Western Cape tackles alcohol menace
New green paper is a step in the right direction, writes CHARLES PARRY
THE Western Cape government has approved an alcohol-related harms reduction policy green paper that goes beyond the largely sectoral approach that has been followed to date in terms of which policies of one department potentially contend with those from others.
The policy is out for public comment before being formulated into legislation and regulations.
The provincial government is to be commended for giving due consideration to the complexities of the problem and steps that can be taken to turn things around.
It is the first province to formulate a far-reaching policy going beyond a narrow focus on the retail sale of alcohol and microbrewing. While recognising the economic contribution of alcohol to the Western Cape, it indicates that it can’t be business as usual for the liquor sector, including unregulated outlets, as the economic contribution is “dwarfed by the costs of alcohol-related harms”.
The green paper also understands that alcohol industry profits are dependent on excessive drinking and that a greater contribution from the industry in combating the burden placed on social welfare systems is required.
This harm-reduction approach is underpinned by a rights-based philosophy that emphasises the rights of individuals, families and communities to live healthy lives — and not just the rights of economic operators to make money and create jobs.
The development of the green paper represents a major step forward. In 2011, the City of Cape Town instituted a policy that would limit alcohol sales in urban precincts until 2am. In 2013, following pressure from liquor traders, the city backed down and again allowed the sale of alcohol until 4am at outlets that applied for a special extension.
In her state of the province address in February, Premier Helen Zille indicated that the Western Cape Liquor Authority would be moved from the department of economic development and tourism to the department of community safety. This signalled her cabinet’s “seriousness in reducing access to alcohol”, she said.
Extrapolating from national estimates presented in the South African Medical Journal in 2014, the harmful use of alcohol is likely to cost the Western Cape about R6bn a year in direct costs, about 25 lives every day — mostly as a result of alcoholrelated murders — and contributes substantially to the rising level of noncommunicable diseases such as cardiovascular disease, cancer and diabetes as well as to the burden of mental disorders, HIV/AIDS and tuberculosis.
Levels of foetal alcohol disorder are as high as 26% among Grade 1 pupils in certain parts of the province. All indicators seem to point to the levels of alcoholrelated risk behaviour, such as binge drinking among school-age youth, and alcohol-related harms, such as murders, as being highest in the Western Cape.
The interventions proposed focus on upstream (supply side) interventions and on the internationally recognised best buys for reducing alcohol-related harm — increasing price, reducing availability, restricting marketing, tackling drink-driving and increasing the provision of brief interventions in health settings. A
NUMBER of specific best-practice interventions and innovations are proposed. With regard to availability, the green paper indicates that it will tackle the issue of the density of liquor outlets (the number of outlets per 1,000 residents) in an area, which has been shown through research to be related to harms such as alcohol-related deaths.
It will do this by taking into account a statistically determined level of harm in a community, such as alcohol-related road trauma and violence.
The Western Cape government is also considering a pilot initiative to assist in bringing illegal outlets into the legal space or to encourage them to move out of the alcohol trade altogether and into other useful enterprises. Undergoing training and passing a test on the Western Cape Liquor Act will be one requirement for obtaining and retaining a liquor licence.
The green paper recognises that the majority of unregulated outlets are unlikely to meet the standards required for licensing and it will seek to guide those outlets in pursuing alternative economic opportunities, but details on how this will be achieved are scant at this stage.
It will also look into ways to determine “effective and cost-efficient disruption mechanisms” that could be put in place to increase the cost for companies distributing legally produced alcohol via illegal markets.
The policy document is calling for communities to be more involved in providing information on unlicensed outlets or outlets operating outside of the regulated hours or in other ways not abiding by regulations, such as selling to underage youth.
This worked in the past in one part of Khayelitsha, where the community was involved in working with the authorities to ensure that liquor outlets closed at 10pm on Sundays to Thursdays.
This resulted in a drop in the number of murders in that area.
Should a national alcohol advertising ban not be realised, the green paper calls for prohibiting the advertising, marketing and promotion of alcohol products at all public facilities and events organised by the Western Cape government.
To reduce road-related injuries and fatalities as a result of alcohol use, the policy calls for imposing restrictions on the sale of alcohol on premises that are on provincial roads, increasing random breath and blood alcohol testing of drivers, and legislating breath alcohol limits for pedestrians on certain classes of roads and at certain times. Testing should be instituted at hot spots where alcoholrelated pedestrian crashes are prevalent.
The policy aims to improve enforcement in other ways by ensuring that transgressions result in appropriate judicial consequences by increasing the number of trained liquor-enforcement officers, lobbying for well-prepared police dockets, establishing one overarching liquor enforcement centre, and mobile testing for breath and blood alcohol by an approved, legally admissible device. T
HE green paper recognises the importance of information, data collection, monitoring and evaluation and calls for the implementation of a purpose-built monitoring and surveillance system.
This will include, for example, better collection of data from local, liquor and SAPS authorities with regard to licences, transgressions and actions.
The policy also details the need to collect regular information in the province on alcohol sales and self-reported consumption together with information on alcohol-related harm, such as single-vehicle night-time fatal crashes per 100,000 registered vehicles.
This information will be used to assess progress over time and can be used in more formal reporting, which the policy document proposes takes place annually. Based on the data, it will be possible to make timely adjustments to interventions and ensure the optimal use of resources.
The policy’s emphasis on a “small-wins” strategy is a realistic way to build momentum for attending to the harmful use of alcohol over time.
The green paper acknowledges that not all policies identified as being effective by the World Health Organisation and others are a provincial competence.
The policy indicates that the Western Cape will lobby the national government to increase excise taxes to make alcohol more expensive or introduce minimum unit pricing, make it cheaper to buy low-alcohol drinks and implement a system to track the distribution and sale of liquor products.
It will also lobby national authorities to impose restrictions on the sale of alcohol on premises that are on national roads and to implement a graduated driving licensing policy in terms of which young or novice drivers are not allowed to test positive for any alcohol when driving.
It proposes lobbying the national government to ban alcohol advertising visible to any person under the age of 18 years and to impose restrictions on sports advertising and promotions that link alcohol to aspirational achievement.
The national government will be lobbied to institute stronger punishments for certain offences, such as licence suspensions for drink-driving offences and dropping the blood alcohol concentration level in drivers to 0.02g/100ml of blood, with the proviso that there would be noncriminal sanctions for offenders with levels greater than 0.02, but less than 0.05.
It will also call for blood samples to be obtained from people involved in crashes as soon as possible following the incident.
The green paper recognises that institutional arrangements will play a critical role in implementing the policy, and in particular, that there needs to be co-operation across spheres of government and departments.
It proposes four models for overseeing the liquor licensing process, but falls short of putting forward a leadership mechanism for ensuring the broad policy is implemented effectively.
After the policy is approved by the legislature, it will be important to set priorities, clear budgets and action steps for each component.
Other provinces and other parts of the world will be watching the passage of this legislation through the provincial legislature with interest, but the real test will be whether it is weakened as it goes through the legislative processes and the extent to which it is effectively implemented.
The Western Cape will face several challenges in implementing this ambitious policy, particularly in building trust with communities, bringing on board viable unlicensed outlets, supporting the development of economic alternatives to running a shebeen, and getting people involved in running outlets that are never going to get a liquor licence to move out of the liquor trade.
Keeping the rest of the population up to speed with developments and accomplishments will be essential in moving this worthy agenda forward. Having a good policy, such as the one on the table, however, is an excellent start.
This harm-reduction approach is underpinned by a rights-based philosophy that emphasises the rights of individuals, families and communities to live healthy lives
Prof Parry is the director of alcohol, tobacco and other drug research at the South African Medical Research Council.
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