A success story from Western Cape in South Africa, with (still) an open ending – about how to use evidence to tackle a massive problem and generate political will and momentum in doing so…

Using evidence to tackle alcohol harm – a success story

Alcohol use is high in South Africa. Too high. And so is alcohol-related harm. I have seen it with my own eyes when I traveled the region and visited our members in Johannesburg.

Fortunately, there are people across the country working tirelessly to put a cap on alcohol consumption, using the best available evidence, such as the Global Burden of Disease study.

Health challenges can seem insurmountable and unimaginably vast. Consider, for instance, the context of South Africa: The combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 to 12% of the 2009 gross domestic product (GDP). The tangible financial cost of alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP.

The costs of alcohol-related harms provide a substantial counterbalance to the economic benefits highlighted by the alcohol industry to counter stricter regulation. Curtailing these costs by regulatory and policy interventions contributes directly and indirectly to social well-being and the economy,” Matzopoulos and colleagues argue.

Generating evidence that matters locally

Alcohol harm is a massive obstacle to sustainable development in South Africa, draining the economy and burdening public health. The case for investing resources in alcohol policy and prevention seems clear, doesn’t it? Nevertheless, health investments are still viewed as bottomless pits.

Evidence can help change that ill-fated perception. And Professor Craig Househam, head of the health department for the Provincial Government of the Western Cape of South Africa set out to do just that.

In 2005, he commissioned a burden of disease study for the Western Cape province. His study was rooted in a national burden of disease study conducted by the South African Medical Research Council in 2000, which emerged from the Global Burden of Disease findings from 1993. The Western Cape Health Department used the evidence published in a 2007 report to motivate local government officials to address a major cause of premature death and disability: alcohol.

The study revealed that alcohol was among the most prominent causes of disease burden in the province, primarily by contributing to injuries from road accidents and violence.

In 2013, alcohol was recognized as the 3rd leading risk factor for death and disability in South Africa, following unsafe sex and obesity. It’s also a dominant substance of abuse in the Western Cape. Cases of Foetal Alcohol Spectrum Disorder (FASD) recorded in the Western Cape are among the highest in South Africa. Evidence shows the massive burden alcohol places in the Western Cape province:

  • 35.2% of Western Cape learners in grades 8-11 binge drink – more than any other province.
  • 70% of crimes in Western Cape communities are linked to harmful substances.
  • 67% of domestic violence in Western Cape communities is alcohol related.
  • 70% of trauma victims in Western Cape hospitals test positive for alcohol.
  • 18 to 26% of grade 1 learners in certain high-risk communities in Western Cape showed signs of FASD.

When evidence helps to empower politicians

The authors of the study analyzing the disease burden highlighted their findings about the negative health effects of alcohol in public hearings on liquor laws in the province. That transformed the discourse and perspectives. Instead of regarding alcohol harm as a bottomless pit, decision-makers in the Western Cape province were empowered to look at all aspects of the issue.

They were able to discuss what the economic benefit of alcohol in the province is, and weigh that against the public health, social and economic harm and costs from alcohol use. This consideration ultimately enabled them to take specific steps to reduce alcohol use after learning about the harm it was causing in their communities. They tightened restrictions on alcohol, such as limiting the hours that liquor could be sold in Western Cape and requiring previously unregulated liquor vendors to obtain licenses.

Understanding the burden of disease is fundamental to the planning and decision-making processes in health departments,” Househam wrote in 2007.

Rather than being reactive to the pressures placed upon the health system, information is actively sought that will enable Government to act in a manner that begins to address – and indeed reduce – the burden of disease.”

Evidence, political will and progressive alcohol policy

Western Cape has come a long way. And it seems like it is just getting started. The government of Western Cape writes:

Our existing laws and policies focus on the regulations of licensing, production, distribution and sale of alcohol, but do not address the impact and consequences of alcohol-related harms on society.

We need change, and we need your help to make it happen.”

The Western Cape Government issued the so called “The Alcohol Harms Reduction Green Paper” as the first step towards making the communities safer and creating more opportunities, by minimising alcohol consumption and reducing unnecessary harm to individuals, families and society as a whole.

This Green Paper has been open for public consultation until a few days ago. As the consultation is now closed, the government says it will continue to gather information from communities to create a policy that works. We will make sure to give input through our members.

Latest by March 2017, we will know what the cabinet is deciding, with regard to evidence-based alcohol policy measures. And so, we are hoping that this success story will have a happy ending.