Alcohol Abuse in South Africa - A National Crisis

The South African Medical Association (SAMA) would like to add its voice and express our extreme concern and regret at the carnage on our roads that we have witnessed since the start of the holiday season.

Whilst many South Africans will be enjoying the festive season, the same cannot be said for doctors and other health professionals. This is a period where workloads in many of our hospitals increase owing to the rise in interpersonal and domestic violence as well as motor vehicle injuries. Despite the intervention of medical emergency teams, doctors, other health workers and law enforcement agencies, many lives are lost due to the severity of injuries. Some of those who have been saved from serious injuries may end-up mentally and or physically disabled. This will change their lives drastically.

The sad reality is that the problem is not confined to this time of year but is prevalent throughout the year and increases during the Easter and December holidays. Because of the nature of the problem, these unfortunate individuals must be given priority over those patients with non-life threatening conditions. As a result, most of our public hospitals have long waiting lists for elective surgery and the unavailability of beds even for deserving cases.

Transport-related injuries account for more than one-third of all external causes of death (33.8%) in South Africa. Road traffic age-specific mortality rates is estimated to be 26% higher than the aggregate for the African region and about double the global rate in both sexes, peaking at 2.5 times the global rate in adult women aged 30–44.

Consumption of alcohol is strongly associated with traffic deaths, with blood alcohol concentrations above the legal limit for driving in nearly half (46·5%) the drivers and over half the pedestrians killed. Other factors like excessive speeding, inadequate consideration for pedestrians and non-motorised road users are also at play. Driver fatigue further plays a huge part in traffic deaths and injuries.

Alcohol consumption has been found to be a major factor in interpersonal violence. Up to two-thirds of patients who presented with injuries to trauma units in Cape Town, Port Elizabeth, and Durban since 1999 to 2001, registered a blood alcohol concentration greater than 0·05 g/100 ml.

The cost of these injuries to the economy is enormous. Crude estimates indicate that the cost as a percentage of a country’s GDP ranges from 1% in ‘developing’ countries to 2% in ‘highly motorised’ countries (Jacobs, Aaron-Thomas & Astrop, 2000). The National Department of Transport (NDoT) indicated that in 2001 the South African traffic burn translated to 512 000 crashes, which resulted in 7900 road traffic deaths and 150 000 injuries (NDoT, 2002; NDoT, 2003a). The cost of this carnage to the South African economy was estimated at approximately R13.8 billion (NDoT, 2002).

The South African Medical Association regards the current problem as a National Disaster and calls on all South Africans to recognise the centrality of alcohol abuse as a major cause. SAMA further calls for an inter-sectoral collaboration in developing alcohol harm reduction strategies. This will involve multiple government sectors such as Health, Education, Social Welfare, Trade and Industry, Civil society, NGO’s  as well as road safety authorities working together to reduce harm associated with alcohol.

International experience has shown the following measures amongst others, to have had a great impact on addressing and mitigating the problem:

  • Increasing the legal drinking age to deter minors and youth from accessing alcohol.
  • A ban on alcohol advertising.
  • Increase in prices through pricing mechanisms.
  • Enforcement of drinking and driving laws.
  • Recognition and adequate redress of social determinants of health.
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