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The 'nanny state' and free choice

When the new Constitution was drafted in post-apartheid South Africa, the notion of ‘free choice’ was integral to its framing. Not surprising, given the extent to which the apartheid government attempted to control every aspect of every South African’s life.

However, free market protagonists like Ron Cregan (Daily Maverick, 21 May 2019) continually subvert the concept of ‘free choice’ to suit their own economic interests – Cregan makes clear that a major concern for him is the impact that increased government regulations will impact on his own future business prospects in the advertising industry.

The same ‘free choice’ advocates are fond of using the term ‘nanny state’ as an insult (as Cregan does) to describe governments who do what they are supposed to do – act in the interests of the people that elected them. It’s a favourite term of ideolgues who want small government and big profits, enabling the production and marketing of products that are not only not essential to people’s well-being, but pose very real risks to public health and life expectancy.

Intensive marketing of products like alcohol, tobacco and sugar-sweetened beverages (and promoting their use as ‘a way of life’) has created serious global health epidemics, burdening governments (not industry), and thus taxpayers with the costs of dealing with the consequences. The situation in South Africa is no exception. An analysis of the national health budget and visits to local clinics bear witness to the excessive resources government is forced to allocate to help manage so-called ‘lifestyle diseases.’

The health challenges caused by smoking and the excessive use of alcohol and sugar are termed ‘non-communicable diseases’ (NCDs). Since 2011, governments across the world have acknowledged these challenges through their adoption of the United Nations NCD Commitments (most recently reaffirmed in 2018) and the 2030 Sustainable Development Agenda. Both require acceptance of the need to regulate the environment in which unhealthy consumer goods are produced and marketed in order to reduce the spiralling burden and cost of lifestyle diseases on government coffers. And that is good news for the tax payer!

When confronted by new legislation restricting a particular industry, those affected are quick to point out the contribution they make to the country through the creation of jobs and the paying of taxes. What they don’t quantify is the cost to the country of the consequences of their profit driven activities. For example, estimates suggest that the alcohol industry contribution to the country is about R97.8 billion a year. This may be true, but alcohol related harm, including pain and suffering borne by citizens cost the country an estimated R236 billion[1] annually, a difference of close to R150 billion. This is money that should have been invested in development so that, for example, children have a better chance of survival (South Africa has a higher child mortality rate than Egypt, Nicaragua, Brazil, the Gaza Strip and Syria)[2] and the prospect of a better life (provincial figures for child poverty in South Africa range from 35% to 80%).[3]

Managing the national budget better for good health is the responsibility of the state. Legislation is one of the tools that governments use to achieve this. The use of speeding cameras, fines and suspension of licences changes how people drive. Would Ron Cregan argue that there should be no speed limits because of state interference in personal freedoms? The threat of increased water tariffs changed the way people in the Western Cape used water during the recent drought. Regulations governing the introduction of prescriptions drugs protect people from the potential harm caused by using them. Anti-poaching laws are there to protect the wild life of the country from ruthless economic exploitation. We restrict ownership of guns to prevent known felons and people with a violent history from acquiring weapons that could be used to harm others. Ron Cregan would have us believe this is, on principle, needless nannying by the State.

Many government interventions are in the interest of the well-being of the people and of the country, including the introduction of legislation controlling smoking, drinking and the consumption of sugar. When considering such legislation, a government must of necessity ensure that it will serve the greater good and not the narrow economic interests of a sub-sector of society and that the limitation of individual freedoms is done consistent with Section 36 of our constitution. ‘Free market’ rhetoric should not be used to prevent governments from taking responsibility for creating the appropriate conditions which will allow for healthier choices by their citizens and protect children from hazardous advertising – which is contained in the Children’s Rights Convention.

A reduction in tax revenue, job losses and the potential increase in illicit trade as a result of increased restrictions (another favourite ploy, currently being used to challenge new tobacco legislation in South Africa) are generally red herrings used to scare governments into watering down their planned legislative changes. This is not to suggest that these are not real issues. But they are often exaggerated as an excuse to maintain the status quo. Steps will need to be taken to mitigate them as public health measures are put in place and take effect.

When NEDLAC was considering the proposed national Liquor Amendment Bill in 2017, the business sector and the unions called for a proper economic impact study of the consequences of the proposed changes. Genesis Analytics[4] were commissioned to carry out the study. Their report provided strong and clearly-reasoned evidence that adoption of the Liquor Amendment Bill would, in fact, have a positive economic and social impact on the country. The provisions for restricting advertising, increasing the legal drinking age to 21 years, changing licensing requirements, and extending liability for alcohol-related social problems to alcohol outlets, would result in:

a) A decline in tax revenue of between R 0.3 billion and R 1.1 billion

b) A saving in government spending of between R 0.7 and R 1.9 billion (including savings on government spending on public health of between R 0.3 and 0.73 billion)

c) At least 185 saved lives a year (a 3% reduction in alcohol-related road traffic fatalities), as well as a reduction in HIV transmission, crime, violence and gender-based violence (GBV)

Legislation and regulations are not about reducing choice. They are about changing the environment and creating conditions which enable consumers to make more informed choices. For too long, the producers and marketers of unhealthy product have had free rein to glamourise and promote their products as ‘essential’ and ‘a way of life’. They create in the minds of the public seemingly necessary and immutable links between alcohol and successful lives, celebrity status, and sport. In so doing, they take away choice from people by shaping their view of the world, spending far more on persuasive, manipulative advertising to sell their products, than they do on promoting a healthy lifestyle or on mitigating the consequences of alcohol-related harm. 

The association between alcohol and sport is particularly questionable. For example, why should South African rugby and cricket be associated with Castle Larger? Sport by its very nature is about being active, using one’s senses and working as a team. Alcohol affects the senses and judgement of the user, making it more difficult to play sport. It impacts negatively on the health of the user, counteracting the positive physical and psychological benefits of sport.

As far as human relationships are concerned, the use of alcohol is often anything but glamorous. It increases the chances of violence when there is a disagreement between people, resulting in much of the interpersonal violence that is reported to the authorities. In some studies, 70% of women who have experienced GBV report that their partners were drinking at the time of the incident.[5] Furthermore, many cases of child abuse have been linked to the consumption of alcohol.

A majority (53.5%)[6] of South Africans abstain from drinking alcohol. However, in the International Alcohol Control (IAC) study of 2015/16, South Africa ranked highest of six countries for the quantity of alcohol consumed in a typical drinking occassion. South Africa also scored highest (37% compared to 14-19% in middle-income countries and 19-27% in higher-income countries) for higher-risk drinking (six or more drinks at least once per week).[7] The World Health Organisation (WHO) reports heavy episodic drinking amongst 15 to 19 old drinkers at 65.4%.[8] The IAC study, however, suggests that the 20+ age groups are more at risk for heavy drinking, particularly amongst men. In a SAMRC study published 2017[9], 78% of adolescent participants reported having been exposed to alcohol through sport. An international review of 12 studies concluded that advertising influences the age at which children start drinking and the amount of alcohol they drink, leading to binge drinking.[10] And these are just some of the alcohol-related behaviours and consequent harms that the proposed amended law seeks to help reduce!

Like the alcohol industry, Cregan believes the problem to be one that can be solved by ‘education’ and teaching the virtues of ‘responsible’ drinking or smoking or sugar consumption. He argues it is a question of individual behaviour which can be changed by a ‘sensible health debate’. However, the evidence is against him. The World Health Organisation (WHO) and public health academics and practitioners around the world have reviewed a wealth of studies that show that education is one of the least effective ways of addressing alcohol-related harm. As a stand-alone alternative, it is of very poor effectiveness, though it does have a place as part of a basket of responses.

In fact, the evidence points clearly to measures to reduce the availability of alcohol (and other harmful products) as a much more effective solution, leading to the very change in consumer habits that Cregan has mentioned. Some of the ways of doing this include increasing the legal drinking age, changing opening and closing times (and days), reducing the density of alcohol outlets (the number of outlets in an area or relative to the number of people in an area), imposing minimum price levels for alcohol, and increasing taxes on alcohol. Similar strategies, tailored to a particular product, have been used to deal with other public health-related problems.

Once upon a time, tobacco advertising dominated the South African landscape and sponsored a range of sporting and cultural activities. When restrictions were introduced in 1999, we were told that it heralded the collapse of the advertising industry, the closing of newspapers and end of sport as we knew it. None of that happened. The space was filled with advertising for existing and new products (think cellphones, for example), and sport acquired new sponsors (banks, cellphone companies, Telkom, insurance companies etc). And now the same scare stories are being bandied about as a way of discouraging government from introducing new restrictions for alcohol.

However, it begs the question: in whose interest would less legislation and regulation be? Even free market capitalists should concede that its really not government’s responsibility to preserve archaic industries. (and especially if they are damaging health and welfare and draining tax revenues). Cregan has been honest about it – “It will … serve a deadly blow to my lifeblood for more than 30 years — the brand and design community”. He goes on to say that he set up Endangered Species, a grassroots membership organisation, “to highlight the unprecedented challenges household brands face around the world from health legislators, government bodies and single-interest lobby groups, all calling for graphic warnings and censorship on many food and beverage products”. The protection of the public health of people around the world must, in other words, be fought at all costs in favour of commercial interests. Need we say more?



  • Aadielah Maker Diedericks – SAAPA regional coordinator
  • Maurice Smithers – SAAPA SA Board Chairperson
  • Prof. Leslie London – Head of Division, School of Public Health and Family Medicine
  • Prof Sue Goldstein - Public Health Specialist, Deputy Director, SAMRC/ Wits Centre for Health Economics and Decision Science; PRICELESS SA
  • Richard Matzopoulos
  • Prof. Charles Parry – Director of Alcohol, Tobacco and ther Drugs Unit, SAMRC

[1] Matzopoulos RG, Truen S, Bowman B, Corrigall J. The cost of harmful alcohol use in South Africa. South African Med J 2014;104(2):127–32



[4]Genesis Analytics, 2017, Evaluating the economic, health and social impacts of the proposed Liquor Amendment Bill, 2017, REPORT PREPARED FOR NEDLAC BY GENESIS ANALYTICS



[7]Chaiyasing, S.,, Drinking patterns vary by gender, age and country-level income:

Cross-country analysis of the International Alcohol Control Study, Drug and Alcohol Review (August 2018), 37 (Suppl. 2), S53–S62



[10]Jernigan, D. et al (2017) Alcohol marketing and youth alcohol consumption: a systematic review of longitudinal studies published since 2008, Addiction, 112 (Suppl. 1) 7-20


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