International studies show that the most effective strategies for alcohol control require legislation to ensure proper implementation. Photos: Lisa Skinner
The South African government is rightfully concerned that up to 1 in 3 teenagers are addicted to alcohol and drug abuse. This figure is based on the numbers of young people that are presenting themselves to treatment facilities.
While the government is concerned about the harm that all drugs have on individuals, families and communities, there is a significant body of evidence that suggests that alcohol is one of the most abused substances.
Organisations such as the Medical Research Council (MRC) and Soul City have indicated the scale that the harmful use of alcohol is having on crime, mortality rates and personal injury. At the same time, alcohol significantly fuels gender-based violence and reckless sexual behaviour — both issues that drive the HIV and Aids epidemic in South Africa.
In community surveys done by the Department of Social Development, people have demanded that government takes action to reduce the harmful use of alcohol and the use and abuse of other drugs. Based on this and the evidence pointing to the harmful health and social impacts associated with the harmful use of alcohol, the Minister of Social Development was tasked both by the African National Congress and the Cabinet to initiate a government-led partnership with civil society to reduce the harmful use of alcohol.
The Minister, Bathabile Dlamini, therefore established an inter-ministerial committee supported by a technical team to develop proposals to be considered by cabinet. Contrary to the assertions of some, the plans of the South African government to reduce the harmful use of alcohol is not the misguided efforts of a so-called ”nanny state”, but our objectives and proposals are informed by local and international evidence and guided by best practice suggestions made by the World Health Organisation (WHO).
The objective of the South African government is to regulate the sale and supply of alcohol to the public in the interests of public health and well-being, with the particular purposes of protecting children and young people, reducing alcohol consumption, and preventing violent crime and other forms of alcohol-related harm. This objective arises from the significant harm to individuals and society caused by the excessive use of alcohol.
Alcohol consumption is one of the most significant risks to health. According to research collated by the WHO, alcohol is responsible for about 4% of all deaths and about 4.5% of the burden of injury and disease globally. In a country like South Africa that has been rated as one of the top six worst alcohol abusing countries by the World Health Organisation, the impact on individuals, families and communities are severe.
Despite different levels of consumption and abuse, many countries face similar alcohol-related harm. Transport-related deaths and injuries are strongly linked to the harmful use of alcohol. There is also a close relationship between drinking and violent crime, including gender-based violence and domestic violence.
Given this, the World Health Organisation passed two resolutions over the last six years that sought to get member states to act on the harmful use of alcohol. The actions of the South African government are therefore guided by our local reality but we are also acting as a member state of the World Health Assembly that is a signatory to these resolutions.
In concert with many other member states, our proposals to reduce the harmful use of alcohol follows guidelines provided by the Global Strategy to Reduce the Harmful Use of Alcohol that was adopted by the World Health Assembly in 2010. Research reviews conducted by the WHO have identified the alcohol policies that are most effective and cost-effective in reducing alcohol-related harm.
Most of the policies with high ratings for effectiveness and cost-effectiveness, are alcohol control policies which require legislation to implement. They include alcohol taxation, restrictions on availability, minimum age provisions, measures against drink-driving and reducing exposure to alcohol marketing.
These proposals are specified in de facto practise notes on developing on how countries should develop appropriate legislation and they are indeed, well researched.
Within the policies identified as effective are what the WHO terms as the 10 best practices. They are: minimum legal age to buy alcohol, government monopoly of retail sales, restrictions on hours or days of sale, restrictions on the density of sales outlets, taxes on alcohol, sobriety checks, lowered limits for blood alcohol concentration, administrative suspension of licences for driving under the influence of alcohol and added restrictions for novice drivers.
Prevention strategies such as education and persuasion, which are the most widely used, have been found not be as effective as measures such as taxation and marketing restrictions are. Globally, the alcohol industry advocates almost singularly on education and behaviour change as the measures that government should favour and, as pointed out in the WHO publications, these strategies are not as effective in the absence of legislative measures to reduce demand and availability of alcohol as drivers reducing the harmful use of alcohol.
As is the case in many other countries, our approach to alcohol policy has to shift from one where the objectives revolve around economic growth to objectives that focus on reducing harm. This is the approach being followed in Australia, most of Europe and many developing countries including China.
Our approach to alcohol policy has to shift from one where the objectives revolve around economic growth to objectives that focus on reducing harm. However, even the World Trade Organisation allows for the adoption and enforcement of any measure necessary to protect human life or health. Similar limitations are to be found in many Bills of Rights across the globe.
The alcohol control policies of France, which is arguably one of the strongest globally, has withstood legal challenges on all these grounds. With respect to the issue of regulating alcohol marketing, research has linked levels of exposure to alcohol marketing to earlier onset of drinking and heavier drinking among young people.
A large body of research shows that children and teenagers who are exposed to alcohol-related messaging the most, have more positive beliefs about alcohol, are more likely to drink, to drink larger amounts and to experience drinking problems at a later stage. Restricting the time, place and content of alcohol advertising is therefore a public health issue and not as much a commercial and economic issue.
Understandably, the alcohol and advertising industry will choose to foreground the potential economic consequences of restrictions on advertising as opposed to the more poignant concerns of alcohol. The economic and commercial concerns of the industry, while understood and enjoying prominence as a legitimate argument, should not detract from the overall objective of this government and others across the world that now have to deal with this within the framework of reducing harm.
At the same time, the preferred alternatives by the alcohol industry, which is the use of voluntary codes, are not as effective as measures that seek to limit the time, location and content of alcohol messaging to the public.
The Interministerial Committee will continue to engage with the public and all relevant stakeholders as efforts to curb the harmful use of alcohol will require partnerships with communities and, indeed, stakeholders such as the media.
Zane Dangor (Adviser to the Minister of Social Development) and Vusi Madonsela (Director-General of Social Development)
This article originally appeared in the Mail & Guardian newspaper as a sponsored supplement
