Implementation and enforcement of laws

Alcohol and firearms:quick wins and quick losses

Richard MatzopoulosUniversity of Cape Town School of Public Health & Family Medicine South African Medical Research CouncilBurden of Disease Research Unit

- 5th Milestones of Global Campaign for Violence Prevention- Included 200 leading experts from around the world- Hosted in Cape Town by WCG and National DoH

The absence of an overarching strategy was highlighted as a weakness

The solution?

A policy

2011

“The policy framework encompasses a comprehensive intersectoral and whole-of-society approach to the prevention of violence.

It is guided […] by the international Global Campaign for the Prevention of Violence.”

- Premier Helen Zille, MEC Theuns Botha Policy Framework Foreword

2013

Adopted by Provincial Cabinet - August 2013

1. blends public health and whole-of-society approach2. evidence-led interventions3. institutionalised monitoring and evaluation4. reliable surveillance to focus on high-risk areas

Key aspects

6 key intervention themes (WHO)1. Investing in early interventions *2. Increasing positive adult involvement *3. Strengthening communities 4. Changing cultural norms *5. Reducing income inequality *6. Improve criminal justice, social welfare

* Nearly all of these strategies require a long term approach well beyond the typical 5–year political cycle

A majority of South Africans would like to see:• corporal punishment reintroduced in schools• the death penalty reintroduced (76%!)• “zero tolerance” approach to drugs

Politicians have to • appeal to populism • appear to be responsive

Crime and violence are urgent problems requiring urgent action

1. Sustainable long term strategies to change societal risks- ECD, youth development, socio-cultural norms, etc

2. “Quick wins”- e.g. firearms and alcohol

Policy is a balancing act….

“… [an] approach to violence prevention that balances short-term interventions (focusing on reduction of access to alcohol and firearms, for example) with longer-term interventions to address the complex antecedents of violence more holistically.”

- Policy Framework, p22

….law to be changed to allow police to "shoot to kill" criminals without worrying about "what happens after that".

“…. police to crush the balls of criminals and make them drink their urine”

“I know about human rights, but for me, that’s where I draw the line. You now become an animal and we need to treat you like an animal”

If you get it wrong / in the meantime…

…enter the tough-talking police minister

2014

Engaging the whole of society - okaySurveillance and M&E – above averageFocus on high risk areas – goodEvidence-based practice - bad

inconsistently interpreted / misunderstood• young men not recognised as a vulnerable group

• globally (67th WHA Resolution) and nationally (NDP)

• Policies ignore evidence-based strategies• Provincial Crime Prevention Strategy and NDP

interventions with no evidence are implemented• Western Cape Liquor Act undermined

– City of Cape Town 2014 by-law to extends trading times

• boxing promoted as key diversion strategy for youths at-risk– despite Health Department concerns about boxing and brain injuries;

increase in long-term risk of violent behaviour

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A few words on epidemiological evidenceUnlike the evidence in judicial processes and political debates (which rely on strength of arguments and the personalities involved)

Epidemiological evidence- based on a hierarchy of study types that can be critically appraised - synthesized in meta-analyses and systematic reviews and meta-analyses- i.e. it is objective and replicable

Violence prevention evidence base• Constantly updated• Defined inclusion criteria

Some caveats….• Programmatic vs structural/policy

-Individual behavioural interventions are easier to evaluate

– but difficult to scale up

• Societal and structural interventions offer largest gains

www.preventviolence.info/EvidenceBase

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Firearm deaths 1997-2016

Firearms Control Act of 2000Stricter licensing, background checks, limits on number and type of weapon

Police clear registry backlogFast- track 1.3 million stalled applications/ renewals

Similar pattern

Non-firearm homicides gradually decline

Firearm homicides peak before Act implemented

Increase is earlier from 2010 Increase is more dramatic

Fitted and observed firearm and non-firearm homicides, Cape Town 1994-2012

> 2000 stolen and confiscated weapons diverted from police armoury to criminal gangs on Cape Flats

Cape Town estimated firearm and non-firearm homicides rates by race, 1994-2012

CoCT Liquor Trading Days and Hours By-law – July 2010– Trading day ends at 6pm– Consumption limit 2am– No Sunday tradeAmendment after industry intervention - July 2012 – Sunday champagne breakfasts for hospitality– Binging after 2am for some clubs

New by-law after industry intervention - Jan 2014 – Sunday trade and routine late night trading approved

Alcohol currently more easily available in the Western Cape than ever before

Alcohol

Reduced: trading hours, days of trade, outlet density, marketing and promotion

Green Paper 2017; White Paper2018; Bill – end 2019 ?; Act –??

New Premier 2019 !– Former Minister of Economic

Development– Community Safety

A new dawn or dead in the water?

New provincial policy being drafted

Alcoholindustry exerts influence at all levels

Conflicts of Interest

Beware of ignoring the evidence• beware especially of ignoring the evidence on “quick wins” • poorly implemented “quick wins” become “quick losses” • this can compromise other evidence-based interventions

Be prepared to repeat yourself• policy development and implementation is repetitive • requires ongoing lobbying, ongoing commitment

Conclusion