On a bitterly cold Saturday afternoon in Worcester, a forlorn rural community near South Africa's southern tip, the queue at the liquor store is the longest in town.
It's a scene constantly repeated across South Africa and a number of other nations on the continent: the prelude to a weekend of binge drinking. After years of turning a blind eye to alcohol abuse, politicians from South Africa to Kenya and Zambia are under pressure to tackle a problem that is adding to Africa's burden of HIV, birth defects, road accidents and violent crime.
Problem drinking in Africa
Africa has the world's highest proportion of binge drinkers, even though its large populations of Muslims and evangelical Christians generally abstain from alcohol. As incomes rise, it has become a boom market for international brewers and distillers whose sales are often flagging in the wealthy world.
"It's true that most people in Africa don't drink for cultural, religious and economic reasons but those who drink, drink a lot," said Dr Vladimir Poznyak of the World Health Organisation (WHO) in Geneva. If governments finally crack down effectively, companies that produce and sell alcohol may find Africa no longer allows the spectacular sales growth they have achieved there in recent years.
The drinks firms say Africans are better off consuming their products than popular but sometimes lethal home concoctions. However, the effects in Worcester of drinkers rapidly consuming dangerous - sometimes even fatal - quantities of alcohol are obvious. The liquor store queue snakes past a drunken man crumpled on the ground in a pool of vomit and in the evening drinkers cram into Worcester's numerous run-down bars.
"They drink and drink and drink. They don't stop when it is necessary to stop drinking liquor," said Berita Jones, a police captain in the town of about 130 000. "Worcester's crime is almost entirely alcohol-related," said Jones, whose time is spent checking that its 166 licenced bars outlets comply with the law, and making regular raids of its more than 300 shebeens, or informal taverns.
Home to some of the world's fastest growing economies, Africa's thirst for beer and spirits is almost unquenchable: analysts estimate beer volumes rose around 7% last year. Excluding the mature South African market, growth reached more than 10%.
Drinks companies want to keep up the momentum. SABMiller is investing up to $2.5 billion over the next five years to build and renovate breweries on the continent. Rival Diageo's African sales have risen by an average 15% in each of the last five years, and now account for 14% of the group's total.
But some public health officials say regulation of alcohol consumption and education about its abuse have failed to keep pace. "In parallel to this increase in commercial alcohol availability, the infrastructure and regulation for effective alcohol control have no strong tradition in many African countries," said Poznyak.
On average an African drinks about 6.15 litres of pure alcohol each year, about half of what a European consumes. However, more than 25% of Africans are binge drinkers, the highest proportion in the world, according to a WHO report. Most African countries already have laws that prohibit underage drinking and drink driving, but critics say these are poorly enforced and often completely ignored.
South Africa is crafting a new law to restrict alcohol advertising, raise the minimum drinking age to 21 from 18 and get tougher on drink driving, Minister of Social Development Bathabile Dlamini has said. The bill would also propose warning labels on alcohol containers, raising taxes and stricter licencing laws for alcohol outlets, said a government official who declined to be identified because the bill has not yet been made public.
The bill will be discussed in South Africa's cabinet in the next few weeks before its release for public comment, the official said. In Kenya authorities are also looking to raise the legal drinking age to 21 from 18, following on from a 2010 law that banned alcohol sales in grocery stores and in bars before 5 p.m.
The Mututho law, named after the legislator who crafted it, John Mututho, is credited for a 90% drop in alcohol-related deaths in Kenya."Even when we say we have succeeded up to that level, we are also saying we have failed 10%, so the age of drinking will be 21. We are amending the law," Mututho said.
Earlier this year, Zambia banned the manufacture and sale of spirits in relatively cheap small plastic sachets, which it blamed for increasing alcohol abuse by young people. Zambia's health department secretary told Reuters that alcohol-related road accidents and health problems are increasingly a concern.
In Nigeria, Africa's most populous nation and a huge beer market, alcohol regulation does exist but critics say it is loosely enforced. Adeline Osakwe, deputy director at the Nigeria Food and Drug Administration, said the country ensures consumers are aware of alcohol content through product labelling. It also regulates alcohol advertising. "For TV commercials, as long as it will not lead people to abuse alcohol, we give approvals," Osakwe said.
Home-brew to Heineken
For years poor Africans were limited to home-brew sorghum or maize beer, sometimes made with dangerous ingredients such as battery acid to increase the potency. Commercial alcohol is now widely available in most African states and premium brands such as Johnny Walker whisky or Heineken beer are increasingly in reach of the average drinker.
Rising incomes have also encouraged conspicuous consumption of premium brands. Even in Worcester's gritty nightclubs, some tables are weighed down by bottles of pricey spirits such Scotch whiskies Chivas Regal and Glenfiddich.
Drinks companies say commercially produced alcohol is safer than home-brews. "The alternative is that lower income people who wish to consume liquor will buy illicit and potentially dangerous alcohol," said Vincent Maphai, executive director of Corporate Affairs at SABMiller's South African unit. SABMiller is already offering lower priced beer in order to win over drinkers from the home-brew market, which it says is about four times the $11 billion commercial market.
Higher alcohol taxes, which the South African bill is likely to impose, risk of pushing the poor back to potentially lethal home-brews. Nevertheless, public health officials say governments need to do more to warn about the dangers of alcohol abuse.
Even several months into pregnancy, Johannesburg resident Martha regularly drank until she passed out. She never worried about the effect until her son was born with a hole in his heart. "I would have stopped if I knew that it would harm my baby like this," said Martha, who declined to give her family name.
Her son, now 12-years-old, was diagnosed with foetal alcohol syndrome, an incurable birth defect that has left him with the brain and body of a four-year old. South Africa has the highest reported number of children with such birth defects: about 122 out of every 1 000 are born with the syndrome, compared with about eight per 1 000 in the United States, according to South Africa's Foundation for Alcohol Related Research.
But experts say many Africans, like Martha, don't get proper education about the dangers of alcohol, especially in rural areas where access to hospitals and clinics is limited. Alcohol also heightens the danger on a continent where driving is already perilous. Kenya's Kenyatta National Hospital treats up to 40 victims of road accidents, mostly caused by drunk drivers and pedestrians, on some Saturday nights. But with little to do beyond drinking for entertainment in many parts of rural Africa, health officials face a tough battle.
"In spite of all economic benefits that increased investments in alcohol production and sales can bring, the health of the population should be properly protected and this should be a priority," the WHO's Poznyak said. "Health is the best investment, also from an economic point of view, in any society."
(Reuters Health, Tiisetso Motsoeneng, Augusts 2012)