SA and alcohol: Time to put a cork in it?

SA’s two-month ban on the sale of alcohol spelt ruin for Zandile Madzena, owner of a licensed tavern in Finetown, south of Joburg. With the shuttering of her shop, she lost her means of supporting herself, her unemployed adult daughter and her late sister’s two children.

Relaxed restrictions on liquor sales, in place since June, have not made things any easier. These permit the sale of alcohol from 9am-5pm on Monday to Thursday, but that’s when Madzena’s customers are at work. It means she now sells a few bottles of beer four days a week — a far cry from the busy weekend trade before lockdown.

Already, Madzena fears she won’t have the money to take her asthmatic niece to the clinic. "If it carries on, I don’t know where my life is going," she says.

Madzena is one of the 1-million people who rely on SA’s alcohol sector for their livelihood, according to industry figures. The number includes producers, bottlers, distributors, shebeens and 540 high-end wine estates. Seventy percent of those wine farms would not have been in a position to pay salaries in July, if the sales ban had continued.

Days before the ban was lifted, large alcohol industry players warned: "With no or minimal revenue for eight weeks … the industry cannot sustain the ban any further and job cuts are a harsh reality."

At the time, Heineken SA MD Gerrit van Loo said alcohol companies were seized with the need to save jobs. "[The] industry has acted responsibly. [But] believe me, it is not easy for the international brands. It’s not easy to tell guys in Amsterdam, in London or in Paris," he said. "For two months we have had absolutely zero revenue, but we have to protect our workforce."

Prof Sithombo Maqungo, head of the orthopaedic trauma department at Cape Town’s Groote Schuur Hospital, tells a different story about the alcohol ban. He says less drinking and fewer drunk drivers on the roads in April and May meant a 60% reduction in patients at the hospital’s trauma unit. This, he wrote in a letter to the Southern African Alcohol Policy Alliance in June, "freed up health-care resources … which allowed for more cancer patients to be called into the hospital to have their surgeries performed".

When alcohol sales resumed on June 1, "the unmistakable smell of alcohol combined with bleeding returned to the trauma units", he wrote. "Every health-care worker in casualty knows about this smell."

The industry, however, says the problem is not quite so straightforward. It points to reduced trauma admissions in countries where alcohol sales were not banned as a result of the Covid-19 pandemic. And, it says, factors such as fewer cars on the road, closed factories and workplaces as well as fewer social gatherings also need to be taken into account.

Prof Ken Boffard runs the state-of-the-art trauma unit at Joburg’s Netcare Milpark Hospital, linked to Wits University. The unit tests the blood of each of its patients for alcohol and drugs. He says those tests find that 60% of car accident victims (including pedestrians) "are over the legal driving limit, or are under the influence of drugs".

Those figures match numbers cited in a 2014 SA Medical Journal report, which found 60% of all driving fatalities at the Salt River mortuary in Cape Town had high blood alcohol levels. SA Medical Research Council (SAMRC) data shows that 50%-60% of drivers who die in car accidents are drunk, while the latest mortality report for the Western Cape (2010-2016) shows 60% of pedestrian fatalities were drunk.

Research also shows that the victims of violence admitted to hospital are often over the legal limit. Boffard says blood tests at Milpark show eight out of 10 victims of gunshots, stabbing and domestic violence have been drinking or taking drugs. Four studies conducted in SA trauma wards in Cape Town, Joburg and Durban between 1999 and 2014 found that 35%-79% of trauma victims were drunk.

"My friend stabbed me" is a line Boffard hears often. It’s heard so often in SA trauma units that it’s become something of a local proverb.

It’s a problem that’s been flagged by the World Health Organisation, which puts SA sixth in the world when it comes to hazardous drinking. Though the health body says a third of the population drinks (this includes underage drinkers), the bigger issue is the level of excess.

The roots of abuse go back centuries.

Dr Mike West, a psychiatrist who specialises in addiction, says: "The origins of alcohol misuse in SA can be traced all the way back to the arrival of the Dutch settlers, who would pay the indigenous inhabitants in alcohol — the beginnings of the ‘dop’ system. During apartheid, unlicensed shebeens became the most common way of purchasing alcohol, and were seen as a way of rebelling against laws that prohibited black people from consuming alcohol."

The cost to the country today is enormous.

In a 2013 study published in the SA Medical Journal, SAMRC researcher Richard Matzopoulos tried to calculate the cost to society of alcohol abuse using data from 2009. He built on overseas research and excluded some figures where local data was sparse, but counted the cost of preventing alcohol-induced crime, responding to crime, hospital care and disability arising from alcohol use. He put the tangible cost at about R37.9bn, or 1.6%, of 2009 GDP.

Intangible costs, such as loss of life and emotional costs, amounted to 10%-12% of GDP, a figure often cited by the anti-alcohol lobby.

At the same time, the alcohol industry also pays its dues. The industry says it pays R51bn a year in tax, including VAT, sin tax and customs levies. For example, R85 of a R130 bottle of spirits goes back to the state in taxes.

The liquor industry, through the NGO Aware, is also working to improve safety in licensed taverns. CEO Ingrid Louw says Aware upgraded 720 taverns in four provinces last year, and 1,000 upgrades were planned for this year. "Taverns are social hubs where township communities interact," she says.

Aware provides physical upgrades such as lighting, closed-circuit TV camera systems, ensuring "safe spaces" for women and water-free Enviro Loo toilets. And it puts checkerboards on tablecloths to encourage other forms of entertainment. In return, says Louw, "the tavern must commit to trading responsibly", including by not serving alcohol to pregnant women or underage teens.

But reducing alcohol abuse requires a huge team effort and the enforcement of laws by the government. "Everybody has to come together — health experts, researchers, industry and the government," says Louw.

As things stand, the lockdown liquor restrictions may be undermining adherence to the law.

A tavern owner working near Benoni tells the FM that she is considering giving up her legal trading licence. If she trades legally, she says, it will take her two months to sell R30,000 worth of alcohol — the amount she previously sold in a week.

Customers want to buy two bottles of beer to unwind after work, she explains, but by the time they knock off for the day, her establishment is closed under current regulations. Illegal shebeens, on the other hand, aren’t.

"Sometimes being legal doesn’t help you," she says. It’s also not easy competing with the cheaper homebrews that have become common, after people started producing their own alcohol during the hard lockdown.

"These restrictions now are pushing us in the wrong direction," she says.

Prof Charles Parry, director of the Alcohol, Tobacco & Other Drug Research Unit at the SAMRC, has for years argued for fewer alcohol outlets, as well as a ban on alcohol advertising except at the point of sale. He also proposes a reduction in the size of beer servings, from the popular 750ml "quart", to decrease consumption, as well as a zero-alcohol, or almost zero-alcohol, limit for driving. And authorities should, believes Parry, test drivers’ blood for alcohol for every accident.

In 2011, then health minister Aaron Motsoaledi had promised a ban on alcohol advertising. And in 2013 a draft bill to that effect received verbal government support — but it stalled after the industry warned it could lead to a loss of 12,000 jobs. By the time Motsoaledi left office in 2018, nothing further had been done.

"By now, there is a large body of literature demonstrating the link between problematic alcohol use and alcohol advertising, [and] the beneficial effects of taxation and regulation of sales," says West.

Like Matzopoulos, he argues that self-regulation and alcohol industry programmes aren’t effective.

For her part, Louw recognises the multifaceted nature of the problem. Add alcohol "to the mix of unemployment, poverty and inequality", she says, and things spiral out of control. There’s little to stop an unemployed person from drinking. "If I have not worked for 10 years, I have no hope for tomorrow."

Boffard is pragmatic. He believes a zero-alcohol driving limit would save lives and dramatically reduce trauma unit admissions. He estimates putting a stop to drunk driving would cut admissions in the private sector by half, and in state hospitals by a third.

It’s a single intervention with wide-reaching consequences, in the same way that a single law stipulating that guns must be kept in safes largely stopped children shooting each other accidentally, he says. And modern breathalysers work well enough to replace the state’s blood alcohol tests, says Boffard, which have reached a backlog of up to nine years.

In Australia, which has regular roadblocks, police take video footage when they administer breathalysers to preempt legal challenges. The day after a driver is caught, he or she will appear in court — even on a weekend — and lose his or her licence for six months. A second offence brings a prison sentence.

In SA, by contrast, only about 7% of those caught driving drunk are sentenced, says Aware.

West, who says most people do drink responsibly, believes this message needs to be hammered home. "Though your right to use alcohol is yours and yours alone," he says, "it is a drug, and a dangerous drug."