The South African government may have been quick to squelch alcohol sales during the Covid-19 epidemic citing the harm caused by drinking, but it continues to take millions from alcohol firms - even after a 2010 Cabinet decision to kick government's habit of industry handouts.
Everyday, an average of 171 people in South Africa die from alcohol-related causes, a 2018 study published in the journal BMC Medicine found.
And, although recent data is scarce, 2009 projections from the South African Medical Journal shows alcohol-related harms could cost the economy R263 billion annually.
Since the start of South Africa's Covid-19 lockdown and alcohol ban in March, weekly trauma unit admissions fell by 60%.
This included more than 10 000 cases that would have been alcohol-related, according to a new unpublished modelling study by the South African Medical Research Council (SAMRC).
A previous SAMRC study estimated a slightly higher fall of admissions at 65%, but a lower number of alcohol-related hospital admissions of 9 000 per week.
Government officials, however, have been less keen to stop taking money from an industry it publicly acknowledges can be bad for the public's health.
In 2010, Cabinet decided to stop partnering with the alcohol industry, for instance by allowing it to sponsor events.
The move was aimed at supporting efforts to curb alcohol’s impact on the country. But South African Breweries (SAB) spokesperson, Refilwe Masemole, has confirmed to Bhekisisa that it continues to work with the national department of transport on road safety programmes.
The department of transport did not respond to Bhekisisa's queries.
This despite a 2012 letter seen by Bhekisisa from former social development minister Bathabile Dlamini reminding Cabinet of its own 2010 decision.
Dlamini chaired an inter-ministerial committee on alcohol and substance abuse from 2011 until about 2017.
The group has since been dissolved and the research and regulations - including the 2013 Control of Marketing of Alcohol Beverages Bill - it spent nearly a decade producing have never been made public.
And in the Bill’s absence, some public health experts say, the industry’s self-regulation of advertising doesn’t go far enough to protect the public from harm.
The curious case of SA’s squashed liquor legislation
The Control of Marketing of Alcohol Beverages Bill of 2013, would have proposed banning alcohol advertising and sponsorships in line with World Health Organisation recommendations, according to a 2013 government statement announcing that Cabinet had approved the Bill and was ready to gazette it.
Zane Dangor worked as Dlamini’s special advisor on liquor and other drugs. He now advises for the department of international relations and cooperation.
Dangor says lobbying by various industries and disagreements among policymakers are to blame for freezing nearly 10 years’ of work by Dlamini’s interministerial committee, including the Bill.
Dlamini, however, dismissed claims Cabinet was divided about the Bill, which was never gazetted.
Sibani Mngadi, the corporate relations director for Diageo South Afrca, says the alcohol industry - just like the rest of the public - was never privy to the approved Bill. "It is disingenuous to claim that the industry has such influence that it can stop an organ of state from releasing a publicly-funded Bill."
Diageo South Africa represents brands such as Guinness, Smirnoff and Johnnie Walker.
But the industry does seem to have taken its cue from the tobacco industry on how to confuse decision-makers about the potential dangers of its products.
A 2001 study published in the American Journal of Public Health reviewed tens of thousands of leaked industry documents outlining deliberate attempts to discredit scientific evidence about the harms of smoking.
The research detailed how the tobacco lobby set up a non-profit organisation to produce research debunking smoking’s risks and then, in some instances, flooded academic conferences with this.
In a page from the Big Tobacco playbook, the South African alcohol industry used a third-party research unit to help push its arguments, lobby decision makers to influence policy and publicly denigrate public health activists, public health researchers argue.
The alcohol-funded non-profit, the Industry Association for Responsible Alcohol Use (ARA), which ceased to exist in 2015, commissioned a 2013 report highlighting the Bill’s adverse socio-economic effects such as the possible hit to jobs in national sports teams, entertainment, and media.
Broadcast media companies, entertainment companies, and SAB are all cited in the report opposing the advertising ban.
The main driver behind the report was the South African Liquor Brandowners Association, Salba, along with South African Breweries, says Sibani, who is also the spokesperson for Salba.
The research was widely quoted in the media, write University of Cape Town (UCT) researchers in a 2018 study for the journal Health Policy and Planning.
The report, the academics explain, was a "perception strategy" that diverted attention from the problem of alcohol advertising "by creating a narrative that banning alcohol advertising would only hurt the economy without being effective in curbing alcohol-related harm".
In addition, there are a host of flaws in the report, public health experts Leslie London and Charles Parry write in an article for Independent Newspapers.
The research, they say, deflects responsibility for alcohol's harms to unlicensed outlets, contradicts its own figures, and uses outdated data to bolster an unfounded argument that alcohol advertising has no effect on the amount people drink - contrary to international research.
The report also claims the ban on alcohol adverts would slash the South African Broadcasting Commission’s budget to such a degree that it would "affect the ability to meet its mandate as the public service broadcaster".
But local and international evidence suggests companies can adapt quickly even when they're set to lose a big chunk of their income due to bans, says Corné van Walbeek, director at UCT’s Research Unit on the Economics Excisable Products.
He explains: "After South Africa’s tobacco advertising ban came into effect in 2000, there was a bit of a dip in total income for media companies across the board from advertising, but since then it's increased hand over fist. Cellphone companies and the banks have taken its place in terms of sponsorships and advertising."
An industry-backed advertising agency took out two full-page adverts over two weeks in the Sunday World, publicly vilifying advocates for the ban including Dangor, according to authors for Alcohol, Drugs and Development.
The government has commissioned three reports into the possible impacts of The Control of Marketing of Alcohol Beverages Bill of 2013. The third report, led by the health department, was never made public.
Dangor explains: "It got stuck."
Health advocates are baffled about what happened to the Bill, but a letter from former Health Minister Aaron Motsoaledi, seen by Bhekisisa, reveals the ministry was instead waiting for another piece of legislation to be passed - The National Liquor Amendment Bill.
This legislation falls short of a complete liquor advertising and sponsorship ban but proposes to, for example, raise the legal drinking age to 21 and restrict advertising.
These rules, Motsoaledi wrote, would take South Africa a number of steps forward to reduce harmful alcohol use in the country.
A 2017 study commissioned by the National Economic Development and Labour Council (Nedlac) estimates the legislation could save South Africa up to about R2-billion a year and 185 lives annually.
The research, which was prepared by Genesis Analytics, anticipates about 500 job losses by 2025 in the worst case scenario, and up to about 1 500 immediate job losses in the alcohol industry.
The study also notes that the country's public broadcaster, the South African Broadcasting Corporation, would be "the biggest loser".
Sibani argues an advertising ban makes even less sense now than it did before.
He explains: "In an economy that was contracting even before the lockdown, it would not be logical to adopt the advertising ban, which is the most expensive policy option in terms of jobs and revenue losses and has very limited effect in reducing alcohol harm."
He cites a 2014 Cochrane study, mentioned in the government's report, which found a lack of good evidence for or against advertising restrictions.
The Genesis report, however, cites at least six studies that support the fact that young people exposed to alcohol advertising are more likely to start drinking sooner, drink more, or binge drink.
Nonetheless, both these Bills and many of the inter-ministerial committee's other recommendations are still gathering dust.
The two pieces of legislation are with the department of trade, industry and competition, says a health department spokesperson, Foster Mohale.
The trade ministry did not respond to Bhekisisa's queries.
Alcohol advertising in South Africa: What’s in an image?
South Africa’s existing Liquor Act prohibits misleading promotion, but marketing of alcohol remains unregulated in the country.
Instead, the industry self-regulates and early this year renewed restrictions on advertising. The country's marketing watchdog, the Advertising Regulatory Board (ARB), monitors how well alcohol companies adhere to self-regulation.
However, only businesses that have a contract with the ARB are bound by its rulings, although complaints against non-members are also investigated.
The local industry's new marketing code forbids firms from advertising on channels where more than 30% of viewers or listeners are under the age of 18, says Sibani Mngadi.
Other rules include bans on alcohol billboards within 500m of schools, restrictions on radio and television advertisements times and age gate-keeping mechanisms on digital platforms.
The code also bans brands from linking their product with success, sexual appeal or health.
But public health experts argue self-regulation is not a sustainable way to curb the harms the alcohol industry causes - although SAB’s Refilwe Masemola says his industry’s internal regulation policy is stringent.
It's not just old-school advertisements public health experts are worried about; branded sponsorships of social campaigns are as much of a concern.
Carling Black Label, for example, launched a promotion to raise awareness for domestic violence with the tagline #NoExcuse. The online adverts refer viewers to a government hotline to report abuse.
In 2017, Johnnie Walker put up 100 life-sized golden statues of its logo's walking man on Nelson Mandela Bridge in Johannesburg as part of a campaign against domestic abuse.
These kinds of sponsorships double as advertising for the industry and don't make a real contribution to mitigate the harms of their products, says head of the Tekano Atlantic Fellowship Health Equity, Lebogang Ramafoko.
She explains: "They're washing dirty money. Many women are raped and killed where alcohol has been involved."
About half of men surveyed in a section of Diepsloot, an informal settlement in Gauteng, said they had raped a woman in the year in which they were interviewed, the 2016 Sonke Change Trial, that studied the reasons for men’s violence against women, found. Drinking heavily increased the odds of violence of men (who already had violent tendencies) against women by 50%.
What's more, exposure to alcohol advertisements were linked to intimate partner violence and community drinking in a study of more than 1 000 women in Tshwane and three rural municipalities in the Western Cape. The research was published in the Journal of Studies on Alcohol and Drugs in 2018.
Ramafoko argues the industry uses social campaigns like these to endear themselves to the government in part to bolster the argument for self-regulation.
Mngadi argues it is "appropriate" to link an important issue to a prominent brand such as Johnnie Walker. South African Breweries did not respond to allegations made against its #NoExcuse campaign.
So what should alcohol companies do if they want to help? Pay more taxes, says the director of Saapa in South Africa Maurice Smithers.
The monies could be pooled in a health promotion fund from which government and civil society can draw from for advocacy work. He explains: "This way, the industry pays, but doesn’t control who gets the money for what."
The government in particular should not take money from industry so that their contributions do not cloud arguments for stricter liquor laws, he says.
"It also means they have no hold over government or civil society organisations on the basis of having granted them financial support because they are not doing so out of the 'goodness of their hearts', but because they have to by law."
Smithers concludes: "The alcohol industry is a business, it aims to make money. There's no need to get worked up about that - just regulate it."
This story was produced by the Bhekisisa Centre for Health Journalism.
South Africa is moving to a level 3 lockdown. Here’s how the SAMRC’s Charles Parry thinks we can avoid the usual alcohol-related carnage:
- Mandatory testing of blood alcohol levels after car accidents.
- Ban the sale of alcohol in larger containers.
- Allow advertising of alcohol only in shops and online where liquor is sold.
- Publicly advertise helplines and psychological and medical care for people with alcohol use disorders.
- Lower the legal blood alcohol level for drivers to zero.