to continue The Case of Kasippu in Sri Lanka. 24 work on this topic in the coming years. Dr. Uditha Liyanage References. .35 ICAP REVIEW 3 Noncommercial Alcohol in Three Regions | 3 Noncommercial Alcohol in Sub-Saharan Africa Prof. Moruf Adelekan Royal Blackburn Hospital, Blackburn, United Kingdom Definitions growth across Africa. Sixteen countries grew by more than 4.5% a year during this period, and several (includ- Within the African context, noncommercial alcohol, as ing Ghana, Mozambique, Senegal, Tanzania, and Uganda) defined in this Review, primarily consists of homebrewed diversified their economies and exports. A number of SSA beers, some fruit-based beverages, palm wine, and nations have benefited from the global economic growth, home-distilled drinks. Although the word “noncommer- which has been fairly steady over that decade (2); further cial” may suggest that these beverages are not produced stimuli came from the rapidly expanded trade with the at an industrial or large-scale level, they are commod- rest of the world, increased foreign direct investment, and itized. In some rural African settings, a majority of women policy improvements in many countries. engage in the production and sale of these beverages as their main commercial activity and as a means of sup- Despite this upturn in economic trends, the ADI have porting their families. In some countries, homemade beer also shown that the volatility of growth—an outcome of may be the most widely consumed alcohol and is quite conflict, bad governance, and unstable world commodity significant in economic terms. prices—has been greater in SSA than in any other region over the past 30 years. Socioeconomic and health indices As a unifying characteristic, these products generally exist in SSA remain largely suboptimal and reflect wide varia- outside the traditional oversight by governments and tions across the region. For example, the 2004 poverty the public health community, making the monitoring of headcount ratio at USD 1 a day was recorded in 41% of drinking behavior, safety regulations, quality assurance, the population, admittedly a reduction from 47% in 1990. and official revenue generation difficult (1). From a legal South Africa has SSA’s highest real gross domestic prod- perspective, these beverages are also sometimes referred uct (USD 160.8 billion); Guinea Bissau, the lowest (USD to as “illicit” or “illegal.” The utilization of such terms varies 213 million). SSA’s highest gross national income (GNI) widely and depends on the availability and enforcement per capita is in Seychelles (USD 6,666), while the lowest of laws in different countries. However, in view of the is in Burundi (USD 105). The adult literacy rates also vary sociocultural and economic importance of these drinks widely: Seychelles has the highest rate of 92%, while the and their popularity among considerable segments of the lowest rate of 24% is in Mali and Burkina Faso. Between African population, the terms “illicit” and “illegal” are not 1990 and 2005, the life expectancy at birth in SSA declined often applied. from 49.2 to 47.1 years (2). Although the life expectancy increased in 25 countries by an average of eight years, it Sub-Saharan Africa in Context declined in 21 more populous countries by an average of four years. HIV/AIDS, malaria, and armed conflict have Sub-Saharan Africa (SSA) comprises 46 of the 53 countries contributed to these falling life expectancies. in Africa. Its total population is estimated at about 0.8 bil- lion people, with a population growth of 2.3% per annum (2). The seven North African countries are not included in The Importance of Alcohol in SSA the present discussion because they share sociocultural Alcohol is a ubiquitous part of everyday life in Africa, and economic features—the focus of this work—with the cutting across