Lessons from a decade's research on poverty alleviation

1. “Controversial” health research
and the creation of impact
Clare Herrick
Department of Geography
King’s College London

2. Alcohol, poverty and development in
Cape Town
2011-2015

3. Rationale
• “Alcohol is about to get the type of attention
usually reserved for AIDS and Malaria” (Science
Magazine, 2008: 862)
• 2010 WHO ‘Global Strategy to Reduce Harmful
use of Alcohol’
• Globally, 3.8% of mortality and 4.6% of disability-
adjusted life years (DALYs) are attributable to
alcohol, disproportionate burden in middle-
income countries
• Multiple burdens: Rising rates of NCDs and
persistence of infectious disease.

4. South African drinking
• Dual and inequitable political economy of liquor:
formal and informal
• 78% of alcohol outlets are unlicensed
• 86% of licenses in Western Cape are white-held
– legacy of colonial and apartheid regulations.
• Alcohol and its regulation historically entrenched
and intensely political
• Alcohol is a deeply ambiguous commodity.

5. Why the Western Cape?
• 51% men and 74% women lifetime abstainers,
but 41% of female and 48% of male drinkers do
so to hazardous levels (3/4 pattern)
• 5th highest levels of consumption in world
• One third drink Friday - Monday
• Alcohol implicated in 39% IP violence, responsible
for 7% of mortality and DALYs (#3)
• Cost = R9 billion/ yr
• significant consumer market, world's second
largest industry player, tourism, subsistence/
entrepreneurial livelihoods

6. • Development and deployment of the Western
Cape Liquor Act – charting novel moment in
Southern African alcohol control agenda
• Opportunity to document debates – protractors,
detractors, narratives, justifications etc
• Important as gives sense of competing issues at
play in the urban governance of alcohol
• Alcohol as a barrier to health and social
development as well as implementation of
Zuma’s electoral promises of ‘social
transformation’.

7. The project
• 2011-2013: Alcohol, poverty and development in the
Western Cape
The intersections:
• Alcohol problems are a direct manifestation of deeper
structural inequalities, opportunities and barriers
• The differential distribution of risks and hazards
relating to drinking are a direct reflection of
developmental issues
• Drinking emerges from and reinforces poverty
• BUT also offers tantalising opportunity to escape from
it.
• Spatial understanding of SDH and direct contribution to
Urban Health agendas

8. Supply chain
Formal liquor
(wine, sprits, beer)
Informal liquor
(home or
industrially
brewed)
Distributor
(wholesale,
direct from
manufacturer)
Formal trade
(licensed)
Informal trade
(unlicensed)
threats opportunities

9. Impact endeavours
• Policymakers as key informants
• Online knowledge-sharing platforms
• Local collaborations
• Policy workshops
• Synthesis reports
• Follow-on funding for lay publication
• Podcasts
• Presentation of findings to emergent
stakeholders

10. Barriers
1. Disciplinary territoriality
2. Funding tussles and legitimacy
3. “Evidence” based policy
4. Findings that fit the diagnosis of the
problem
5. “Problem deflation”

11. Reflections
• How can social science findings become the
“evidence requested by policy makers?
(metrics, cost-benefit analysis, soundbytes,
factoids)
• How can policy makers be encouraged to
accept and work with uncomfortable truths?
(that alcohol is a threat to livelihoods and that
“working with” industry is not tainting)

12. Looking forward
• No more alcohol research!
• Thinking about how to work alternative
perspectives through strategic partnerships (i.e.
get public health on board and in the team from
the start)
• Accept industry and public health’s controversial
relationship and work with it.
• Be better attuned to opportunities for impactful
intervention
• Brand the research and market this brand
• Then ensure demand for the brand

13. Contact:
clare.herrick@kcl.ac.uk