The Burden of Alcohol on the Health Care System

By Dr Zweli Mkhize
Minister of Health, South Africa

The regulations relating to the restriction of alcohol sales have sparked much debate about the role the alcoholic beverage industry plays both in our society and our economy.

It has also exposed the nature of our relationship with alcohol as South Africans – although only 31% of our population drinks alcohol, we consume more alcohol per person than anywhere in Africa and are amongst the top drinkers in the world at 64,6 grams of absolute alcohol per drinker per day (as compared to the global average of 32,8 grams per drinker per day).

Prior to the COVID-19 pandemic, South Africa was already contemplating the devastating effects of alcohol on our society and taking steps towards legislated regulation of alcoholic beverage sales and consumption. A literature review of best international practices showed that measures such as curfews, restriction on days and times of sales, limitations on the amount one person can purchase at a time combined with communication and awareness campaigns had an impact on social behavioral change that led to a quantifiable decrease in interpersonal violence, road accidents and gender-based violence.

The Medical Research Council made the following commentary on their findings when they studied alcohol related unnatural deaths during levels 5, 4 and 3 of lockdown:

“The level 5 lockdown, which included both a prohibition on alcohol sales and a curfew presented the country with a natural experiment. Though we had postulated that there would be a decrease in trauma related mortality, we did not expect such a dramatic result: unnatural deaths plummeted, providing us with evidence that alcohol control coupled with a curfew was a significant intervention to control unnatural deaths in our country. This significant impact was reversed when alcohol sales were allowed and people could move about at night. The decline in unnatural deaths has again occurred following the recent temporary ban on alcohol and the re-introduction of a curfew.”

Data on alcohol induced injuries was also obtained from a sentinel trauma report shared by the Western Cape Government. The data clearly shows that the lockdown regulations and the alcohol ban effectively reduced the number of trauma presentations to the order of 40-50% in the Western Cape. Prior to the lockdown (30 January to the 26 March 2020) there was a consistent trend of weekend increases in trauma cases (140-160) across five facilities sampled, with the average being 89 trauma cases in the province. During the lockdown and the alcohol ban (26 March to 21 April 2020), there were 60-80 trauma cases at the weekend with the average of 46 across the five selected facilities sampled over that period. Immediately after the alcohol ban was lifted the number of trauma cases in a single day (07 June 2020) went up to 98 cases in the five selected facilities (a 53.1% increase). The average during that period (01 June to 08 June) increased to 90 trauma cases per day (66% increase).

The graph below clearly demonstrates the dramatic drop in unnatural causes of deaths following the alcohol restrictions under level five; the return to average levels following the easing of those restrictions during level 3; and a return to the lower prediction when the restrictions were re-instituted.

These deaths represent significant burden to the health care system and to the economy at large. In 2009, it was found that the direct cost to the state from alcohol related injuries was R17 billion, while in the same year the government collected 16 billion from the industry in taxes and excise duties. Whilst these numbers may be dated, it does indicate that the argument that the industry contributes to the economy is not compelling enough to simply allow irresponsible alcohol consumption to go unabated

With such clear evidence of the deleterious impact of alcohol on our health care system, economy and society, it is clear that we all need to work together – industry, civil society, communities and government – to ensure that we get the best out of the industry and limit the negative effects of excessive alcohol consumption.

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