Health

(a) The province has been developing a growing understanding of this impact over the last few years and continues to supplement and strengthen this going forward.

Firstly, our clinicians that work in the Emergency Centres (ECs) have reported for many years that the relationship is glaringly obvious. On a Friday night the EC team would brace themselves for the weekend ahead knowing full well the trauma and violence that is to come. By Saturday night there is a distinct smell of alcohol and blood that often fills the air, as patients fill the ECs with anything from blunt trauma, to broken glass bottle injuries, to multiple stab wounds and to road traffic accidents, several of them requiring ICU admission. This experience is not unique to the Western Cape and is experienced across the country and almost every clinician who has spent time in an EC will attest to it (See comments from a petition last year from frontline clinicians).

Prior to COVID-19 the province performed an assessment of the impact of alcohol on our trauma mortality and found that 50% of homicide deaths tested positive for alcohol. The highest proportion of homicides occurred over weekends, and 70% of these weekend homicides tested positive for alcohol. Similar findings were found for motor vehicle accidents as well. It is important to note that this mortality burden only looks at the tip of the iceberg, as the underlying morbidity burden is a far larger challenge that greets our Emergency Centre’s every weekend.

In 2020, the promulgation of several alcohol bans exposed this phenomenon even further. Barron et al (2020) found that the complete ban on alcohol sales in July 2020 resulted in a decrease in trauma mortality by 21 deaths per day for the full period, or 740 deaths over the five weeks. Van Zyl et al (2021) looked at ICU admissions at one of our hospitals and found a 50% reduction in ICU admissions during the alcohol ban and lockdown period. Chu et al (2021) also explored the impact of the alcohol bans on surgical admissions at one of our regional hospitals and found a clear temporal relationship with non-availability of alcohol during July 2020, resulting in a 39-46% drop in surgical admissions. This aligns to the trends we saw during sentinel surveillance of our Emergency Centres and validates the experience of frontline clinicians working in the ECs and who experience alcohol-related trauma and violence every weekend.

(b) The ability to accurately quantify the costs to the public healthcare system requires detailed and complete data on the morbidity burden that alcohol contributes. Whilst we have clear evidence of the relationship and impact of alcohol on both morbidity and mortality we are still uncovering and improving our ability to quantify the magnitude of this impact. In saying that, though, economists have estimated the net loss on GDP that alcohol causes in the province. This was made clear in the Western Cape Alcohol-Related Harms Reduction Policy White Paper and is as follows:

“The alcohol sector contributes to our economy. A recent study showed that the production and sale of alcohol contributed R93.2 billion to the economy or 2.9% to GDP. This contribution is important, especially in the Western Cape, but the cost of alcohol-related harms outweighs the contribution. The financial, tangible and intangible, cost of alcohol to the economy was estimated as a net loss 7-10% of our GDP or R165-236 billion.”