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Action for a Sober South Africa

Morojele, Alcohol and Drug Research Unit, South African Medial Research Council Jernigan, Johns Hopkins Bloomberg School of Public Health, USA

Figures collected by the UN suggest that South Africa has one of the highest rates for murder and other crimes of voilence in the world and alcohol is deeply implicated. Here Charles Parry, Neo Morojele and David Jernigan, describe the problems and what needs to be done.

Crime is a major issue on South Africa, with “contact” crimes (such as murder, rape, assault, and robbery) accounting for a third of the over 2 million cases of crime reported per year.1 Adult per capita consumption of absolute alcohol among drinkers in South Africa is among the highest in the world at more that 17 litres per year2 and alcohol has been found to be the third largest contributor to death and disability in this country.3 The three largest contributors to the burden specifically related to alcohol included homicide and violence (40% of alcohol’s burden), alcohol use disorders (15%) and road traffic injuries (15%).

Various categories of criminal behaviour have been identified as having alcohol links such as drinking and driving, homicide, domestic violence, other assaults, sexual violence, and child abuse. In particular there appears to be a strong link between alcohol use and homicides and purposeful injuries with between a quarter and half of such events being shown to be attributable directly to alcohol use. 4,5 & 6 Over the past decade there has also been a wealth of research coming out of South Africa indicating a very strong association between alcohol, crime, violence, and injury.7 Research conducted to assess factors related to intimate partner violence for example found that men who reported problem alcohol use were twice as likely to have committed violent acts against their partners in the past 10 years.8 Research has also shown that women who drink are also more likely to be victims of violent act.9

In early 2008 Action for A Safe South Africa (AFSSA) was established by a number of civil society organisations and partners in business with the aim of “enabling every South African to contribute to making South Africa safe through sustained actions that prevent crime. A major goal of this initiative is to address the question of “How do we shift South African thinking, spending and action, from security, to preventative strategies for a safe South Africa?” Eight areas were identified for focusing preventive efforts: early childhood development; creating peace in the home; providing opportunities for youth; supporting victims of crime; harnessing the energy of all South Africans; reducing substance abuse; reducing gun-related violence; and rehabilitation of offenders. The first important step in moving forward was to hold a convention in Johannesburg in August 2008 to strategise the best way forward.

Two day workshops were convened for each of the eight areas above. While a variety of substances are related to crime in South Africa,10 it was decided to focus on alcohol in the two-day “Sober South Africa” workshop due to the ubiquity of alcohol-related crime and because it is generally recognized that more evidence-based strategies exist to address alcohol. The overall aim of this working group was to strategise on how to create an alcohol safe South Africa. Specific objectives included:

  • highlighting and reviewing the problem of alcohol-related crime,
  • imagining what the problem would look like if it was fixed,
  • reviewing and brainstorming policy solutions,
  • prioritizing these solutions based on evidence,
  • strategizing the way forward,
  • identifying how will we know if it is fixed, and
  • identifying ideas for sustainability.

Interventions were considered in five broad areas for which there is good evidence for their effectiveness based on international experience and which are likely to have a good chance of having a positive impact on crime in South Africa.7 & 11
These included:

  • drinking and driving countermeasures,
  • brief treatment for problem drinkers (especially those convicted of drink driving offences or alcohol positive trauma unit patients),
  • addressing the retail sale of alcohol from shebeens and taverns,
  • reducing the density of liquor outlets in South Africa, and
  • reducing the impact of alcohol industry marketing.

In addition, strategies that would increase political will by the government to address alcohol misuse were also considered.

Over the two days more than 30 participants from various sectors came together to strategise on how to create an alcohol safe South Africa. Participants included academics, public and private health and social service providers, representatives of liquor traders associations, persons working for NGOs, advocacy and intervention groups, police, staff from the South African Revenue Service, experts on advertising and the built environment, etc.

The working group prioritized systemic rather than individual level interventions. Two big ideas were put forward as likely to have a big impact on reducing alcohol-related crime in South Africa. First, it was stressed that we need to facilitate greater community ownership of the alcohol environment in our communities. Among other things community members need to become much more involved in making decisions around the licensing of liquor outlets in their communities. Specifically this relates to issues like selling hours and even days of sale. It was, for example, proposed that communities should have a say in whether they want alcohol sold on social grant payout days. They could also pressure outlets directly or the regulating authority in areas where alcohol-related crime and injuries are high to reduce hours of alcohol sales.

Second, action at various levels needs to be supported by a strong national commitment in the form of a single body, possibly an Alcohol Health Promotion Foundation. There was substantial support for having such a body funded by a 1% levy on turnover from the major manufacturers of alcohol, “1% for health”. The newly enacted National Liquor Act12 requires alcohol manufacturers in their license application to state how they intend to contribute to combating alcohol abuse, but the policy intention (of balancing the competing interests of stimulating economic development with minimizing the social costs to society) needs to be strengthened by adding a levy to facilitate new initiatives to reduce alcohol related crime more directly by persons and organizations without a competing interest in alcohol sales. One advantage of such a levy is that it would be directly related to the amount of alcohol produced, with more alcohol produced resulting in more funding being available to address the social costs of alcohol.

This national organization would not replicate existing programmes, but would instead be used to kickstart, support and maintain the proposed community mobilization efforts and various new initiatives, like stimulating alternative economic activities for persons who are involved in survivalist selling of alcohol, supporting counteradvertisements, providing funding for policy-oriented research, establishing and new networks for persons and agencies broadly involved in addressing alcohol abuse. It should also facilitate a partnership between civil society and the government in moving the agenda forward in reducing the burden of alcohol in society. Key areas for intervention and priority strategies within each area as agreed by the working group members are set out in Table 1 .

Many of the initiatives involve civil society (e.g. around getting communities to be more engaged in proactively addressing alcohol problems in their communities and in developing a culture of social host responsibility when providing alcohol to people in one’s home), but government agencies in the Health, Social Welfare, Trade & Industry, Education, Transport, Community Safety (Police), Treasury (Revenue), and Communication will need to step up to the plate in several ways, for example:

  • testing for alcohol at all crash scenes,
  • passing legislation around 0,00g/100 ml of alcohol to be allowed in novice drivers,
  • requiring a levy to be imposed on the turnover of alcohol manufacturers who have licenses with DTI,
  • redeveloping and standardising alcohol safety intervention programmes for persons convicted of drink driving,
  • providing training to health care workers in trauma units to screen for alcohol problems and provide brief interventions and referrals where necessary,
  • imposing greater restrictions on alcohol advertising,
  • imposing earmarked taxes on alcohol advertisements in the media to pay for counter advertisements,
  • making schools alcohol free zones,
  • requiring external regulation (pre-vetting) of alcohol advertisements, and
  • getting police to be more proactive about addressing alcohol problems associated with shebeens, taverns and other drinking outlets.

To move forward in many of these areas will require support from civil society organizations and the broader community. Civil society and the community in general will need to become less apathetic about alcohol abuse, alcohol marketing practices and retail practices that affect them. To make the efforts of civil society more meaningful mechanisms are needed that will educate South Africans about the consequences of alcohol use, existing legislation, and how and where they can be more actively involved.

References
1. South African Police Service. Crime statistics 2007/2008. Retrieved 20 August 2008, from http://www.saps.gov.za/ statistics/reports/crimestats/2008/ crime_stats.html. Pretoria: Crime Information Management Centre.

2. Parry, C.D.H. (2005). South Africa: alcohol today. Addiction, 100, 426-429.

3. Schneider, M., Norman, R., Parry, C.D.H., Plüddemann, A., & Bradshaw, D. (2007). Estimating the burden of disease attributable to alcohol in South Africa in 2000. South African Medical Journal, 97, 664-672.

4. English, D.R., Holman, C. D. J., Milne, E., Hulse, G. & Winter, M.G. (1995). The quantification of drug caused morbidity and mortality in Australia, 1995 edition. Canberra: Commonwealth Department of Human Services and Health.

5. Shultz, J. M. & Rice, D. P. (1991). Quantifying the disease impact of alcohol with ARDI software. Public Health Reports, 106, 443- 450.

6. Single, E., Robson, L., Xie, X & Rehm, J. (1998). The economic costs of alcohol, tobacco and illicit drugs in Canada in 1992. Addiction, 93, 983-98.

7. Parry, C.D.H, & Dewing, S. (2006). A public health approach to addressing alcohol-related crime in South Africa. African Journal of Drug & Alcohol Studies, 5, 41-56.

8. Abrahams, N., Jewkes, R., Laubscher, R., & Hoffman, M. (2006). Violence Victims, 21, 247- 264.

9. Kalichman, S., & Simbayi, L. (2004). Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa. AIDS CARE, 16, 681-689.

10. Parry, C.D.H., Myers, B., Morojele, N.K., Flisher, A.J., Bhana, A., Donson, H., and Plüddemann, A. (2004), Journal of Adolescence Vol 27, 429-440

11. Mosher, J. & Jernigan, D. (2001). Making the link: A public health approach to preventing alcoholrelated violence and crime. Journal of Substance Use, 6, 273-289.

12. Government of South Africa. (2004), Liquor Act No. 59 of 2003. Pretoria: Author.