Alcohol is a psychoactive and potentially dependenceproducing substance with severe health and social consequences. It is estimated that 2.5 million people died worldwide of alcohol-related causes in 2004, and alcohol ranks as the third leading risk factor for premature deaths and disabilities in the world. Evidence suggests that groups of low socioeconomic status experience a higher burden of alcohol-attributable disease, often despite lower overall consumption levels. Health outcomes and socioeconomic consequences are determined not only by the amount of alcohol consumed, but also by the pattern of consumption and the quality of alcohol consumed. These three determinants are again shaped by–and shape–the wider social determinants related to socioeconomic context and position, exposure and vulnerability. The level of abstention, reflecting such issues as gender and poverty levels, is an important mediating factor that often serves a protective role.

Alcohol consumption rates are markedly lower in poorer than in wealthier societies. However, withinsociety differences in alcohol-related health outcomes by socioeconomic status tend to be more pronounced than differences in alcohol consumption. In other words, for a given amount of consumption, poorer populations may experience disproportionately higher levels of alcohol-attributable harm. Such nuances in the relationships between alcohol and inequity demand further empirical exploration, particularly in developing countries.