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1. INTRODUCTION

capita consumption, WHO has sponsored research projects in four countries
(Brazil, China, India and Nigeria) to determine the level of unrecorded
consumption in these countries.
It is expected that more precise estimates of alcohol use will lead to better
understanding of the association between use and problems. In this regard
the comparative risk analysis (CRA) project of WHO is noteworthy. The CRA
uses per capita consumption data together with patterns of drinking to link
use to disease burden (Rehm et al., 2002). A patterns approach to alcohol
consumption assumes that the way in which alcohol is consumed is closely
linked to disease outcome. Drinking during meals, for example, is associated
with less risk of problems than drinking during fiestas or drinking in public
places. In the CRA analysis, four pattern values have been developed, with 1
as the least hazardous and 4 as the most detrimental. At pattern value 1 there
are few occasions of heavy drinking, and drinking is often done with meals,
while pattern value 4 is characterized by many heavy drinking occasions and
drinking outside meals. Table 1.2 shows the pattern values for different WHO
regions, with each region divided into at least two subregions. Values for some
regions are based on limited aggregate data and are only indicative of the
pattern of drinking in these regions.
In the African Region, there was a steady rise in per capita consumption
in the 1970s and a decline beginning from the early 1980s. However, the
pattern of drinking has tended towards the higher levels with men in most
countries drinking at pattern value 3 of the CRA estimates. This is the case
for Gabon, Ghana, Kenya, Lesotho, Senegal, and South Africa, for example.
However, it is only in very few countries (e.g. Zambia and Zimbabwe) that
the pattern value is 4. The detrimental pattern of drinking in many sub-
Saharan countries has been shown in several surveys (e.g. Mustonen, Beukes
& Du Preez, 2001; Obot, 2001). In most countries women drink much less
than men and in some of these countries the abstention rate for older
women is very high.
In the Region of the Americas, heavy drinking (i.e. drinking five or more
drinks on at least one occasion in the past month) is a common drinking
behaviour among young people. Both alcohol consumption and heavy
drinking are reported much more often among males than females in both
Mexico and the USA (WHO, 1999; Medina-Mora et al., 2001). Though Mexico
has a relatively low per capita consumption of alcohol, the pattern value for
that country is 4. This is because there is high frequency of heavy drinking,
especially by young people, on fiesta occasions.
Heavy drinking among young people is also common in the Western Pacific
Region. Though there has been some decline in the rates of drinking in
Australia and New Zealand, 50% of male youths in these countries as well as
in South Korea and Japan often drink to intoxication. Table 1.2 shows
abstention rates for males and females, annual per capita consumption in
the general population and among drinkers, and patterns of drinking in WHO
subregions.

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