In South Africa and Botswana, researchers are mapping every factor that drives people to drink harmfully—from the political decisions that shape alcohol regulation to the corner shop selling cheap liquor. Harmful alcohol use is a leading cause of death and disease in Southern Africa, yet most interventions fail because they ignore the full "alcohol environment": industry lobbying, community drinking norms, and the density of outlets in poor neighbourhoods. This five-year project combines policy analysis, geospatial mapping of alcohol vendors, household surveys, and interviews with drinkers and young people to build a complete picture of why people drink and what makes it dangerous. If successful, the research will produce politically feasible policy recommendations—such as tighter licensing, pricing controls, or restrictions on marketing—that are co-created with communities and policymakers. The goal is not a single silver bullet but a suite of evidence-based, locally grounded actions that could reduce alcohol-related violence, injury, and chronic disease across the region. The project also builds capacity by training PhD and Masters students in both countries.
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SUMMARY Harmful alcohol use is a major public health concern in South Africa (SA) and other African countries including Botswana. The drivers and influences of harmful alcohol use are complex and to reduce alcohol-related harm we need to understand the total alcohol environment. AIMS AND OBJECTIVES Our proposal aims to examine political, commercial, environmental and cultural influences on harmful alcohol use, assess impacts of harmful use on health and co-create with stakeholders politically feasible policy and programme interventions. We address 4 research questions via 4 work packages (WPs): WP1: Political economy of the alcohol environment. What characterises the political, economic and regulatory context of harmful alcohol use in SA and Botswana, incl. strategies by industry to further their interests? WP2: Alcohol acquisition and consumption environments in SA and Botswana. What community-level and cultural factors influence alcohol acquisition/consumption? WP3 Impacts of political, acquisition, consumption environment changes. How do drivers shape drinking patterns/behaviours, health outcomes and the alcohol economy? WP4 From evidence to action and advocacy: co-creation through mutual learning. How can we harness community and policy maker voices to advocate for reduced alcohol harm and influence policy/interventions? METHODS This is a multi-disciplinary project utilizing a variety of different methods within WP1-WP3 to map holistically the alcohol environment within South Africa and propose evidence-based solutions to reduce alcohol-related harm. Methods will include policy and literature reviews, geospatial mapping of alcohol outlets, qualitative interviews with relevant stake holders including vendors, drinkers and young people, a cross-sectional household survey on drinking patterns and alcohol-related harms, and Bayesian modelling of alcohol related harms and harm reduction scenarios. Findings from WP1-3 will feed in to WP4 where we will explicitly engage the community and policy makers in the co-creation of solutions through a range of research activities. We will also use findings to document the data requirements to monitor the alcohol environment going forward.We will also undertake formative research in Botswana, particularly focusing on WP1 and WP2, and also involving colleagues from Botswana in engaging in WP4 and reflecting on possible implications for policy action and further research in that country. TIMELINES FOR DELIVERY This is a five-year project. Milestones for the first year include the establishment international and community advisory boards for oversight, strategic insight and optimisation of stakeholder engagement. Thereafter we measure our success through outputs and engagement activities that include extensive CEI and capacity strengthening both through formal training (PHD and Masters students) and skills transfer, and at the organisational and network levels. ANTICIPATED IMPACT AND DISSEMINATION We aim to build up an objective evidence base on effectiveness of alcohol policy-level interventions within SA and Botswana and engage with policy makers and the community with the aim of actively co-producing solutions for reducing alcohol-related harm. Stakeholder engagement at the policy and community level is a key component built in throughout the proposal and is the explicit focus of WP4.
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