ASSESMENT
Figure 1 Background information
Figure 2: Determinants of health
South Africa has 60.65 million inhabitants, 69% of whom reside in cities in 2023 (Lin et al. 2023). Young people are abundant, as the median age is 27.6 years. Population age matters when creating public health policy due to disparities in health needs and alcohol consumption.
South Africa's economic growth: 1% annually, and unemployment: 34.9% in 2021. Poverty growth reversed progress. Climate change worsens poverty and inequality, especially for low-income households. Consider poverty and economic factors when making alcohol laws.
South Africa's economy is weak, with GDP growth at 1.1% in 2023. Nation faces recession due to energy problem (Makgetla, 2021). Budget, debt, and infrastructure limit social initiatives, like alcohol misuse prevention.
African National Congress (ANC) rule has brought stability to South Africa but has led to corruption and state takeover. The 2024 general election might tip the country's political system towards a democratic-authoritarian form. The political environment affects public policy, especially alcohol marketing and usage.
South Africa protects the poor and vulnerable. 2023/24 budget priorities: social development, gender-based violence, child care, disability services, addiction. R263 billion budget for social welfare and development. Budget shortfall for social development.
Figure 3: Processes explanation
● South Africa sees alcohol abuse as a big problem due to high consumption and related issues.
● Alcohol marketing policy formulation involved proposing measures to regulate advertising and sales, considering public health and societal impacts.
● Public consultation: Draught policy open for comments. Stakeholders can share views and concerns.
● Policy approved and enacted after revisions and feedback.
● Govt Departments: Social Development and Health Depts involved in policy formulation and implementation.
● Research institutions like the South African Medical Research Council provide data for policy decisions.
● NGOs and advocacy groups supported policy and provided expertise.
● Alcohol industry involved in policy discussions.
● Public: Citizens gave opinions on policy through consultations.
● Decrease alcohol consumption, especially binge drinking.
● Goal: Reduce alcohol-related harm, including accidents, violence, and health issues.
● Policy aimed to reduce alcohol abuse's economic and social burden.
● Policy reduced alcohol-related trauma and violence, especially during sales bans.
● Policy had economic impacts: reduced revenue for alcohol industry, potential job losses, balanced against public health gains.
● Mixed public response to policy: Some support health benefits, others criticise economic and personal freedom constraints.
● Policy led to illegal alcohol trade, tension between government and industry.
Aspect | Description |
Economic Implications | · Costs: The alcohol sector's contribution to the GDP stood at 3.9% in 2009. · The industry's expenditure on advertising in 2012 was R1.7 billion. A consultancy report projected a potential loss of R4.3 billion, with an additional R2.6 billion loss in sponsorships, necessitating government investment in sports and recreation. · The South African Broadcasting Corporation (SABC) faced an annual revenue loss of R857 million. · Benefits: The potential reduction in alcohol-related harm, which was costing 10-12% of South Africa's GDP in 2012, could significantly offset these economic losses. |
Administrative and Technical Aspects | · The bill primarily aimed at limiting or prohibiting alcohol advertising, sponsorships, and promotions, grounded in scholarly research. · However, it was critiqued for not adequately addressing the socio-political determinants influencing alcohol consumption and for its lack of focus on equity building. · The policy was seen as overly reliant on prevention and individual behavioural change, neglecting the broader social norms around alcohol consumption. |
Extent of Stakeholder Participation | · The bill drafting involved the Minister for Health and the Minister for Social Development, with input from the National Department of Trade and Industry (NDTI) (Yates et al. 2019). · However, the process did not fully engage with agenda setting, development, and implementation based on a comprehensive blend of formal and informal evidence. · Civil society health advocates and public health researchers, alongside international pressure from the WHO, supported the bill (Lesch et al. 2021). Conversely, internal governmental actors, SABC, and stakeholders in the alcohol, media, and advertising industries opposed the bill due to anticipated economic losses. |
Resource Allocation and Considerations | · The Department of Recreation highlighted the need for revenue sources to replace lost sponsorships. · The alcohol industry endeavoured to influence public opinion and policy by investing in media campaigns and corporate social initiatives while promoting self-regulation. · A proposal to convert the bill into a Money Bill, facilitating revenue generation through taxes and levies, was opposed by the National Treasury for reasons that were not explicitly stated, leading to a policy deadlock. |
Case Study: Marketing of Alcoholic Drinks in South Africa
● South Africa regulates alcohol advertising and sales to address public health issues from alcohol abuse.
● Regulations. Restrictions on advertising, alcohol sales, and enforcement.
● Health Impacts:
● Policy reduced alcohol-related harms.
● Cost: Mental health impacts from restricted alcohol access.
● Economic Impacts:
● Cost reduction: Less alcohol-related healthcare and crime.
● Cost: Revenue loss for alcohol businesses and job losses in the industry.
● Marketing restrictions aim to reduce exposure of alcoholic beverages, especially among vulnerable populations like youth.
● Sales restrictions imposed on alcohol to reduce accessibility.
● Enforcement mechanisms: Policy includes penalties for non-compliance.
● Civil society groups were involved in advocating for the policy.
● Public health experts and organisations shaped policy through research and advocacy.
● Alcohol industry opposed the bill. They focused on economic drawbacks and job losses.
● Campaigns and lobbying influenced public opinion and policymakers.
● Legal challenges may delay policy implementation.
Actor | Understanding of Policy | Main Role and Influences in the Policy Process | Strength and Main Types/Sources of Power | Power Limits |
Alcohol Industry | Perceived the policy as a threat to economic interests. | Actively lobbied against the bill, using economic leverage and advertising influence. | Economic power through contribution to GDP and job creation. Influence in media and advertising sectors. | Limited by public health advocacy and regulatory potential of government. |
Government Departments (e.g., Health, Social Development) | Viewed the policy as a means to reduce alcohol-related harm. | Drafted the bill, aiming to regulate alcohol advertising and consumption. | Legislative power and ability to enact and enforce laws. Access to public health data and research. | Constrained by industry lobbying, political pressures, and economic considerations. |
Civil Society and Public Health Researchers | Advocated for the policy as a tool to improve public health. | Supported the bill, providing research and international perspectives (e.g., from WHO). | Moral and ethical authority. Expertise in public health. International support and evidence-based advocacy. | Limited influence in the face of economic arguments and industry lobbying. |
South African Broadcasting Corporation (SABC) | Concerned about revenue loss from advertising. | Opposed the bill due to potential loss of advertising income. | Influence through media and public opinion shaping. Economic interest as a revenue generator. | Dependence on advertising revenue limits its support for advertising restrictions. |
National Treasury | Uncertain stance due to unclear opposition to the Money Bill proposal. | Held the financial authority to approve or reject the Money Bill proposal. | Control over national budget and fiscal policies. | Conflicting interests and pressures from different stakeholders limit decisive action. |
Department of Recreation | Focused on the loss of sponsorship revenue. | Advocated for maintaining sponsorship to support its initiatives. | Dependency on sponsorships for funding sports and recreational activities. | Reliant on external funding, limiting its ability to support advertising restrictions. |
● MOH in South Africa saw alcohol marketing policy as important for public health. High alcohol harm rates likely led the MOH to see this policy as important for health promotion and disease prevention.
● MOH's role in public health: safeguarding health, reducing disparities, managing costs.
● MOH led advocacy for alcohol policy, emphasising health risks (Lesch et al. 2021)
● MOH involved in policy formulation and implementation, using health data and research.
● Collaboration: MOH worked with others to ensure a multi-sectoral approach to alcohol policy.
● Expertise and Authority: The MOH's primary source of power in this context stems from its expertise in public health and its authoritative role in health policy-making (Buse et al. 2023).
● Data and Research: Access to comprehensive health data and research enables the MOH to influence policy decisions by providing evidence-based insights.
● Public Trust and Credibility: As a government body responsible for health, the MOH holds a position of public trust, which adds weight to its recommendations and decisions.
● MOH's power limited by politics and economics. Balance health and economy, considering alcohol industry (Elliott et al. 2023).
● MOH's effectiveness relies on coordinating with other departments.
● Alcohol industry resists strict regulations.
● MOH's enforcement capacity depends on limited resources.
● Theory in public health places an emphasis on government action to improve the health of populations and reduce the prevalence of illness. This hypothesis highlights the significance of initiatives such as limits on alcohol marketing in lowering community health hazards.
● Understanding how marketing may impact consumer behaviour and how policy changes might improve these behaviours to prevent hazardous practises like excessive drinking can be achieved by using the framework of behaviour modification theory (Spangenberg et al. 2019).
● Health Economics Theory: Offers insights into how economic incentives and market forces interact with health outcomes (Jasiński, 2021). This theory may assist analyse the economic implications of alcohol marketing strategies on public health and industry.
● Recommendations from the World Health Organisation The World Health Organization's worldwide strategies on alcohol give evidence-based recommendations for decreasing damage associated with alcohol use (Who.int, 2023).
● Taking a look at Australia and other European countries that have enacted stringent advertising laws and experienced favourable public health results as a result of their alcohol regulatory measures.
● Benefit-Cost Studies: Evidence from international studies evaluating the health and economic effects of alcohol marketing bans is useful. These calculations are useful for estimating the health policy's potential return on investment.
● Reduction in Alcohol-Related Harm: The policy is projected to lead to a reduction in alcohol-related health concerns, such as liver disorders, injuries from accidents, and violence.
● Effect on Underage Drinking Rates Strict marketing regulations may minimise underage drinking by lowering young alcohol consumption (Sargent et al. 2020)
● Long-term, the strategy may help bring about a larger change in public health trends, such as a reduction in alcohol-related hospitalisations and the associated societal cost.
● As a result of this strategy, the alcohol sector may witness a drop in sales at first, but a healthier workforce and lower healthcare expenditures may help the economy in the long run.
● Changes in societal Norms: Stricter marketing rules may gradually modify societal norms and attitudes towards alcohol use, supporting healthier lives.
● SDG 3: Good Health and Well-being: Policy reduces alcohol-related health hazards.
● Reduced underage drinking improves education outcomes (Unodc.org, 2023).
● SDG 5: Gender Equality: Policy can reduce alcohol-related violence, making safer environments for women and girls, addressing domestic violence (Unodc.org, 2023).
● SDG 8: Decent Work and Economic Growth: Healthier workforce, less alcohol-related health issues, better productivity, economic growth (Unodc.org, 2023).
● SDG 10: Reduced Inequalities: Policy may address health inequalities by targeting high-risk groups affected by alcohol issues (Unodc.org, 2023).
Evaluation Criteria | Relevance | Progress | Efficiency | Effectiveness | Impact |
1 = Strongly Disagree 2 = Disagree 3 = Undecided 4 = Agree 5 = Strongly Agree | Is the policy aptly targeted towards public health improvement? Does it align with the nation's health objectives? | Have the anticipated outcomes been realised in the implementation phase? | Is the policy economically viable in terms of costs vs. benefits? | Has the policy met its intended goals in reducing alcohol-related harm? | Has the policy led to measurable benefits in public health and social development? |
Prevention of underage drinking through advertising restrictions | 4 | 3 | 3 | 3 | 4 |
Decrease in alcohol-induced social issues due to sponsorship limitations | 4 | 2 | 3 | 3 | 3 |
Curbing alcohol consumption via promotional bans | 3 | 3 | 2 | 3 | 3 |
Overall enhancement of public health by mitigating alcohol misuse | 5 | 4 | 3 | 4 | 4 |
● Policy criteria: Address key issues, like reducing alcohol harm.
● Alcohol issues in South Africa make the policy relevant. Targets public health issue. Aligns with national priorities.
● Evaluation of policy implementation stages and milestones achieved.
● Policy progress made in legal formulation and public consultation. Implementation and enforcement need assessment due to resistance from alcohol industry and stakeholders.
● Cost-effectiveness of policy.
● Mixed efficiency. Balanced approach needed for alcohol industry's economic sustainability and health benefits.
● Policy effectiveness: Achieving intended outcomes, like reducing harm and underage drinking.
● Policy effectiveness in reducing alcohol-related harm seems promising, supported by global evidence. Continuous monitoring and evaluation needed to determine effectiveness in South Africa.
● Socio-economic and health impacts of policy.
● Policy may help public health by reducing alcohol-related harm. Consider socio-economic impact on employment and alcohol industry, plan mitigation strategies.
● Policy aligns with public health goals and reduces alcohol-related harm.
● Areas for improvement: Balance economic impacts, allocate resources efficiently, collaborate with stakeholders to mitigate opposition and increase compliance.
Buse, K., Mays, N., Colombini, M., Fraser, A., Khan, M. and Walls, H., 2023. Making Health Policy, 3e. McGraw Hill.
Elliott, L.M., Waqa, G.D., Dalglish, S.L. and Topp, S.M., 2023. A sweet deal for domestic industry: the political economy and framing of Vanuatu’s sugar-sweetened beverage tax. BMJ Global Health, 8(Suppl 8), p.e012025.
Jasiński, Ł., 2021. Markets Vs Public Health Systems: Perspectives from the Austrian School of Economics. Routledge.
Lesch, M. and McCambridge, J., 2021. Coordination, framing and innovation: the political sophistication of public health advocates in Ireland. Addiction, 116(11), pp.3252-3260.
Lesch, M. and McCambridge, J., 2021. Waiting for the wave: political leadership, policy windows, and alcohol policy change in Ireland. Social Science & Medicine, 282, p.114116.
Lin, Y.E., Zhang, X., Chen, M., Ji, Y., Shi, Y., Lin, Y., Cao, W. and Chang, C., 2023. Prevalence and associated factors of denture use among elderly living in rural and urban areas of China: A national cross-sectional study.
Makgetla, N., 2021. The COVID-19 pandemic and the economy in Southern Africa. Helsinki: UNU-WIDER.
Sargent, J.D. and Babor, T.F., 2020. The relationship between exposure to alcohol marketing and underage drinking is causal. Journal of Studies on Alcohol and Drugs, Supplement, (s19), pp.113-124.
Spangenberg, J.H. and Lorek, S., 2019. Sufficiency and consumer behaviour: From theory to policy. Energy Policy, 129, pp.1070-1079.
Unodc.org, (2023). United Nations Office on Drugs and Crime Available at: https://www.unodc.org/unodc/en/about-unodc/sustainable-development-goals/sdg3_-good-health-and-well-being.html [Accessed on: 2.12.23]
Who.int, (2023). Alcohol, Drugs and Addictive Behaviours Unit https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/alcohol/governance/global-alcohol-strategy [Accessed on: 2.12.23]
Yates, L., Csipke, E., Moniz-Cook, E., Leung, P., Walton, H., Charlesworth, G., Spector, A., Hogervorst, E., Mountain, G. and Orrell, M., 2019. The development of the Promoting Independence in Dementia (PRIDE) intervention to enhance independence in dementia. Clinical interventions in aging, pp.1615-1630.
