On 26 June 2022, 21 young people died at the Enyobeni tavern in East London, in South Africa’s Eastern Cape province. The incident refocused public attention on the safety of young people in the country.
The direct cause of the 21 deaths has not yet been determined. But questions are being asked about why children under the age of 18 were consuming alcohol in the tavern.
Questions about teenage alcohol consumption are particularly pertinent given how frequent alcohol use is among young people in South Africa and the considerable harm caused by underage drinking. One third of the South African population is under the age of 18.
A 2011 national survey of learners in grades 8 to 11 found that 37% of males and 28% of females reported drinking in the past 30 days. An alarming 30% of male and 20% of female learners reported binge drinking during the same period. A more recent survey in the Western Cape found that 5.6% of first-year university students reported an alcohol use disorder in the past 12 months.
The latest Child Gauge report drew attention to a number of child and adolescent health issues. The publication gives an annual snapshot of the situation of children in South Africa. Some of the issues highlighted were the problems associated with underage drinking and the need for public and government action to safeguard young people.
Globally, alcohol is a leading risk factor for death and disability among adolescents aged 15 to 19 years. South Africa is no exception. Several factors shape the patterns of alcohol use. These include the accessibility and affordability of alcohol as well as indiscriminate marketing. This highlights the need for child-centred laws that restrict access to alcohol, regulate marketing and establish minimum unit pricing.
Drivers and impact
Adolescent alcohol consumption is driven by several factors. These include the availability of alcohol and social norms. The media also play an influential role in young people’s drinking habits.
Young people are prolific consumers of media. They are frequently exposed to alcohol advertising and marketing. This marketing encourages the consumption of alcohol. It also perpetuates the idea that drinking is safe and normal.
Adolescents are vulnerable to the harmful effects of alcohol advertising. Research suggests that they may be disproportionately exposed to marketing by alcohol producers. Exposure to alcohol marketing has been shown to get young people to drink at younger ages and in greater quantities. Voluntary advertising industry guidelines and self-regulation are not adequate to protect young people. This highlights the importance of – and urgent need for – government oversight in this area.
Adolescent drinking has harmful direct and indirect consequences. These include rape, interpersonal violence, absenteeism, school failure, unwanted pregnancies, sexually transmitted infections, and HIV transmission.
Adolescents with alcohol use problems often experience mental health problems, including mood disorders, anxiety disorders, conduct disorders and suicidal behaviour. These can be both the consequence of and the cause of alcohol use.
Impulsivity and risk taking are hallmarks of adolescence. Alcohol use exacerbates impulsivity and impairs judgement, thus increasing risk-taking behaviour in adolescence and increasing the likelihood of adverse outcomes, including injury and death.
Crucially, alcohol has harmful effects on adolescent brain development. It leads to changes in brain structure and function which affect cognitive functioning.
Addressing the problem
The South African government has attempted to address problems associated with underage drinking. In South Africa it is illegal for anyone under the age of 18 to purchase alcohol. The National Liquor Act (2003) also stipulates that no one may supply liquor to minors.
Government has proposed pieces of legislation aimed at banning the advertising of alcohol, raising the legal drinking age, limiting hours for alcohol sales, and lowering the legal maximum alcohol limit for drivers.
To date no legislation in these areas has been enacted by Parliament. Alcohol use among young people remains high, with resulting negative consequences. On 4 July 2022, in response to the Enyobeni tragedy, President Cyril Ramaphosa called for a conversation on the problem of under-age drinking. This suggests there may be political will to follow through with the proposed legislative changes.
The president referred broadly to action needed in several areas:
- good parenting
- strengthening families
- addressing shortcomings in recreational facilities
- better enforcement of liquor outlet regulations
- greater community engagement and stopping people aiming to put profit before the lives of children.
Progress on these proposed interventions would go a long way to reducing alcohol consumption by young people and the associated harms.
The president’s recommendations place the burden of care on families and communities. However, the government also has a responsibility to protect children from alcohol-related harm.
To have a more meaningful effect, we propose concrete action in the following areas:
- a ban of packaging that appeals to young people
- an increase in excise taxes on products that appeal to young people, such as fruit-flavoured alcoholic drinks
- a ban on free alcohol and other forms of heavy discounting of alcohol prices
- a limit on young people’s exposure to alcohol marketing at points of sale, on billboards, at sporting events and in other media such as via the internet and social media
- accrediting of school-based prevention programmes to improve the quality of such programmes
- ensuring that there are appropriate and high-quality treatment programmes available for young people
- increased inspections of liquor outlets to ensure compliance with licensing regulations
- mandatory verification of age for people buying alcohol via home delivery
- a graduated driver’s licensing system whereby drivers aged 18 to 21 years are not permitted to test positive for any alcohol when driving.
Our recommendations are in line with the World Health Organization’s SAFER initiative as well as the Global Alcohol Action Plan which was unanimously adopted by member states – including South Africa – at the World Health Assembly in May 2022.
Jason Bantjes and Charles Parry are contributors to the latest issue of the South African Child Gauge, which focuses on child and adolescent mental health, including the problems associated with underage drinking in South Africa and the need for public and government action to safeguard young people.
Charles Parry, Director, Alcohol, Tobacco & Other Drug Research Unit, SAMRC, South African Medical Research Council and Jason Bantjes, Chief Specialist Scientist in Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council