Health Budget: Committee Report; Medical Research Council on impact of alcohol on Health Services

Meeting report

The Chairperson conveyed his condolences on the passing of Ms N Chirwa’s (EFF) grandmother and Ms S Gwarube’s (DA) mother. He asked Members to observe a moment of silence prior to commencing with the meeting’s agenda.

Report of the Portfolio Committee on Health on the adjusted Budget Vote 18 of the Department of Health

Ms E Wilson (DA) said that the shortage of field hospitals was a pressing issue and should be addressed as a matter of urgency. She had observed that there were several provinces that had not made any advances in building adequately equipped field hospitals, despite the surging cases of COVID19 cases. The three-month timeframe that had been provided in the conclusion of the report for feedback on the Committee’s recommendations was too long, considering the current health crisis.

The Chairperson agreed and noted this.

Mr T Munyai (ANC) moved the adoption of the Report, given its solid scientific grounding. He felt that the Committee should adhere to the Report in toto, as it was of strategic importance to the country, and stated that the three-month timeframe may be adequate, given the extensive nature of the Report.

The Chairperson cautioned Members that the meeting was currently being broadcast, and asked them to behave accordingly. He advised them to turn off the video if there was any background disturbance, or if they wished to eat comfortably.

Mr A Shaik Emam (NFP) endorsed the Report and commented that the observations should include the impact of the virus. He had received several complaints from employees that some businesses were not adhering to providing the necessary protective measures, and asked that the Department consider setting a minimum standard of compliance, to force businesses to comply with the necessary COVID19 measures. He commented that there were private citizens who had resolved to set up quarantine facilities at their own cost and were having trouble, as some communities did not accept these facilities as being legitimate. He asked that the Department intervene to recognise these endeavours, as they would immensely aid in the fight against COVID19.

Ms M Hlengwa (IFP) asked the Committee to adopt the Report, and said that the IFP supported it.

Ms A Gela (ANC) welcomed the Report’s recommendations, stating that it addressed many of the issues the Committee had noted during the hospital visits, particularly infrastructure development. The ANC endorsed the Report, and asked that the Department accelerate its implementation.

Mr Munyai interjected on a point of order, stating that the Committee was not in a party briefing. The endorsement of the Report was not an endorsement by the political party but an endorsement of the Members in their capacity as Members of the Portfolio Committee on Health.

The Chairperson responded that Ms Gela was correct in stating her party’s position on the matter. Members were permitted to express the mandate from their parties.

Mr Munyai accepted the correction, and thanked the Chairperson.

Dr K Jacobs (ANC) concurred with Members’ endorsements of the Report, stating that it addressed the challenges the health sector was facing. However, he agreed that the three month time frame should be shortened to ensure better oversight during the pandemic.

Dr P Dyantyi (ANC) echoed the Members sentiments on the adoption of the Report, and said the Committee needed a response on their recommendations, specifically on the recommendation regarding quarantine infrastructure development, noting that the Committee had observed a lack of quarantine facilities during hospital visits. She concluded that she agreed with the Report.

Dr Jacobs moved the adoption of the Report.

Ms Gela seconded its adoption.

Mr Shaik Emam asked for clarity on whether the draft Report should be adopted as the final Report without amendments.

The Chairperson said that the amendments should be included to reinforce the Report, particularly noting shortening the three-month time frame. The adjusted budget vote Report would be adopted once the relevant amendments had been made.

The Chairperson informed the Committee that the issue of scooters and health service delivery in the Eastern Cape had been brought to his attention. He had been in contact with the Chairperson of the Eastern Cape Portfolio Committee on Health, and was waiting for more information on the matter. His silence on the matter had not been apathetic, but rather that he did not want the Committee to deliver an opinion without having enough information on the issue.

MRC: Impact of alcohol on health services.

The Chairperson welcomed Professor Glenda Gray, President and Chief Executive Officer (CEO): Medical Research Council (MRC), and her team. He commended the MRC for producing research with the interests of South Africans at heart, and the researchers for having their ears to the ground and being in tune with the happenings in society.

Professor Gray said the MRC’s purpose was to produce research that would improve the lives of South Africans. Its work targeted the social determinants of health, encompassing a broad range of issues, including gender-based violence, mental health and alcohol abuse. Its research was intended to provide a holistic understanding of the average South African to formulate research-based public health interventions that would mitigate the top ten causes of death in the country. She introduced Professor Charles Parry as a leading expert on the impact of alcohol on health services.

Prof Charles Parry, Director: MRC’s Alcohol & Drug Abuse Research Unit (ADARU), commenced with the presentation on the impact of alcohol on health services, and said the team that developed the Level Three model on the effects of alcohol was comprised of leading epidemiologists, trauma doctors, health economists and leading researchers.

Referring to the drinking context in South Africa, Prof Parry said that approximately 30% of adult South Africans engaged in drinking alcohol, which was less than the African average of 43%. However, the average South African drank about five to six units of alcohol per day, which was significantly greater than the African average. He highlighted that 59% of South African alcohol consumers engage in binge drinking monthly.

He explained that the South Africa alcohol attributable mortality rate was in the second highest category globally, noting the high number of alcohol-attributable bodily trauma for males specifically. He also commented on the correlation between alcohol, physical trauma and disability.

Prof Parry drew the Committee’s attention to the fact that during the initial stages of lockdown from 21 March, a decrease in alcohol-related transport accidents of 25% to 50% was reported. During Lockdown Levels Four and Five, hospitals had reported a decline of approximately 60% in trauma admissions and hospital visits. During Level Three, when alcohol sales were permitted, trauma admissions in hospitals increased sharply, which led to several Premiers requesting a reversion to stricter measures pertaining to the use and sale of alcohol.

According to figures provided by the Groote Schuur, Charlotte Maxeke, and other tertiary and secondary hospitals, approximately half of all trauma admissions to hospitals were alcohol-related. He said the ban on alcohol during Level Three Lockdown could potentially decrease alcohol-related trauma hospital admissions by 18 %. From these findings, he found that an alcohol ban could potentially avail about 17 000 hospital beds for COVID19 treatment.

Prof Parry said the MRC had considered other alternatives to a ban on alcohol, including implementing more restrictive measures on alcohol usage by reducing the amount of alcohol consumers were permitted to buy, by reducing alcohol advertising, as well as by reducing the amount of alcohol that producers were permitted to transport. His research highlighted the need for alcohol dependency recovery centres for people who were experiencing severe alcohol withdrawal. He admitted that although the alternative measures followed the World Health Organisations guidelines on mitigating the spread of COVID19, they were not as effective as a hard ban on alcohol. He added that both scenarios had been presented to the Ministerial Advisory Committee (MAC).

“New normal” and future interventions

Prof Parry acknowledged that alcohol could not be banned indefinitely, as this would be in breach of peoples’ constitutional rights. However, the Committee should consider future interventions in preparation for when the ban was lifted. One of the strategies the Committee could consider was to target the availability of alcohol through restrictive measures, such as reducing the density of liquor outlets and targeting liquor availability times. The Liquor Amendment Bill had already set a precedent for increasing the drinking age, and he suggested that the Committee consider increasing the drinking age to 19 years, as most people aged 18 years old were still completing matric.

Prof Parry also advised the Committee to devise accountability measures for delivery companies such as Über Eats, which often infringed alcohol laws by delivering alcohol to under-age drinkers without consequence. He commented that alcohol was relatively cheap in South Africa and that taxation on alcohol had declined in comparison to cigarette tax, which suggested that there was still room to discourage alcohol consumption through taxation. For South Africa to better measure the effect of an alcohol targeting policy, there needed to be better tracking and data capturing of the liquor supply chain, like Russia’s alcohol monitoring system.

In conclusion, he said there was a need for strong and competent leadership to address the many challenges that alcohol consumption posed. He reiterated that the MRC strongly recommended that all trauma related to alcohol be made reportable and notifiable in order to build a sustained bank of information to better inform the impact of alcohol on the health system and the economy of the country.

Discussion

The Chairperson thanked Prof Parry for his presentation, and drew the Committee’s attention to Prof Gray’s opening remarks, which highlighted the need for research that impacted the lives of South Africans. He commented that South Africa had suffered a greater loss from alcohol consumption than the monetary income generated by the liquor industry, as the social loss due to alcohol-related deaths and violence could not be quantified.

Mr Shaik Emam thanked the MRC for their presentation, and said that most religions cautioned against excessive alcohol usage. He asked if the MRC could provide any research on alcohol fetal syndrom. He agreed that the loss of revenue due to alcohol restrictions was far outweighed by the loss of life and social welfare caused by alcohol abuse. He noted from the presentation that 70% of heavy drinkers were men, and pointed out the risky drinking behaviour by young people. He echoed the view that increasing the price of alcohol through taxation may be a strategy that could be employed, but questioned whether increasing alcohol prices would lead to a further increase in poverty.

Dr Jacobs commended the MRC for its work, noting that the decision to ban alcohol had followed its research, and thanked them for their contribution to mitigating the pandemic. It appeared that the 30% of South Africans who drank were responsible for a R1.6 billion annual deficit in terms of the gains made from alcohol consumption and expenditure on hospitals, and reiterated that the social and economic loss from alcohol consumption was far greater than the benefits derived. He referred to the MRC’s recommedation to restrict alcohol advertising, and asked whether this would result in people changing their alcohol consumption habits. He lamented that it was a common sight to see South Africans drinking in public, and questioned whether this had an effect on tourism. He questioned whether there was a way to make alcohol consumption more discreet and private.

Ms Wilson said that South Africa had now been in lockdown for 110 days, and emphasised that the initial stage of the lockdown had been intended to allow the health sector to prepare for the inevitable surge of COVID19 transmissions. She said that the word “prepare” indicated that there needed to be an improvement in the existing health infrastructure to meet the demands that the pandemic placed on the health sector. She asked whether the alcohol ban was constitutional, as individuals had the right to self determination, and commented that the ban had resulted in alcohol retail businesses reporting stock theft and looting. She also drew the MRC’s attention to the fact that poorer communities tended to have a high alcohol consumption, due to a lack of entertainment and other services. She strongly supported Prof Parry’s concluding remarks on the need for strong leadership.

Ms Hlengwa lamented the fact that various social issues, including gender based violence (GBV) and femicide, were linked to alcohol abuse. She referred to the tremendous pressure that alcohol-related trauma exerted on hospitals and medical resources, and highlighted its compounding effect on families and communities, which propogated further alcohol abuse. She asked the MRC to advise on how the Committee could formulate a double-edged policy that would provide relief to the health sector and mitigate alcohol abuse. She stressed the need for a strong policy on the matter.

Ms Gela said that the ban would be the most effective interim measure to provide relief to the health sector. and echoed Ms Hlengwa’s sentiments on formulating a strong policy on the matter.

Mr G Hendricks (Al Jama-ah) said he had attended a meeting with the Portfolio Committee on Small Business Development, and where the Minister had identified the Western Cape as being the prime reason for the ban. However, he disagreed as the Werstern Cape had been the most progressive province in addressing alcohol abuse by establishing alcohol-free suburbs such as Fish Hoek and Pinelands. He said South Africa should transition from being an alcohol-driven economy to being alcohol free, as research had found that longer alcohol trading hours resulted in increased alcohol-related harm.

The Chairperson said that Members, as legislators, had an opportunity to make a difference by formulating a strong policy on the matter.

Mr Munyai said that the Committee would not be applying Shariah law on the matter, but would formulate a policy based on science, not based on a whim or emotion. He stressed that individual decisions should not supersede the right to life, and commended the MRC for their work.He said the advertising of alcohol during sporting events should be banned.

Dr Dyantyi echoed Members sentiments on the matter, saying that alcohol had no health benefit and a strong policy on the matter was imperative. She responded to Ms Wilson’s concern regarding the breach of constitutional rights, stating that rights gave rise to obligations and responsibilities -- more specifically, that the right to express one’s right to self determination through drinking alcohol came with the burden of drinking responsibly.

The Chairperson appreciated Members’ input on the matter, and echoed Mr Munyai’s statement that individual decisions could not trump the right to life.

MRC’s response

Prof Parry said that the MRC’s modelling had not included information on private hospitals, which meant that the impact of an alcohol ban may be greater.

He responded to Mr Shaik Emam’s question regarding the correlation between alcohol and poverty, stating that the research revealed that unit pricing could affect the heaviest poorest drinkers. The MSC’s findings also showed that the economic costs of alcohol did exceed income from value added tax (VAT) and sin taxes on alcohol consumption.

He confirmed that the reduction in trading hours did have a positive effect, and the Committee could consider restricting alcohol sales further to specific times during the day as a future intervention.

He responded that the Control of Alcohol Marketing bill did restrict alcohol packaging, and required alcohol sales to be more discreet.

Some of the revenue generated from alcohol sales was taken overseas, indicating that there was still room for taxation on alcohol. However, he suggested that the Committee consider diverting funds from taxes on alcohol to health, as Thailand had done for a more successful outcome.

As to whether there needed to be an improvement in the existing health infrastructure to meet the demands that the pandemic placed on the health sector, Prof Parry confessed that he was not in a position to speak on the matter, but he had noted several improvements at Western Cape hospitals in preparation for the surge in COVID19 admissions.

Regarding peoples’ constitutional rights, he responded that there were multiple rights that needed to be taken into consideration regarding alcohol, specifically childrens’ rights, as they were most vulnerable.

He said it was often argued that it was only a few drinkers who drank excessively and caused problems, but this was a fallacy as the research proved that 60 % of South African adult drinkers engaged in excessive drinking monthly, which was often followed by engaging in risky behaviour.

Regarding methanol poisoning and home-brewed alcohol, he said there were fewer than 20 deaths from methanol poisoning during the initial stage of the lockdown, but advised that the government should issue warnings through the media in this regard. He agreed with Ms Wilson that information on alcohol-withdrawal care facilities should be made more readily available.

The World Health Organisation (WHO) had found that reducing alcohol availability resulted in a reduction in consumption and alcohol-related harm. He noted Ms Hlengwa’s comments on GBV that alcohol was not the only cause of gender-based violence. He highlighted that alcohol consumption was linked to impaired lung health and immunity, which could mean that an alcohol ban may result in reduced transmission of COVID19 in communities.

He added that alcohol advertising restrictions could decrease consumption among younger consumers.

Prof Gray, in her closing comments, said that South Africa had embarked on monitoring and regulating alcohol consumption only recently. She felt that Professor Parry’s suggestion to increase the legal drinking age to 19 was too generous -- she preferred a legal drinking age of 21. 

South Africa should endeavour to create a policy that encouraged responsible drinking in light of alcohol-related crime and death.

The Chairperson endorsed Prof Gray’s sentiments, stating that he felt that a 19-year-old should not be permitted to drink, as they may still be completing matric or be in their first year of university.

He informed Members that they would be formulating an action plan at the next meeting, asked them to consider what stakeholders the Committee could involve in their deliberations.

The meeting was adjourned.