Drug and Alcohol Dependence 59 (2000) 199–206 Alcohol consumption amongst South African farm workers: a challenge for post-apartheid health sector transformation Leslie London * Department of Community Health, Occupational and Enironmental Health Research Unit, Uniersity of Cape Town Medical School, Anzio Road, Obseratory, Cape Town 7925, South Africa Received 12 March 1999; received in revised form 20 August 1999; accepted 27 August 1999 Abstract A cross-sectional analytical study was conducted amongst farm workers in the deciduous fruit industry in South Africa to assess levels of alcohol consumption and abuse, and to explore the impact of the DOP system, whereby farm workers are paid in part with alcohol, on indicators of alcohol consumption. High levels of alcohol consumption were found. On the CAGE and a shortened version of the MAST questionnaires, 87 and 65%, respectively, had responses indicating problem drinking. Close to half of the sample consumed more grams of alcohol per week than considered safe drinking (210 g) and 9.3% consumed amounts in excess of dangerous drinking ( 490 g/week). Almost one-fifth (19.4%) of workers interviewed reported current use of the DOP system, and 47.8% of workers had experience of one or more farms in the past where the DOP system had been used. Workers with past experience of the DOP system were 9.8 times less likely to be asbstainers than colleagues without exposure to the DOP system. The pervasive effects of excessive alcohol consumption, and its relationship to past and current DOP practices pose substantial public health challenges to the transformation of health services currently underway in South Africa. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Alcohol consumption; CAGE; MAST; DOP system; Farm workers; South Africa www.elsevier.com/locate/drugalcdep 1. Introduction Agriculture plays a central role in the South African economy and is seen as one of the key sectors able to contribute to national economic development needed to support post-apartheid transformation. As one of the biggest single employers in the economy, agriculture is the largest source of formal employment for women who form the bulk of the 40% of the workforce em- ployed as seasonal workers (Central Statistical Services, 1991). However, health and socioeconomic indicators amongst South African farm workers are extremely poor, reflecting a historical legacy of very difficult living and working conditions for most agricultural em- ployees. Poor sanitation, lack of electricity (Farmwork- ers Research and Resource Project, 1997), inadequate wages (Donaldson and Roux, 1994; Community Agency for Social Enquiry, 1995) and low education levels (Groenewald, 1986; Donaldson and Roux, 1994) are amongst the many problems faced by farm workers. Illiteracy is not uncommon with a 1993 occupational health study finding that 20% of workers were unable to sign consent to participate in the study (London, 1995). While such extreme conditions may not apply to the whole country, particularly to large export-oriented agribusiness, it is clear that such conditions are not uncommon. Farming is particularly important to the economy of the Western Cape province of South Africa, (WES- GRO, 1992) and provides employment to 150 000 workers (Central Statistical Services, 1991) with  250 000 dependants. However, unique to the Western Cape agricultural economy has been the historical prac- tice of paying workers in part with alcohol, known as the DOP system. The DOP system was introduced in the early years of colonial settlement in the Cape Colony in order to induce indigenous pastorlalist and coastal peoples to enter service on farms with payment of tobacco, bread and wine (Scully, 1992). This tradi- * Tel.: +27-21-4066524; fax: +27-21-4066163. E-mail address: ll@anat.uct.ac.za (L. London) 0376-8716/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII:S0376-8716(99)00120-9