South Africa: ‘Nightmare’ at Hospitals as Alcohol Sales Restart
Which alcohol policy path is South Africa going to take? After a two month long ban on alcohol sales, South Africa lifted the ban from June 1, as the country entered the third phase of the lockdown. But as alcohol sales restart the situation in hospitals is characterized as a ‘nightmare’ with alcohol related injuries filling up the emergency departments. The question is whether the government will bow to alcohol industry pressures or act in the interest of communities and society burdened by alcohol harm.
As Movendi International reported, the South African government implemented an alcohol sales ban early on when the coronavirus crisis hit the country, as part of its public health response to contain the spread of the virus. The alcohol sales ban was intended to reduce the heavy alcohol burden on the country and specifically on the healthcare system. Big Alcohol has been relentless in their opposition of the ban from the beginning.
But the benefits of the governments approach to alcohol during the public health crisis showed very positive results quickly.
As the alcohol sales ban is lifted now, the decline in alcohol-related injuries and trauma cases seen in hospitals in South Africa is reversing. Trauma specialists said that during the first two months of lockdown, trauma admissions dropped by 70% at hospitals in Gauteng and the Western Cape. Those declines, according to the South African Medical Research Council (SAMRC), are now being dramatically reversed.
SAMRC modelling predicts that 5,000 patients a week will burden hospitals with injuries related to alcohol use. According to Professor Charles Parry, director of SAMRC ’s alcohol, tobacco and other drug research unit, out of the 2.2 million trauma cases in South Africa each year, 40% are alcohol-related. Under lockdown, weekly trauma admissions would have decreased from 42,700 to about 15,000.
“People are going to die,” warns doctors
Between March and May this year, trauma admissions at Baragwanath Hospital dropped from 3,761 (an average of 41 cases a day) to 2,715 (an average of 30 cases a day). Since lifting the ban on June 1 alone, the hospital had 117 emergency trauma admissions.
The Helen Joseph Hospital emergency department in March received 506 assault patients, an average of 16 a day. That dropped to 208, seven a day, in April. In the first three days of June alone the hospital received 66 assault patients, an average of 22 a day. Car accident victims have also increased with the lifting of the alcohol sales ban. It reduced to six a day in March and then two a day in April and has now increased to 12 a day.
Healthcare professionals are saying the increase in trauma patients is over-burdening the healthcare system that is strained under COVID-19. Some hospitals are quickly getting overwhelmed with the sharp increase in patients.
People are going to die because there are not enough staff to look after everyone at the same time. With staff becoming infected by Covid-19, it’s going to get worse,” said Dr Pat Saffy, head of the Helen Joseph Hospital emergency department, as per Sunday Times.
Professor Elmin Steyn, Tygerberg Hospital’s head of surgery and the trauma unit, said as per Sunday Times:
If trauma cases block ICUs and operating rooms. In times of such overwhelming injury numbers there are delays to emergency surgery, which lead to serious complications in a patient, which adds to the existing overload on the intensive care unit,”
According to Professor Ken Boffard, trauma director of Netcare’s Milpark Hospital, normal alcohol-related trauma cases are about 60% of all trauma admissions. Under lockdown he recorded a 70% reduction in trauma cases at the hospitals. However since lifting the ban he reports an almost doubling of trauma cases.
Support to extend the ban
Several high-profile ANC ministers and organisations in South Africa are in support of banning alcohol again as news of the spike in alcohol harm since lifting the ban spread.
Minister of Police, Bheki Cele supports to extend an alcohol ban even beyond the lockdown. Minister of Cooperative Governance and Traditional Affairs, Nkosazana Dlamini-Zuma supports keeping alcohol banned untill lockdown 1. The ANC Women’s League have rejected lifting the alcohol ban while the country is under a National State of Disaster.
More politicians including the Eastern Cape Premier, Oscar Mabuyane; EFF leader, Julius Malema; Gauteng Education MEC, Panyaza Lesufi; Gauteng Health MEC, Bandile Masuku; and IFP President Velenkosini Hlabisa have backed maintaining the alcohol ban.
New laws for safer roads
The National Road Traffic Amendment Bill was approved by the South African Cabinet for submission to Parliament in March this year. Despite the COVID-19 setbacks the draft law has been released. The amendment brings a 0% blood alcohol level (BAC) for all motor vehicle drivers in the country.
As Movendi International reported, the law was initially set to be active from June, the date has been pushed back but Transport minister Fikile Mbalula promises the law will come into force from January 2021.
According to the Bill’s explanatory memorandum, the amendment has the effect of introducing “a total prohibition for the use and consumption of alcohol by all motor vehicle operators on South African public roads”.
Big Alcohol influence in South African alcohol policy making
South Africa took timely action to ban alcohol sales during COVID-19, which eased the burden on the healthcare system significantly and saved lives. Now with lifting the ban, the situation is turning bad again. The government’s continuous partnerships with Big Alcohol will take it from bad to worse. Despite the cabinet’s own decision to stop taking handouts from the alcohol industry and the government’s own acknowledgment that alcohol is a threat to public health, the South African government continues to take industry money and partner with Big Alcohol companies.
In 2010, the Cabinet decided to stop partnering with the alcohol industry, for instance by allowing it to sponsor events. However, according to South African Breweries (SAB) spokesperson, Refilwe Masemole, SAB continues to work with the national department of transport on road safety programmes. The breweries’ website lists partnerships with at least five other national and provincial departments in the last seven years.
But the alcohol industry has a clear and fundamental conflict of interest that pits it agains the public interest of promoting health and welfare for all. In pursuit of ever more profits in South Africa, alcohol giants are using an array of aggressive, harmful and often unethical strategies, such as over-sized bottles, extremely cheap products and an avalanche of marketing and lobbying. For instance, the world’s biggest beer giant, AB InBev, is pumping up the volume in Africa through ultra-cheap beer in extremely large containers. A beer war is unfolding on the back of people and communities with major rival Heineken.
A lobbying onslaught lead to the dissolving of the inter-ministerial committee on alcohol and substance abuse that worked between 2011 and 2017 on producing both research and draft regulations — including the 2013 Control of Marketing of Alcohol Beverages Bill. The committee spent nearly a decade producing evidence-based alcohol policy solutions for South Africa that have never been made public.
In the absence of the bill, the industry self-regulation of marketing is failing to protect children and youth from alcohol promotions.
The Control of Marketing of Alcohol Beverages Bill of 2013, would have proposed banning alcohol advertising and sponsorships in line with World Health Organisation recommendations, according to a 2013 government statement announcing that Cabinet had approved the Bill and was ready to gazette it.
According to Zane Dangor special advisor to the chairperson of the inter-ministerial committee, lobbying by various industries and disagreements among policymakers are to blame for freezing nearly 10 years’ worth of work by the committee, including the drafted ban on alcohol advertising and sponsorship.
Big Alcohol company Diageo has refuted claims that they had anything to do with the bill’s disappearance.
Whether the alcohol industry did or did not influence the bill, may remain a question, but the fact that Big Alcohol manipulates policy in South Africa is backed by evidence.
The alcohol-funded non-profit, the Industry Association for Responsible Alcohol Use (ARA), which disbanded in 2015, commissioned a report in 2013 highlighting the Bill’s adverse socio-economic effects such as the possible damage to jobs in national sports teams, entertainment, and media. The main driver behind the report was the South African Liquor Brandowners Association, Salba, along with South African Breweries SAB.
A 2018 study in the journal Health Policy and Planning, surmised the report was a “perception strategy” that diverted attention from the problem of alcohol advertising “by creating a narrative that banning alcohol advertising would only hurt the economy without being effective in curbing alcohol-related harm”.
at the time, it was also reported that an alcohol industry-backed agency went as far as publishing two full page advertisements for over two weeks in the newspaper Sunday World to target those who advocated for the bill.
Since the bill, the government has commissioned three reports into the possible impacts of The Control of Marketing of Alcohol Beverages Bill of 2013. The third report, led by the health department, was never made public.
Now, The National Liquor Amendment Bill is also facing a similar fate. While this bill falls short of a complete liquor advertising and sponsorship ban, it proposes to raise the legal age for alcohol purchase to 21 and restrict advertising.
A 2017 study commissioned by the National Economic Development and Labour Council (Nedlac) and conducted by Genesis analytics estimates the legislation could save South Africa up to about R2 billion a year and 185 lives annually.
The South African Broadcasting Company is already pushing against the bill claiming it will cause losses for the company – basically using the same arguments as before.
Alcohol industry self-regulation failure
South Africa’s existing Liquor Act prohibits misleading promotion, but alcohol marketing is self-regulated. The Advertising Regulatory Board (ARB) monitors whether alcohol companies adhere to their own self-regulation codes of conduct.
It has been proven that this self-regulation is simply not good enough. Many unethical advertising strategies are still continued. For example, Carling Black Label launched a promotion to raise awareness about domestic violence with the tagline #NoExcuse, In 2017, Johnnie Walker put up 100 life-sized golden statues of its logo’s walking man on Nelson Mandela Bridge in Johannesburg as part of a campaign against domestic abuse. This type of advertising promotes brands and brand awareness is associated with higher brand specific alcohol consumption.
Considering alcohol’s link with violence and specifically domestic violence, this type of marketing is also contradictory and unethical. The 2016 Sonke Change Trial, that studied the reasons for men’s violence against women, found heavy alcohol use increased the odds of violence of men (who already had violent tendencies) against women by 50%.
Reducing the alcohol burden in South Africa
Charles Parry from SAMRC suggests the following actions to reduce South Africa’s alcohol burden:
- Lower the legal blood alcohol level for drivers to zero.
- Mandatory testing of blood alcohol levels after car accidents.
- Ban the sale of alcohol in larger containers.
- Allow advertising of alcohol only in shops and online where liquor is sold.
- Publicly advertise helplines and psychological and medical care for people with alcohol use disorders.
The future will tell whether South African law makers will act on the experience of the COVID-19 related alcohol sales ban and heed the advice from communities across the country, or whether they will bow, once again, to alcohol industry pressures.
For further reading from the Newsfeed:
Sunday Times: “‘Nightmare’ at hospitals as alcohol takes its toll”
[This article was edited on June, 16th 2020 according to new information received via The South African.]