Alcohol use, economic development and health burden: A conceptual framework

Abstract

Economic development has been identified as an important contributor to life expectancy: wealthier countries with better living conditions generally have different causes of death and show overall lower all-cause mortality rates. Economic development also impacts on alcohol consumption: upper-middle and high-income countries, on average, have higher levels of consumption and less abstention. Thus, there are two influencing factors on alcohol-attributable mortality, acting in opposite directions. This often leads to a paradoxical situation whereby, for some low- and middle-income countries (LMICs), increases in alcohol consumption may be associated with decreases in alcohol-attributable mortality rates due to the impact of improved living conditions outweighing the impact of higher alcohol consumption. Without any change in alcohol consumption, both alcohol-attributable and all-cause mortality are substantially improved with economic development—but an increase in consumption diminishes these benefits. Thus, increases in consumption diminish the potential benefits of economic development. Two case examples from Thailand and Vietnam are presented to illustrate this phenomenon, where failure to implement alcohol control policies in Vietnam led to marked increases of alcohol attributable mortality despite an overall decreasing rate of all-cause mortality.