Public appeal to Government: Urgent measures to curb the abuse of alcohol linked to gender-based violence

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The Covid-19 epidemic has shone a light again on the value of each human life, and the message from our leaders is that lives must be saved through urgent and radical action. In his speech to the nation on Wednesday 17 June 2020, President Ramaphosa stated that, especially in the light of the unbridled violence against women and children, “we will also need to look at further, more drastic measures to curb the abuse of alcohol”.

Gender-based violence is driven by gender inequality, made worse by social and economic marginalisation, failures of policing and justice, and the abuse of drugs and alcohol. No single intervention will address it, and we must tackle all of these factors at the same time.  We note the steps that have been taken as part of the National Strategic Plan to Combat Gender-Based Violence.  We also agree with the President that it “is not alcohol that rapes or kills a woman or a child.  Rather, it is the actions of violent men.  But if alcohol intoxication is contributing to these crimes, then it must be addressed with urgency”.

In this regard, there are a number of ‘best buy’ measures that the World Health Organization has identified which are highly cost-effective, feasible and implementable at low cost[1],[2]. These are not drastic measures. They make both economic and social sense and need to be implemented as a matter of urgency.  They include:

1. A ban on advertising of alcohol (except on the site of sale, where it should not be visible to those under 18 years).
2. Increase the price of alcohol, both through excise taxes and by introducing a minimum price per unit of pure alcohol in liquor products.
3. Reduce the legal limit for drinking and driving to a blood alcohol content of 0.02% or below.
4. Reduce the availability of alcohol, especially in residential areas (by limiting the density of liquor outlets, shorter trading hours, and ending the sale of alcohol in larger containers like 1 litre bottles of beer).
5. Intensify the availability of counselling and medically assisted treatment for persons struggling with dependence.[3]

Binge-drinking is a strong proximate risk factor for violence against women and children, and a notable contributor to intimate femicide[4]. 50-60% of South African men who drink alcohol drink in heavy, episodic ways (> 5 units at one time).^[5], [6] Alcohol is an acknowledged factor in perpetration of more than 40% of rape[7]. In addition, binge-drinking is strongly associated with interpersonal violence, motor vehicle accidents and risk-taking behaviour. These associations are even stronger in poorer communities than wealthier ones.

The measures described above have been shown to significantly reduce the societal harm of alcohol and should be supported by other interventions shown to be effective, including raising the legal drinking age to nineteen years and ensuring that product tracking and tracing is in place to close the supply routes to illegal vendors. These provisions are included in the Draft Liquor Amendment Bill. We call on the government to proceed with the implementation of this Bill and other legislation aimed at reducing alcohol harm such as the Control of Marketing of Alcoholic Beverages Bill.

Equally critical is effective enforcement of national and provincial legislation and local by-laws, including adherence to trading hours, prevention of underage drinking, confiscation of alcohol sold at illegal outlets and restrictions on public drinking.[8]

The alcohol industry will point to its contribution to GDP of about 3% per year, and we recognise its benefits to the local economy and the value of its exports. However, this contribution does not take into account its costs to society and the economy. Alcohol causes the deaths of 62000 South Africans every year.[9] When the direct costs of alcohol-related crime and injuries are factored in, the net economic benefit of the industry is halved (to about 1.5% of GDP). When alcohol-related premature morbidity and mortality is factored in, the net contribution is negative. In other words, the alcohol industry costs the country more than it contributes to the economy.[10] These costs stem largely from excessive drinking that is not sufficiently curbed by legislation and policy.

Reducing the benefit and harm of alcohol to economic terms alone masks the devastating effect on the lives of families and individuals harmed through the abuse of alcohol.  The liquor industry and lobby groups will point to individual freedoms and rights. We agree. This is a critical consideration, and it is the role of government to ensure that the freedoms and rights of one part of society is not upheld to the detriment of another. None of the interventions above are intended to restrict responsible alcohol use and social drinking. They are aimed at curbing the harm of excessive drinking. We can no longer allow poorer people, and women and children in particular to bear the costs of alcohol abuse.

Many of the individuals and organisations described below have undertaken substantial research with respect to the potential impact and viability of implementation of the measures described above.  We would be pleased to work with government to inform the drafting of the relevant legislation and policies.

Support as institutions:

• South African Medical Research Council (SAMRC)
• Chronic Disease Initiative for Africa at the University of Cape Town (CDIA)
• DG Murray Trust (DGMT)
• Public Health Association of South Africa (PHASA)

Signatories

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Total number of signatories at 10:32  29/06/2020: 164 (This list is updated a number of times a day)

Category: Academic/research/medical

1. Prof Glenda Gray, President, South African Medical Research Council (SAMRC)
2. Prof Charles Parry, Director: Alcohol, Tobacco & Other Drug Research Unit, SAMRC
3. Ms Jane Simmonds, Alcohol, Tobacco & Other Drug Research Unit, SAMRC
4. Prof Rob Warren, Unit Director: Centre for Tuberculosis, SAMRC 
5. Mr Brinton Spies, Executive Director: Human Resources, SAMRC
6. Prof Andre Pascal Kengne, Non-Communicable Diseases Research Unit SAMRC
7. Mr Wisdom Basera, Epidemiologist, SAMRC
8. Ms Rifqah Roomaney, Senior Scientist, Burden of Disease Research Unit, SAMRC
9. Prof Angela Mathee, Director: Environment & Health Research Unit, SAMRC
10. Dr Arvin Bhana, Director: Environment & Health Research Unit, SAMRC
11. Dr Pam Groenewald, Specialist Scientist Public Health, Burden of Disease Research Unit, SAMRC
12. Ms June Teare, Senior Scientist, Environment & Health Research Unit, SAMRC
13. Ms Busisiwe Shezi, Senior Scientist, Environment & Health Research Unit, SAMRC
14. Mr Sulaiman Abrahams, IT Admin Burden of Disease Research Unit, SAMRC
15. Dr Catherine Mathews, Director: Health Systems Research Unit, SAMRC
16. Prof Jeffrey Mphahlele, Vice President for Research, SAMRC
17. Prof Richard Matzopoulos, Co-Director: Burden of Disease Research Unit (SAMRC); Honorary Professor, UCT School of Public Health 
18. Prof Susan Fawcus, Emeritus Professor and senior Scholar, Dept Obstetrics and Gynaecology, UCT; and Peoples Health Movement
19. Dr Virginia Zweigenthal, Public health specialist, School of Public Health and Family Medicine, UCT and Health Impact Assessment, Western Cape Department of Health (WCDoH)
20. Prof Hassan Mahomed, Public Health Medicine Specialist, WCDoH / Division of Health Systems and Public Health, Stellenbosch University
21. Prof Leslie Swartz, Distinguished Professor: Department of Psychology, Stellenbosch University  
22. Dr Lizahn Cloete, Medicine and Health Sciences, Division of Occupational Therapy, Stellenbosch University
23. Prof Soraya Seedat, Faculty of Medicine and Health Sciences, Stellenbosch University
24. Prof Keymanthri Moodley, Professor and Director, Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University
25. Prof Leslie London, School of Public Health and family Medicine, University of Cape Town (UCT)
26. Prof Mohamed Jeebhay, School of Public Health and family Medicine,  UCT
27. Prof Andrew Boulle, School of Public Health and family Medicine,  UCT
28. Dr Tracey Naledi, Division of Health Medicine, School of Public Health and Family Medicine, UCT
29. Dr Morna Cornell, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, UCT
30. Dr Shahieda Adams, Division of Occupational Medicine, School of Public Health and Family Medicine, UCT
31. Prof David Coetzee, Division of Occupational Medicine, School of Public Health and Family Medicine, UCT
32. Dr Nisha Jacob, Division of Occupational Medicine, School of Public Health and Family Medicine, UCT
33. Dr Chivaugn Gordon, Head, Undergraduate Obstetrics & Gynecology, UCT
34. Dr Peter Delobelle, Senior Researcher, Chronic Disease Initiative for Africa, UCT
35. Prof Corne van Walbeek, Professor of Economics and Director of Research Unit on the Economics of Excisable Products (REEP), UCT
36. Ms Nicole Vellios, Researcher, Research Unit on the Economics of Excisable Products, UCT
37. Dr Hana Ross, Principal Research Officer, REEP, UCT
38. Ms Tali Cassidy, HIV Epidemiologist, Médecins Sans Frontières, Khayelitsha
39. Prof Martin Smith, Academic Head of the Department of Surgery, University of the Witwatersrand (WITS)
40. Prof Jane Goudge, Centre for Health Policy, School of Public Health, WITS
41. Prof Karen Hofman, Director Priceless SA, SA MRC/Centre for Health Economics and Decision Science, School of Public Health, WITS
42. Prof Brett Bowman, Professor and Assistant Dean (Humanities Research), School of Human and Community Development, WITS
43. Dr Nechama Brodie, Researcher and lecturer, WITS
44. Prof Gillian Eagle, Department of Psychology, WITS
45. Prof Gill Nelson, Head: Occupational Health Division, School of Public Health, WITS
46. Prof David Rees, Emeritus Professor, WITS
47. Dr Harsha Somaroo, Public Health Specialist, Department of Community Health, WITS School of Public Health/ Charlotte Maxeke Johannesburg Academic Hospital
48. Prof Yousuf Vawda, School of Law, University of KwaZulu-Natal (UKZN)
49. Dr Velile Ngidi, Public Health Medicine Registrar, UKZN
50. Prof Saloshni Naidoo, Associate Professor/ Head of Department, Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, UKZN
51. Ms Mary de Haas, Honorary Research Fellow, School of Law UKZN
52. Dr Waarisa Fareed, Private Practitioner 
53. Prof Willem Hanekom, Director, Africa Health Research Institute (AHRI)
54. Prof Helen Schneider, School of Public Health, University of the Western Cape 
55. Dr Anam Nyembezi, School of Public Health, University of the Western Cape 
56. Prof Michael Pepper, School of Medicine, Department Immunology, University of Pretoria
57. Dr Sherianne Kramer, Amsterdam University College
58. Dr Saiendhra Moodley, Public Health Medicine Specialist, School of Health Systems and Public Health
59. Prof Francis Hyera, HOD – Public Health, Faculty of Health Sciences, Walter Sisulu University
60. Ms Jane Simmonds, Programme Manager- goGOGOgo, SAMRC
61. Dr Wanga Zembe-Mkabile, Programme Manager- goGOGOgo, SAMRC
62. Ms Trisha Ramraj, Scientist, SAMRC
63. Ms Neetha Shagan Morar, Research Manager, HIV Prevention Research Unit (HPRU), SAMRC
64. Mr Zakir Gaffoor, Clinical Research Site Leader, SAMRC
65. Mr Naren Dhoodhanath, Human Resources Generalist, SAMRC
66. Dr Terusha Chetty, Specialist Scientist, SAMRC
67. Ms Olive Gumede, Finance Manager, SAMRC
68. Mr Sindisiwe Hlangu, Data collector, SAMRC
69. Ms Kubashni Woeber, Laboratory Scientist Manager, SAMRC
70. Ms Inathi Maxhakana, Senior Research Technologist, SAMRC
71. Dr Brodie Daniels, Senior Scientist, SAMRC
72. Ms Kerusha Chunderduri, Regulatory and Quality Coordinator, HPRU, SAMRC 
73. Dr Naeemah Abrahams, Interim Unit Director, SAMRC
74. Prof Tina Steiner, Associate Professor of English Studies, Stellenbosch University 
75. Dr Grieve Chelwa, Senior Lecturer, UCT
76. Prof Kopano Ratele, SAMRC-Unisa Masculinity and Health Research Unit, University of South Africa
77. Prof Lynn Morris, Executive Director (interim), National Institute for Communicable Diseases (NICD)
78. Dr Elizabeth Spooner, Interim Deputy Director HPRU, SAMRC
79. Prof Samuel Manda, Director: Biostatistics Research Unit, SAMRC
80. Prof Charles S Wiysonge, Director: Biostatistics Research Unit, SAMRC
81. Dr Moeketsi Modisenyane, President, Public Health Association of South Africa (PHASA)
82. Dr Harsha Somaroo, Vice President PHASA
83. Dr Natisha Dukhi, Board member, PHASA
84. Prof Stephen Hendriks, Board member, PHASA
85. Mr Tawanda Chivese, Board member, PHASA
86. Dr Thameshree Naidu, Board member, PHASA
87. Dr Mohammed Ishaaq Datay, Chairperson: PHASA health promotion SIG
88. Mr Mbongeleni Buthelezi, Health Counselor, SAMRC
89. Dr Makandwe Nyirenda, Demographer, SAMRC
90. Mr Praba Govender, SHE Officer, SAMRC
91. Dr Fareed Abdullah, CTU Programme Director, HIV Prevention Unit, SAMRC
92. Prof Debbie Bradshaw, Director: Burden of Disease Research Unit, SAMRC
93. Prof Ameena Goga, Interim Unit Director: HIV Prevention Research Unit, SAMRC
94. Mr Mzimhle Berrange Popo, General Counsel, SAMRC
95. Dr Mongezi Mdhluli, Chief Research Operations Officer, SAMRC
96. Prof Sarah Skeen, Department of Global Health, Stellenbosch University
97. Assoc Prof Simone Honikman, Director: Perinatal Mental Health Project, UCT
98. Dr Nimi Hoffmann, Lecturer, University of Sussex
99. Prof Fiona Ross, Professor of Anthropology, UCT
100. Prof Andrew Spiegel, Emeritus Associate Professor, Antropology, UCT
101. Ms Lori Lake, Communication and education specialist, Children’s Institute, UCT
102. Ms Neziswa Titi, Researcher, Children’s Institute, UCT
103. Ms Thanya April, Counsellor, The Perinatal Mental Health Project, UCT
104. Prof Martha Van Der Walt, Director, Tuberculosis Research Platform, SAMRC
105. Assoc Prof Helen Macdonald, Anthropology, UCT
106. Ms Elise Farley, Epidemiologist, UCT
107. Emeritus Prof P L A Bill, Emeritus Professor of Neurology, UKZN
108. Dr Alfred Thutloa, Head of Corporate Communications, SAMRC
109. Ms Neziswa Ntante, Transcriber, Institute for Life Course Health Research, Stellenbosch University
110. Dr Takalani Grace, Senior Lecturer, University of Venda
111. Ms Pakeezah Rajab, Research Psychologist, Psychological Society of South Africa
112. Mr Gareth Newham, Head of the Justice and Violence Prevention Programme, Institute for Security Studies
113. Ms Emmanuelle Daviaud, Senior Specialist Scientist, SAMRC
114. Dr. Chandré Gould, Senior research fellow, Institute for Security Studies
115. Ms NKhensani Golele, Lecturer, Univen
116. Dr Pieter Aartsma, Psychiatrist (private practitioner)
117. Ms Tirhani Masia, Lecturer, University of Venda

Category: Government

1. Mr Moeketsi Modisenyane, Director: International Relations and Support, National Department of Health
2. Prof Lukas Muntingh, Board member,Western Cape Liquor Authority (WCLA)
3. Dr Laurine Platzky, Board member, WCLA
4. Ms Undere Deglon, Board member, WCLA
5. Ms Lizanne Venter, Board member, WCLA
6. Ms Karen Harrison, Cities Support Programme, Economic Development Lead

Category: Civil Society

1. Dr John Volmink, Chairperson, DG Murray Trust (DGMT)
2. Dr Mvuyo Tom, Deputy Chairperson, DGMT 
3. Dr David Harrison, Chief Executive Officer, DGMT 
4. Dr Hugo Nelson, Trustee, DGMT
5. Prof Michael Kahn, Trustee, DGMT
6. Ms Diane McCann, Trustee, DGMT
7. Ms Carol-Ann Foulis, Director, DGMT
8. Ms Iris Nxumalo-De Smidt, Innovation Manager, DGMT
9. Ms Judy-Marie Smith, Director, DGMT
10. Ms Onesisa Mtwa, Innovation Manager, DGMT
11. Mr Kayin Scholtz, ECD Resource Hub Manager, DGMT
12. Dr Colin Almeleh, Executive Director, Ilifa Labantwana
13. Ms Amanda Edwards, Education Researcher & Performance Analyst, DGMT
14. Ms Nokuthula Futwa, Programme Manager, DGMT
15. Ms Jade Jacobsohn, Social impact and sustainability consultant
16. Ms Nicole Biondi, Head of Marketing and Communication, Innovation Edge
17. Ms Julie Mentor, Movement Leader, Embrace, the movement for mothers
18. Ms Rumbi Goredema Görgens, Operations Manager, Embrace 
19. Dr Kopano Matlwa Mabaso, Executive Director, Grow Great
20. Dr Claudine Bill, Medical doctor, Philani Maternal, Child Health and Nutrition Trust
21. Dr Ingrid le Roux, Director, Philani Maternal Child Health and Nutrition Trust
22. Ms Nokwanele Mbewu, Senior Programme Manager, Philani Maternal, Child Health and Nutrition Trust
23. Ms Sinazo Nkwelo, Programmes Integration Specialist, DGMT
24. Ms Maggie Marx, Research Uptake Officer, Centre for Public Mental Health at UCT
25. Ms Sonja Giese, Executive Director, Innovation Edge
26. Ms Merle Mansfield, Programme Director, Zero Dropout Campaign
27. Ms Lynn Hendricks, Director, Research Ambition
28. Ms Leanne Porter, Embrace
29. Ms Anja Hertong, Practice Manager, Charis 
30. Ms Nozuko Matiso, Masiphuhlisane
31. Mr Timothy Mohlala, Board Member, Just like Heaven
32. Ms Thea Jarvis, Founder/Director, The Love of Christ (TLC) Children’s Home
33. Ms Magdalena Malebogang, Boitumelo creche

Category: Corporate/Industry/Private

1. Mr Heinrich Marsh, Accountant (private)
2. Ms Wendy Wiles, Proofreader/Editor (private)
3. Mr Robin Bleekers, Foundation Associate, Letsema
4. Ms Lettie Miles, Education consultant (private)
5. Mr Mathew Kennedy, (private)
6. Mr Peet Voster, Industrial Psychologist, JVR Africa
7. Ms Amanda Frost, Recovering alcoholic
8. Ms F B Ronquest-Ross, Director, B1zHero Consulting

Total number of signatories at 10:32  29/06/2020: 164 (This list is updated a number of times a day)

To be added as a signatory click here. To sign and share a public petition via Amandla.mobi to mobilise large scale public support, please click here).

UPDATE – 21 July 2020

The appeal was sent to various government departments, parliamentary portfolio committees and political parties. One such recipient was Ms Thandi Modise, Speaker of the National Assembly of South Africa. We await further feedback from all recipients who have sent similar letters to ascertain next steps so that this appeal gains traction. View her letter here.

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[2] World Health Organisation (2018). WHO launches SAFER alcohol control initiative to prevent and reduce alcohol-related death and disability. https://www.who.int/substance_abuse/safer/launch/en/

[3] Chisholm D, Moro D, Bertram M, Pretorius C, Gmal G, Shield K, Rehm J (2018). Are the “best buys” for alcohol control still valid? An update of the comparative cost effectiveness of alcohol control strategies at the global level.  Journal of Studies on Alcohol and Drugs 514-522

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[5] National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research

Council (SAMRC) & ICF. (2017). South African Demographic and Health Survey 2016: Key indicators report.

Pretoria, South Africa, and Rockville, Maryland, USA.

[6] Probst C, Shuper P, Rehm J (2016).  Coverage of alcohol consumption by national surveys in South Africa.   Addiction 112:705-710

[7] Jewkes R, Sikweyiya Y, Morrell R, Dunkle K. (2011) Gender inequitable masculinity and sexual entitlement in rape perpetration South Africa: findings of a cross-sectional study  PLoS One  6(12): e29590. doi:10.1371/journal.pone.0029590

[8] Matzopoulos R, Bloch K, Bowman B, Lloyd S,  Berens C, Myers J, Thompson ML. 2020. Urban upgrading and levels of interpersonal violence in Cape Town, South Africa: the Violence Prevention through Urban Upgrading Programme. Social Science & Medicine 255: 112978. https://doi.org/10.1016/j.socscimed.2020.112978

[9] Probst C, Parry C, Wittchen H-U, Rehm J (2018) The socio-economic profile of alcohol attributable mortality: A modelling study. BMC Medicine 16:97  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1080-0

[10] Matzopoulos R, Truen S, Bowman B and Corrigall J (2014.  The cost of harmful alcohol use in South Africa. South African Medical Journal Vol 104 (2): 127-132