The research was conducted by first author Dr Jürgen Rehm, of the Centre for Addiction and Mental Health in Toronto, and the University of Toronto, and colleagues and is published as part of a cluster of studies and commentary papers on alcohol and health in the 27 June issue of The Lancet. Rehm also holds posts at the Technische Universität Dresden, Dresden, Germany, and the World Health Organization.
In their first paper, Rehm and colleagues review published work on exposure and prevalence of alcohol-use disorders and quantify the extent to which alcohol contributes to deaths and diseases, worldwide and in ten large countries.
Using figures from 2004, the most recent year for which global data is available, they estimate that the net effect of alcohol consumption on health is harmful, accounting for 3.8 per cent of deaths globally (6.3 per cent for men and 1.8 per cent for women), and 4.6 per cent of years lived with disability.
Most of the alcohol-related deaths were due to cancer, cardiovascular disease, liver disorders like cirrhosis, plus injuries and violence, say the authors.
Rehm and colleagues suggest that the level of alcohol-related disease is linked to the amount consumed, the effect being strongest on poor people and those marginalized from society, for every extra unit consumed.
The cost of this burden is equal to more than 1 per cent of gross national product in high income and middle income countries, they wrote, and most of this is not the health care cost but the social harm caused, said the researchers.
"Overall, we conclude that alcohol consumption is one of the major avoidable risk factors, and actions to reduce burden and costs associated with alcohol should be urgently increased," they wrote.
They likened the problem of alcohol to that of tobacco a decade ago.
"Globally, the effect of alcohol on burden of disease is about the same size as that of smoking in 2000, but it is greatest in developing countries," said the authors.
Speaking to the Canadian Press, Rehm put the global figures into an even more alarming context, because while the global statistic suggests 1 in 25 deaths is linked to alcohol, more than half the population of the world doesn't even touch alcohol.
"Worldwide, more people abstain than drink," said Rehm, explaining it wasn't only Muslim countries, but also:
"Countries like India where about 95 per cent of the women abstain, where about 80 per cent of the males abstain."
"And India has more than one billion inhabitants, so they really count," he added.
Rehm said they looked at two different aspects of alcohol consumption: the total amount drunk and the pattern of drinking, such as binge drinking where a lot is consumed in a short time.
They calculated the average global alcohol consumption per person per year is about 6.2 litres of pure ethanol, which is a rate of a dozen or so units of 10 mls each per week. One unit is roughly the amount of alcohol in a shot of spirits, a medium strength bottle of beer or a medium glass of wine.
However, in Europe, where 1 in 10 deaths are linked to alcohol, this figure is much higher at around 22 units per week, while in North America it is around 18 units. The lowest consumption was in eastern Mediterranean countries at 1.3 units per week.
Europe includes countries that were once in the Soviet Union, and these had the highest percentage of deaths linked to alcohol: 15 per cent or 1 in 7.
However, Rehm said that he was also concerned about the developing world, and Asia in particular, where increasing industrialization is going hand in hand with increasing alcohol consumption.
"We're not talking about the poorest of the poor, we're not talking about Africa," he told The Canadian Press.
"We're talking about those emerging economies like China, like Thailand, who are right now increasing their gross national product, who are getting more and more westernized in a lot of ways, and that is where alcohol is currently the Number 1 risk factor," said Rehm.
Professor Ian Gilmore, chair of the Alcohol Health Alliance UK and president of the Royal College of Physicians, told the BBC that:
"This study is a global wake-up call."
"We need an international framework convention for alcohol control, similar to that on tobacco, as soon as possible, to put into practice the evidence -based measures needed to reduce alcohol-related harm," he added, suggesting this should include raising the price of alcohol, restricting its availability and banning advertising.
"And the action needs to start now," said Gilmore.
"Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders."
Jürgen Rehm, Colin Mathers, Svetlana Popova, Montarat Thavorncharoensap, Yot Teerawattananon, Jayadeep Patra.
The Lancet, Volume 373, Issue 9682, Pages 2223 - 2233, 27 June 2009
Additional source: The Canadian Press.
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