Alcohol In South Africa Research Articles

The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020-21).

This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.

A cost–benefit analysis for alcohol in South Africa for the year 2019

A cost–benefit analysis for alcohol in South Africa for the year 2019

Stakeholder Engagement in the Development of Public Health Economic Models: An Application to Modelling of Minimum Unit Pricing of Alcohol in South Africa.

Health economic models aim to provide decision makers with information that is contextually relevant, understandable and credible. This requires ongoing engagement throughout the research project between the modeller and end-users. We aim to reflect on how a public health economic model of minimum unit pricing of alcohol in South Africa benefited from, and was shaped by, stakeholders. We outline how engagement activities were used during the development, validation and communication phases of the research with input gathered at each stage to inform future priorities. A stakeholder mapping exercise was completed to identify stakeholders with the required knowledge, for example academics with expertise in modelling alcohol harm in South Africa, members of civil society organisations with lived experience of informal alcohol outlets, and policy professionals working at the forefront of alcohol policy development in South Africa. The stakeholder engagement consisted of four phases: developing a detailed understanding of the local policy context; co-producing model focus and structure; scrutinising model development and communication planning; and communicating research evidence to end-users. The first phase utilised 12 individual semi-structured interviews. Phases two to four centred around face-to-face workshops (two online) with both individual and group-based exercises employed to achieve required outputs. Phase one provided key learning on policy context and initiated working relationships. Phases two to four provided a conceptualisation of the problem of alcohol harm in South Africa and the choice of policy to model. Stakeholders chose population subgroups of interest and advised on both economic and health outcomes. They provided input on critical assumptions, data sources, priorities for future work, and communication strategies. The final workshop provided a platform to communicate the results of the model to a largely policy audience. These activities led to the production of highly contextualised research methods and findings that were able to be communicated widely beyond academia. Our programme of stakeholder engagement was fully integrated into the research programme. It resulted in a number of benefits including creating positive working relationships, guiding modelling decisions, tailoring the research to the context, and providing ongoing opportunities for communication.

Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: a modelling study

ObjectivesTo quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups...

The case for minimum unit prices on alcohol in South Africa.

Although only about a third of South African (SA) adults indicate that they consume alcohol, heavy drinking is common. As a result, society carries large alcohol-related mortality and economic burdens. To investigate the feasibility of a minimum unit price (MUP) on alcohol, aimed at reducing the prevalence of heavy drinking. The study calculates unit values, defined as total monthly alcohol expenditure per household, divided by the household's total monthly alcohol consumption, for four categories of drinking households (moderate, intermediate, occasional heavy and regular heavy), using wave 4 data (2015) from the National Income Dynamics Study. A cumulative distribution of the unit values is derived for each of the four categories of drinking households. A number of hypothetical MUPs are imposed, and the impact of these MUPs on the consumption of the different categories of drinking households is estimated, taking cognisance of the fact that these households respond differently to price changes. Moderately drinking households tend to be more price sensitive than regular heavy-drinking households. Occasional and regular heavy-drinking households comprise a quarter of all households (and half of all drinking households) in SA, but consume 84% of all alcohol consumed in the country. There are large differences in the calculated average price of alcohol between different categories of drinking households, ranging from ZAR12.00 per standard drink among moderately drinking households to ZAR1.53 per standard drink among regular heavy-drinking households. An MUP of ZAR3.00 (alternatively ZAR10.00) per standard drink is estimated to reduce alcohol consumption by 11.9% (21.8%) among regular heavy-drinking households, by 3.1% (11.6%) among occasional heavy-drinking households, by 2.3% (15.9%) among intermediate-drinking households and by 0.3% (6.1%) among moderately drinking households. An MUP on alcohol is not a silver bullet, but could have a significant impact on reducing the consumption of alcohol among regular heavy-drinking households, and to a lesser extent among occasional heavy-drinking and intermediate-drinking households. The government should strongly consider implementing such a policy.

Effects of Minimum Unit Pricing for Alcohol in South Africa Across Different Drinker Groups and Wealth Quintiles: A Modelling Study

Background: Previous research in high income countries has found Minimum Unit Pricing (MUP) for alcohol to be an effective policy for reducing alcohol-related harm. However, these results may not translate well to South Africa, notable for high levels of abstinence, binge drinking, unrecorded alcohol and alcohol-related injury and infectious disease. Methods: We built an epidemiological policy appraisal model using secondary data to estimate the effects of MUP across sex, drinker groups and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance. Model outcomes include individual consumption, individual spend, tax revenue, retail revenue and group health harms (HIV, intentional injury, road injury, liver cirrhosis and breast cancer). Findings: We estimate that a MUP of R10 per standard drink (15ml of pure alcohol) would lead to an immediate reduction in consumption of 5.5%. The absolute reduction in standard drinks per drinker per year is greatest for heavy drinkers, followed by moderate drinkers and then binge drinkers (-97.76, -25.48, -17.16).A R10 MUP generates 23,149 lives saved and 1,009,477 cases averted across the five health harms over 20 years. Poorer drinkers would see greater impacts from the policy (consumption: -7.9% in poorest, -3.7% in richest quintile). The bottom three wealth quintiles accrue 76% of the deaths averted and 74% of the cases averted. Interpretation: Our model estimates minimum pricing would reduce alcohol consumption in South Africa, improving health outcomes whilst raising retail and tax revenue. Consumption and harm reductions would be greater in poorer compared to richer groups. Funding Statement: This work was supported by the Wellcome Trust Doctoral Training Centre in Public Health Economics and Decision Science [108903/Z/19/Z] and the University of Sheffield. Also the South African Medical Research Council. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethical approval for engaging with stakeholders was granted by the South African Medical Research Council (Protocol ID: EC005-4/2019) and the School of Health and Related Research at the University of Sheffield, UK (Reference Number: 023357). All data for the model came from secondary sources and was managed according to an approved information governance plan.

Alcohol and Short-Run Mortality: Evidence from a Modern-Day Prohibition

On July 13, 2020 a complete nation-wide ban was placed on the sale and transport of alcohol in South Africa. This paper evaluates the impact of this sudden and unexpected five-week alcohol prohibition on mortality due to unnatural causes. We find that the policy reduced the number of unnatural deaths by 21 per day, or approximately 740 over the five-week period. This constitutes a 14% decrease in the total number of deaths due to unnatural causes. We argue that this represents a lower bound on the impact of alcohol on short-run mortality, and underscores the severe influence that alcohol has on society—even in the short-run.

Looking back, moving forward: 50 years of South African Medical Research Council alcohol-related publications.

Alcohol is one of the highest risk factors for death and disability in South Africa (SA).Objective. To explore the trajectory of empirical research on alcohol in SA between 1969 and 2019, with an emphasis on South African Medical Research Council (SAMRC) authored publications.Methods. We reviewed published research (Pubmed and Africa-Wide Information) using systematic methods, clear inclusion and exclusion criteria, and defined search terms. The search was not limited by language. Data synthesis was carried out by the first and last authors.Results. A total of 867 journal articles met the inclusion criteria, with 243 (28.0%) authored or co-authored by SAMRC researchers. For the latter group, three-quarters had an SAMRC researcher as first or last author. Over three-quarters (78.6%) of the SAMRC author positions ('first', 'last' or 'other, counting researchers from a unit only once, but counting authors across different units on a single publication) were from intramural units. Over half the articles authored by SAMRC researchers focused on non-communicable diseases (55.9%), 23.8% focused on communicable diseases, and 10% on crime, violence or injury. Few articles focused on alcohol and tuberculosis (TB), alcohol and cancer, or alcohol policy. Over three-quarters (76.9%) were epidemiological in nature, and 65.3% were cross-sectional studies. There were 17 reviews (7 systematic) and 11 randomised controlled trials (RCTs). There was an increase in the annual number of publications over the 50-year period for both SAMRC and non-SAMRC researchers. Over time, there has been a trend towards publishing on alcohol research in journals published outside SA, but the SAMJ still remains a popular journal choice.Conclusion. The SAMRC has contributed substantially to the growing field of alcohol research in SA, but gaps in areas such as alcohol policy evaluation, alcohol and its association with TB and cancer, and interventional research, are evident.

Actual and predicted prevalence of alcohol consumption during pregnancy in the WHO African Region.

To estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population in the World Health Organization (WHO) African Region, by country. First, a comprehensive systematic literature search was performed to identify all published and unpublished studies. Then, several meta-analyses, assuming a random-effects model, were conducted to estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population for countries in the WHO African Region with two or more studies available. Lastly, for countries with less than two studies or no known data predictions were obtained using regression modelling. The estimated prevalence of alcohol consumption during pregnancy among the general population ranged from 2.2% (95% confidence interval [CI]: 1.6-2.8%; Equatorial Guinea) to 12.6% (95% CI: 9.9-15.4%; Cameroon) in Central Africa, 3.4% (95% CI: 2.6-4.3%; Seychelles) to 20.5% (95% CI: 16.4-24.7%; Uganda) in Eastern Africa, 5.7% (95% CI: 4.4-7.1%; Botswana) to 14.2% (95% CI: 11.1-17.3%; Namibia) in Southern Africa, 6.6% (95% CI: 5.0-8.3%; Mauritania) to 14.8% (95% CI: 11.6-17.9%; Sierra Leone) in Western Africa, and 4.3% (95% CI: 3.2-5.3%; Algeria) in Northern Africa. The high prevalence of alcohol consumption and binge drinking during pregnancy in some African countries calls for educational campaigns, screening and targeted interventions for women of childbearing age.

CASE NOTE: Illegal sales of alcohol and asset forfeiture

The Constitutional Court recently confirmed an order for the forfeiture of a house from which an unlawful shebeen had been run for years (Van der Burg and Another v National Director of Public Prosecutions).In deciding whether to confirm the order of the full bench of the High Court, Justice van der Westhuizen, writing for a unanimous court, addressed the following questions: whether the house was an instrumentality of an offence; whether the illegal sale of alcohol is an organised crime; the proportionality of the crime to the forfeiture under the Prevention of Organised Crime Act 121 of 1998 (the POCA); as well as the impact of the forfeiture on the rights of the children that lived in the house. This judgment comes at a time where issues such as the proposal for the reduction of the legal limit of alcohol for drivers to 0%2 are topical, and seems to point to a tougher stance towards the sale and consumption of alcohol in South Africa. The judgment may therefore be seen as a warning that the illegal sale of alcohol and running of a shebeen will no longer be seen as business as usual in cases where the seller does not heed the call to desist such business.

Testing the National Alcohol Policy Score Card (NAPSC) to assess progress in implementing a comprehensive policy response to reduce the harmful use of alcohol in South Africa

Parry, C. (2013). Testing the National Alcohol Policy Score Card (NAPSC) to assess progress in implementing a comprehensive policy response to reduce the harmful use of alcohol in South Africa. The International Journal Of Alcohol And Drug Research, 3(3), 202 – 209. doi:http://dx.doi.org/10.7895/ijadr.v3i3.98Aims: To complement recent alcohol policy initiatives of WHO, a study was designed to test the feasibility of a simple instrument to assess the state of alcohol policy development and implementation in a developing country.Design: A cross-sectional survey.Setting: Data were collected via a web-survey.Participants: 52 experts across various sectors were approached.Measures: Study participants were asked to complete a 13-item web survey that draws on the target areas for national action identified in the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (2010). The state of policy development and implementation was assessed for 2011 and then retrospectively to 2006. Participants were also asked to comment on the ease of completing the survey.Findings: Based on the responses from 37 experts, improvements were noted in alcohol policy development and implementation in all areas over time, with particular movement in developing a national alcohol strategy; increasing leadership, awareness and commitment; drink-driving; and health services’ response. The total (average) score of 35% in 2011, while up by 11 percentage points, indicates that much work remains to be done, particularly to restrict the marketing of alcoholic beverages, address informal alcohol, increase community action to address harmful alcohol use, and increase financial resources.Conclusions: Participants found the web-survey easy to use. The overall findings and the way they are presented could be used to promote discussions around the development and implementation of national alcohol strategies and how they change over time, and even to compare the situations in different countries. Refinement of the instrument continues.

Units of alcohol in South Africa

(2012). Units of alcohol in South Africa. South African Family Practice: Vol. 54, No. 4, pp. 367-367.

A total ban on alcohol advertising: Presenting the public health case

Evidence from burden of disease and economic costing studies amply indicate that the public health burden from hazardous and harmful use of alcohol in South Africa warrants drastic action. Evidence that banning alcohol advertising is likely to be an effective intervention is reflected in WHO strategy documents on non-communicable diseases and harmful use of alcohol. Studies on young people furthermore support arguments refuting the claim that advertising only influences brand choice. Given the weakness of relying on industry self-regulation, the government is considering legislation to ban alcohol advertising, resulting in heated debate. Tobacco control and studies investigating the effect of alcohol advertising bans on consumption and alcohol-related deaths point to the effectiveness of such action - ideally supplemented by other policy interventions. Arguments against an advertising ban include possible communication sector job losses, but these are likely to have been exaggerated. Banning alcohol advertising will necessitate greater scrutiny of digital media, satellite television and merchandising to reduce the likelihood of subverting the ban.

The Role of Health Economics in Alcohol Policy

In a 2010 editorial, Doran and Jainullabudeen[1] outlined the potential role health economics can play in the development and implementation of alcohol policy. In particular, efficiency can be attained when the negative externalities due to alcohol consumption can be reduced and where the socially optimum level of alcohol is consumed. A socially optimum level can be thought of as one where the marginal cost of reducing associated harm is equal to the marginal benefit from reduced harm.[2] This optimum level requires an assessment of both supply-side factors (availability, marketing and price of alcohol) and demand-side factors (taste, willingness, preferences and income) and the interactions of these factors in minimizing alcohol misuse.[3] With the aim of enhancing the evidence base related to the role of health economics in alcohol policy, Applied Health Economics and Health Policy invited submission of original work to be published in this special issue. After a rigorous peer-review process, three original research articles are presented that focus on the impact and role of pricing strategies. Byrnes et al.[4] consider the efficiency of a volumetric alcohol tax in Australia; Ataguba[5] examines alcohol policy and taxation in South Africa and Ludbrook et al.[6] present research aimed at addressing alcohol misuse using a minimum pricing approach in the UK. Each article offers a unique contribution to the literature and enhances our limited understanding of the potential role health economics can play in the development of efficient and equitable alcohol policy. Byrnes et al.[4] quantify the economic impact of four different alcohol taxation systems, relative to the current Australian system: two different types of volumetric taxation (deadweight loss neutral and tax revenue neutral); the recent strategy trialled in Australia of increasing the tax only on ready-to-drink alcoholic beverages; and a tiered tax system, which may be more politically acceptable. A partial equilibrium approach was used to measure taxation revenue and deadweight loss in alcohol markets. The results of the analysis suggest that a volumetric tax on alcohol, relative to the current system, can reduce pure alcohol consumption for the same amount of tax revenue collected and increase consumer welfare, or, for the same level of loss to consumer welfare, taxation revenue can be increased. A tiered taxation system, as considered by the National Preventative Taskforce,[7] appears to achieve some benefit relative to current practice, but is not as efficient as an unmixed volumetric tax. Specifically, compared with the deadweight loss neutral scenario, a tiered taxation system is associated with an increased deadweight loss of taxation, less taxation revenue collected by government and a smaller reduction in pure alcohol consumption. However, the ability of taxation policy to reduce pure alcohol consumption for the least amount of deadweight loss may only be one consideration of alcohol taxation policy. As Ataguba[5] notes, the application of alcohol taxation policy on efficiency grounds is difficult to impose in reality and the goal of alcohol taxation as it relates to equity is also an important consideration, especially in a highly unequal society like South Africa. Ataguba[5] empirically examines the distribution of economic burden (i.e. the tax incidence) that taxes on alcoholic beverages place on households in South Africa. Using data from the 2005/06 South African Income and Expenditure Survey, Ataguba suggests that the taxation of alcohol in South Africa is regressive, with the most regressive tax on local beer and the least regressive on spirits. In the context of these findings, Ataguba[5] contends that within South Africa, alcohol tax policy built on the principle of 'the drinker should pay' has produced a regressive distribution of tax that has had little impact on per capita consumption over the years. Ataguba[5] comments that it is important to gain a better understanding of the current pattern of drinking and explore why the poor drink and thereby bear a greater burden of alcohol taxes. …

The Case for an Increased Tax on Alcohol in South Africa

The Case for an Increased Tax on Alcohol in South Africa