Health commentary

Choices … to be or not to be?

We all face choices in life, some important and some trivial. A career choice or what to wear on a particular day for instance. With a libertarian approach to life I become uncomfortable when the space within which I can exercise my freedom to choose is limited.  I accept that clearly there are situations in life where restricting the freedom of an individual to choose is justified and indeed essential. Life under a COVID-19 lockdown that has now extended well beyond 100 days, has resulted in significant limitations of the freedom of choice for the citizens of this country.

In response to the COVID-19 pandemic, like governments across the globe, the South African government using the provisions of the Disaster Management Act has limited the rights of citizens to choose in many areas of their lives, such as whether to wear a mask in a public space or whether to be able purchase alcohol to mention two. More severe have been the limitations placed on movement and trade that has resulted in economic hardship for many citizens. The justification for these limitations is the COVID-19 pandemic that the country faces and is based on the need to protect the health of the citizens weighed against the consequences of not doing so.

Choices are made weighing up the balance of probabilities and most sensible individuals will not make a choice that on balance will do them harm. So the requirement to wear a mask in a public space would appear to be a logical and sensible choice. However, the choice to allow a taxi to be filled to 100% capacity, even if the occupants crowded into the taxi are wearing masks, the taxi has been “sanitised” and the windows are left open, is less clearly a logical and sensible one.

So what of the decision of government to ban the sale of alcohol initially and again from Sunday 12th July 2020?

South Africa faces multiple burden of disease including infectious diseases, injuries from interpersonal violence and motor vehicle crashes, chronic disease and mental-health disorders. In the case of interpersonal violence and motor vehicle crashes a high proportion of those affected have consumed alcohol prior to their injury. Therefore the significant drop in the numbers of people presenting to hospitals with injuries related to the consumption of alcohol subsequent to the COVID-19 ban on sale of alcohol would appear to support the correctness of the decision to prohibit the sale and transportation of alcohol.  The motivation for the initial decision to impose the ban was to reduce the load on hospitals and free up space for patients suffering from severe COVID-19 infections requiring hospitalisation. The reported increase in trauma cases presenting to hospitals following the lifting of the ban on alcohol sales on 1st June 2020 again appeared to confirm the link and so it would seem that the continued prohibition of the sale of alcohol is entirely justified. But is it as simple as that?

Prohibition in the United States from 1920 until 1933 deemed the production, importation, transportation and sale of alcohol as unconstitutional and was banned. As in South Africa during the relatively short period of the initial ban on sales as part of the lockdown regulations, there was a proliferation of the illegal sale of alcohol and a reduction of revenue from the taxation imposed on the sale of alcohol. More important was the loss of support for the ban over time from the citizens which lead ultimately to the end of prohibition in the U.S.  Even the most zealous advocates of increased restrictions on the sale of alcohol in South Africa are wary of prohibition and it is questionable whether if imposed for a prolonged period it would be deemed constitutional.

However, the lessons from the results of the COVID-19 induced short-term ban on the sale of alcohol in South Africa should provide the nation with food for thought. Returning to my earlier statement that choices are made weighing up the balance of probabilities and that most sensible individuals will not make a choice that on balance will do them harm. Why is it then that South Africans fail to make choices with respect to alcohol that on balance will not harm them? Certainly there has been a very mixed reaction from South Africans to the continued ban on alcohol sales and while it may initially have been supported after 100 days that support is waning with many seeking to circumvent the ban.

Uncomfortable as it is for a whiskey lover like myself to say, we as South Africans do have choices that we need to make on the role and consequences of alcohol consumption in this country. If prohibition in the longer term is not an option, how do we as a country educate and regulate the citizenry to make the correct choices in this regard? Again as a libertarian … should we? Or should we rather accept the consequences as the result of the freedom of choice exercised by the people? Is there a way to promote “responsible drinking” as the industry would wish to term it? While I have my own opinions, I will leave the answers to those questions for the reader to ponder! 

A health professional with over 40 years of experience both as a clinician and a senior health manager in South Africa