An equity analysis of the burden from alcohol consumption in South Africa

Type Thesis or Dissertation - PhD Thesis
Title An equity analysis of the burden from alcohol consumption in South Africa
Publication (Day/Month/Year) 2020
Alcohol consumption remains one of the leading contributors to the risk of mortality worldwide. While literature sources are clear that alcohol consumption has a major negative impact on
society and which is felt more severely amongst low-socioeconomic families, the literature on alcohol related harm on individuals and households in South Africa, especially from different socio-economic backgrounds, is very limited. This study represents an initial attempt to assess inequalities and inequity in alcohol consumption, at the household and individual levels, in South Africa using national household data. The objectives of this study are (1) to examine the usability of existing survey data in South Africa for assessing alcohol-related expenditure and impacts; (2) to provide a detailed description of alcohol consumption patterns in South Africa at the individual level using various equity stratifiers and (3) to assess the socioeconomic distribution of expenditure on alcoholic beverages at the household level in South Africa. For objective 1, all publicly available alcohol data sources for South African populations were scanned to examine their usability. A set of qualitative interviews with 10 key researchers in the alcohol policy and economics field in South Africa were undertaken to capture their experience and perceptions of alcohol data in South Africa. The analysis involved identifying databases known to key informants, exploring challenges in using the datasets for research and further analyzing any recommendations for
how routine datasets could be better used to inform policy. For Objectives 2 and 3, this study used publicly available secondary data, including the National Income Dynamics Study (NIDS) and the
Income Expenditure Survey (IES). The data have been anonymized and can be accessed from the DataFirst website.
There are differences in alcohol consumption patterns and alcohol expenditure among equity stratifiers. The findings show that the burden of alcohol consumption is heavier on the poor. Poorer households spend a significantly larger share of their total household consumption expenditure on alcoholic beverages than richer households—a case of regressivity in spending on alcoholic beverages. Spending on alcohol beverages became less regressive (i.e. a pro-poor ‘shift’) between 1995 and 2000; and between 2005/06 and 2010/11. For alcohol consumption patterns, current drinkers are more prevalent among the rich; whereas binge drinkers are more prevalent among the poor. Binge drinking is a problem among the low-income, young individuals, male and African populations. The results also show that there are significant constraints limiting the quality and usefulness of alcohol data in South Africa. These constraints are related to (a) lack of accessibility of survey data, (b) lack of systematic and standardized measurement of alcohol consumption, (c) limited geographic coverage, (d) infrequent survey timing and (e) lack of public availability of industry data on price, production, distribution and consumption of alcohol. This study provides evidence that alcohol consumption in South Africa may be a reflection of genuine differences in consumption patterns among socioeconomic status, and the burden falls most heavily on poorer households and individuals. Based on the results, there is an opportunity to further reduce the regressivity of alcohol expenditure by implementing comprehensive alcohol harm-reduction policies. This study supports recommendations for the South African government to continue to push for evidence-based alcohol policies aiming to decrease alcohol consumption, especially for risky drinkers. However, limited data accessibility in South Africa could potentially impact on the implementation, monitoring and evaluation of relevant policy and interventions to address alcohol-related harms. Thus, for implementing evidence-based alcohol policy in South Africa to be successful, the government must have accessible, reliable and meaningful data for stakeholders and researchers to evaluate interventions and assess whether national alcohol policies aiming to decrease alcohol consumption have achieved their intended objectives.

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