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Although anthropologists have proved particularly adept at chronicling the experiences of this disconnect Bourgois ; Nguyen and Peschard ; Scheper-Hughes ; Livingston , they have tended to pay less attention to the relational and, indeed, the broader sociospatial genesis and consequences of disjuncture however, see Crane By contrast, here I both draw on and critique H. Although their work is a powerful contribution to our conceptual armory for exploring the outbreak of viral infections such as VHFs, it is of less use in the context of NCDs, which have arguably more politically and economically contentious pathogens i.
Geography, as ever, matters.
This also means that Botswana is more than just the context of policy deployment; it matters deeply because of how, who, what, and where it is. Places, then, can act both as conduits for and the emergent outcomes of contingency. Although I do not wish to glamorize the quotidian tedium and peril that can be produced by living with uncertainty, these ideas draw attention to the geographical foundations of contingency and hint at the productive nature of the emergent contingent geographies that they might inadvertently produce and to which I now turn.
Alcohol occupies a liminal space within the global health landscape. On the one hand, its use, abuse, and health consequences are virtually absent from the programmatic priorities of the world's most significant global health philanthropies Casswell and Thamarangsi On the other, mounting critique of this lacuna has invigorated the advocacy efforts of the global alcohol control movement, especially in the Global South.
In this paradigm, demand-side interventions such as education campaigns or labeling are rejected as unscientific and nonscalable see, e. With this context in mind, Botswana—a midsized, land-locked country whose significant mineral wealth accounts for roughly 40 percent of all government revenues—serves as a particularly interesting location for an exploration of alcohol and global health for two reasons. Second, Botswana has arguably spearheaded the current southern African trend toward the stricter regulation of alcohol. This trend cannot be dissociated from work undertaken by the WHO in singling out the African region as lagging behind in the uptake of alcohol taxation WHO Regional Office for Africa Their recommendations for taxation have been justified through numerous public health publications highlighting the urgency of the region's alcohol scourge and the relative inadequacy of the current policy response C.
Alcohol has long played a role in southern African life. Chibuku, a traditional, low-alcohol sorghum beer, has, for example, been consumed in various guises across the region for at least the last century van Wolputte and Fumanti Despite being challenged in court by the country's largest brewer, the levy was quickly increased to 40 percent in , 45 percent in , and 55 percent in after a government-commissioned report revealed the resilience of public consumption Pitso and Obot Moreover, and as I explore, it also exemplifies how geographical contingency and the genesis of new and emergent contingent geographies fundamentally call the public health faith in universally applicable public health interventions into question.
Thus, it is assumed that as prices rise and affordability declines, population-level rates of consumption and, therefore, alcohol-related harms will also fall Wagenaar, Salois, and Komor ; Wagenaar, Tobler, and Komro Although this advice is presented as universally applicable, it is important to remember that the evidence called to the service of such arguments is often drawn solely from an exceptionally limited number of Global North case studies Herrick forthcoming.
ECAS Africa: Connections and Disruptions
Just as with other global health interventions, the aspatialized and simplified evidence used to justify alcohol taxation is itself, ironically, a product of multiple geographical contingencies. Indeed, instead of managing the risks and uncertainties engendered by alcohol consumption, the convergence of the levy with sociospatial processes unique to Botswana offers up the conditions of possibility for emergent geographical formations.
The point is that both geographical contingency and the contingent geographies that result cannot be predicted by the methodological arsenal of epidemiology; they are instead the outcome of the happenstance that is coproduced in unique and opportunistic ways by the dialectic between people and places. To explore these ideas in more depth, in I undertook twenty interviews with alcohol policy and industry stakeholders in Gaborone and conducted surveys across five of the city's districts exploring the levy's effects on attitudes toward drinking and consumption behaviors. The same survey was administered across the city and the research assistants recruited respondents from a variety of drinking establishments across middle- and low-income neighborhoods to talk to customers.
This purposeful sample was chosen to ensure the recruitment of drinkers, rather than nondrinkers, to better gauge the influence of the levy on attitudes toward drinking and consumption habits something that nondrinkers would be less able to answer. The survey was administered over the course of two weeks and responses were recorded by hand in the field for reasons of security and convenience. The interviews were undertaken with a variety of policy and industry actors, with respondents recruited through contact networks and snowballing techniques.
As might be imagined in a capital city of only ,, the worlds of alcohol production, distribution, retail, and regulation are fairly small, so the sample size represents a very thorough cross section of key actors. The semistructured interviews each lasted around an hour and were audio recorded where consent was given , usually in respondents' places of work. The interviews aimed to elicit a sense of the multiple dimensions of the alcohol control debate, the arguments for and against the levy, and perceptions of its consequences.
The interviews thus act as a counterpoint to the public and lay opinions evinced in the survey findings, exploring the rationales for the implementation of the levy from governance and public health perspectives and the challenges that it poses to the private sector.
On the Road with Robert Kaplan
Given the autocratic nature of government in Botswana, it was unsurprising that respondents requested anonymity and many were reticent to directly criticize the president, despite discussing a policy tool that was very clearly his personal moral pursuit. This fear of directly criticizing the leadership was compounded by the small social circuit that respondents tended to move within. In the text, anonymity is maintained and context deepened by identifying respondents by their domain of work. Here I want to explore the effects of the levy through the lens of geographical contingency before examining their emergent contingent geographies.
Somewhat unhelpfully given the broader demonstration potential inherent in such a large-scale public health intervention, no baseline data were collected on drinking rates by the Ministry of Health before the levy's imposition. By , the last year for which WHO data are available, drinking rates had again risen by almost 20 percent to 5.
This rebound was corroborated by industry stakeholders who noted a substantial drop in volume sales as the initial price shock of the levy took effect. As one interviewee thus noted,. With the introduction of the levy it was quite a shock because the product got very expensive very quickly, initially we saw a decline in volumes, but I don't think that is the case anymore.
Alcohol producer, interview, Alcohol consumption in Botswana, —, in liters per person per year. Since and despite annual rises in the levy rate, however, not only has per capita consumption been steadily climbing according to industry sources, but drinking habits themselves have changed. As another industry interviewee asserted,. As the levy has gone on and increased, people have carried on moving downwards [in value terms] in what they buy, so my business hasn't declined at all, it's just shifted. Alcohol distributor, interview, As prices have gone up, value sales might have suffered, but volumes of cheaper drinks have remained relatively steady.
In asking about the consumer response to the constant upward trend in alcohol prices, respondents from the liquor industry highlighted a turn from market-leading beer St. Louis 3. These formats are seen as representing better alcohol unit-per-Pula value but also represent new sources of risk as, unlike other countries in the region where large bottles are shared among drinkers, Batswana tend to consume their own. The levy has also precipitated a collapse in the capital's formal nightlife due to restrictive opening hours and prohibitive pricing, much to the dismay of the city's musicians and young people.
Some industry interviewees were also unsurprisingly swift to offer anecdotal evidence of a rise in drug use, a flood of cheap nonbranded alcohol imports from India, and the development of a significant cross-border liquor trade alcohol distributor and retailers, interviews, With prices in South Africa over 60 percent cheaper than in Botswana and the Mafoeking branch of wholesaler Makro only a couple of hours' drive over the border, professional bootleggers and couriers have begun taking advantage of relatively lax border controls trade association, interview, As one NGO interviewee noted:.
If you ask government, they'll say that the money from the levy is going down so people must be drinking less, but there are all these villages along the border where people are just going across and buying alcohol. If you go over the border on a public holiday, the queues of cars coming back over the border, filled with booze ….
Another from an industry trade association did little to hide his complicity in this trade:. I buy from South Africa by courier; you only need to pay Pula. Instead, they have emerged at the junctures of sociospatial conditions of possibility with uncertainty, chance, and fortuitousness of which I highlight two clear examples.