Curbs on Drinking Limits Harm

The Western Cape province in South Africa through an amendment to the 2008 Western Cape Liquor Act will from 2011 limit on-site consumption sales of alcohol from 11 am to 2 am the next day and off-site consumption sales of alcohol from 9 am to 6 pm, seven days a week. The City of Cape Town (situated within this province) has passed a bylaw that will see even more stringent restrictions coming in from 1st January 2011. City bottle stores will, in addition, be prohibited from trading on Sundays, and on-site consumption sales of alcohol in outlets operating in residential areas will only be allowed up until 11 pm. The Western Cape province and the City of Cape Town are jurisdictions where the Democratic Alliance, the major opposition party in the National Assembly, currently holds the majority of seats in the respective legislatures.

The article below discusses issues related to these policy changes and provides evidence supporting the move towards greater restrictions on alcohol sales. It appeared in the Weekend Argus newspaper in South Africa on 24th October 2010 and has been reprinted with permission.

Does it make sense to cut back on liquor trading hours in the City of Cape Town? What evidence is there that the city’s amended bylaw that will come into effect in January 2011 will have the intended consequences? Among other things the amended bylaw will outlaw bottle stores from selling alcohol on Sundays and will limit off-premise consumption sales on other days to between 9 am and 6 pm. It will also restrict restaurants, taverns and night clubs in residential areas to selling alcohol between 11 am and 11 pm, but premises zoned for business purposes may sell alcohol for consumption on their premises between 11 am and 2 am the next day. Businesses are crying foul, claiming that it will affect their profits and impact jobs. Questions are being raised as to whether this policy will work in an environment where perhaps as many as 80% of liquor outlets are unregulated.

In order to address these legitimate questions it is essential to look briefly at the context in which decisions have been made to reduce liquor trading hours by both the Western Cape provincial government and the City of Cape Town. Contrary to the mantra of the liquor industry that their products are misused by only a small proportion of their customers, the evidence clearly shows this not to be the case. One in four South African drinkers drink at hazardous or harmful levels over weekends, a phenomenon that seems to be getting worse. There is also evidence of increases over time in levels of binge drinking by youth, with past month binge drinking by males in grades 8 to 11 increasing from 29% in 2002 to 34% in 2008. For females the corresponding percentages are 18% and 24%.

In terms of negative consequences alcohol has been shown to be the third largest risk factor for death and disability in South Africa accounting for roughly 7% of all years lost through premature death or years lived with a disability, with the burden coming largely as a result of alcohol’s impact on infectious diseases such as HIV and TB, intentional and unintentional injuries, and neuropsychiatric disorders. The cost of alcohol misuse to the public sector has been conservatively calculated as being in excess of R17 billion per year, with total costs to society estimated to be around 2% of GDP, or roughly R43 billion annually. Research has shown the Western Cape to be particularly burdened by alcohol-related crime and violence, and also by problems associated by foetal alcohol syndrome.

The World Health Organization’s draft global strategy has recently been endorsed by health ministers at the May 2010 World Health Assembly in Geneva. This strategy urges the governments to implement evidence-based strategies. One of the most comprehensive reviews of what works in addressing alcohol problems in different countries is contained in the book Alcohol: No ordinary commodity – Research and Public Policy (2010), which was a collaborative effort of a group of international alcohol policy experts.

These experts reviewed 42 strategies in terms of evidence for effectiveness, breadth of research support, cross-national testing and other considerations such as the population reach, the target group for the intervention, feasibility of implementation, adverse side effects and cost to implement and sustain. Several strategies were rated highly, including increasing alcohol taxes, lowering blood alcohol concentration legal limits for drivers, making brief interventions available for at risk drinkers, and increasing alcohol testing of drivers. Also included in the top 15 strategies were enforcing restrictions on young people’s exposure to alcohol advertising and regulating hours of sale and days of sale. With regard to the latter, there is strong and consistent evidence from several countries that changing the hours or days of trade has a significant effect on the volume of alcohol consumed and on the levels on alcoholrelated problems. Most of the research has been on the impact of increasing hours of sale and it has been clearly demonstrated from studies in Australia, Brazil, Canada, Nordic countries, and the USA that when hours and days of sale are increased, consumption and harm increase.

A few studies have also shown that cutting hours and days of trade reduces the consumption of alcohol and leads to reduced alcohol-related harm. A study in Diadema in Brazil, for example, found that a new law mandating on-premise consumption alcohol outlets to close at 11 pm had the effect of reducing murders by 106 per year, or 30 per 100,000 population (approximately 9 per month). Prior to the new law most bars traded 24 hours a day. Diadema is an industrial city of 360,000 persons located near to São Paolo which, like parts of Cape Town, has poor socioeconomic conditions and high levels of interpersonal violence.

Less rigorously controlled studies in Australia and in South Africa have also shown positive effects resulting from cutting back on hours of alcohol sales. For example, in Tennant Creek in the Australian outback, an aboriginal community group successfully mounted a campaign to close offpremise consumption outlets on the days pay checks arrived and to limit bars on Thursdays and Fridays to opening only after 12 noon. Off-premise consumption sales were limited to between noon and 9 pm on other days. Alcohol-related admissions dropped by 34% and admissions to a womens’ shelter dropped by almost half.

In Siyahlala, an informal settlement of around 1,300 dwellings in the Brown’s farm area of Nyanga, a suburb of Cape Town with the highest murder statistics in South Africa in 2006/7, a broad-based community crime prevention initiative was implemented between May 2006 and June 2007. Over this time crime figures plummeted in Siyahlala from between 5 and 8 murders a month to zero and between 30 and 38 assault cases a month to between 10 and 17. One of the interventions involved getting shebeens to close by 9 pm. The drop in violent crimes correlated closely with the enactment of these early closures and this was backed up by the views of shebeen owners.

With regard to studies of the effects of removing bans on particular days of selling alcohol and reinstating such bans, a study in the US state of New Mexico found that the removal of a ban on Sunday off-premise consumption alcohol sales resulted in a 42% increase in alcohol-related crash fatalities on Sundays. Counties that reinstated the bans experienced a subsequent reduction in alcoholrelated crashes to near where they had been before the removal of the ban.

Reducing hours and days for on- and off premise alcohol sales alone will not be a magic bullet by which to reduce the burden of alcohol. However, if Cape Town could achieve even a third the reduction in murders of Diadema in Brazil, i.e. 10 per 100,000 per year, that would result in 350 less murders in the city each year (or 29 per month). Other benefits are also likely, such as reduced traffic accidents. This is not a strategy we should lightly ignore. Yes, there may be a reduction in the profits of establishments selling alcohol, but the rights of such establishments and the rights of consumers to buy alcohol after 11 pm in a residential area or after 2 pm in a business district must be weighed against the duty of the state to protect the broader population from unnecessary harm and economic burden. There may be other negative consequences, for example, people may leave residential areas to find places to purchase alcohol in business areas after 11 and then drive home in the early hours of the morning under the influence of alcohol. Others may buy several drinks just before 11 pm in drinking establishments in residential areas or before 2 am in business areas, and then leave after having consumed several drinks in a short period of time. This problem can, however, be addressed through more roadblocks testing alcohol levels of drivers. The fact is, with the new restrictions on hours of sale, consumption levels will drop and alcohol-related harm of various kinds will be reduced.

The success of this particular strategy will, however, require resources to be expended on enforcement – ensuring that liquor outlets do not get away with selling outside of the allowable hours. This will require not only getting the police and liquor inspectors to monitor the behaviour of liquor sellers, but also the support from community members who need to play a role in putting pressure on outlets to comply.

To be really effective in bringing down alcohol-related harm in South Africa we need a focused, inter-sectoral alcohol strategy where the different components (e.g. reduced hours of sale, improved training of liquor sellers, more testing of drivers, and provision of treatment to persons requiring it) complement each other. It will also be essential to monitor the effects of different interventions and report back to the broader public on things like compliance with the new liquor outlet bylaws and indicators of alcohol-related crime (such as murders and drunk-driving fatalities) in order to make changes where necessary and also to facilitate ongoing public support.

Charles Parry is the Director of the Alcohol & Drug Abuse Research Unit at the Medical Research Council and an Extraordinary Professor in Psychiatry at Stellenbosch University. He has recently been appointed to the Board of GAPA.