Las lecciones del caso Pujol

Alcohol abuse and maternal drinking during pregnancy and consequently FASD has a significant impact economically, socially, and medically. When one considers the primary and secondary disabilities that result from prenatal alcohol exposure (PAE) – “intellectual deficits and learning disabilities; hyperactivity; attention and/or memory deficits; inability to manage anger; difficulties with problem solving; and prenatal and postnatal growth deficiencies - it is easy to understand that parenting a child with FASD presents a significant set of challenges throughout the life cycle of the child” (Rendall-Mksoi, et al. 2008). The birth of a disabled child, often places heavy demands on family morale, and if they are poor, thrusts them deeper into poverty and hence seriously hinders their development. Moreover, and depending on the nature

89 and severity of the child’s disability, they would be unlikely to find meaningful employment and be almost entirely dependent on social assistance from the state. Alcohol imposes a high economic cost on society (WHO 2004). A “conservative estimate of the economic costs of alcohol abuse (harmful use) based on research conducted in other countries is 1% of gross domestic product (GDP)” (Freeman & Parry 2006). Between 2000 and 2001, the harmful use of alcohol reportedly cost the South African economy approximately nine billion rand a year (Parry, Myers & Tiede 2003; Schmidt 2003). This amount includes the costs for alcohol-related crime, hospital expenses, and lost production (Parry, Myers & Tiede 2003; Schmidt 2003) and is almost twice as much as that which was received in excise duties over the same period (Freeman & Parry 2006). In 2009, alcohol was estimated to have cost the provincial and national health department R 6.1 billion and R 0.5 billion respectively (Budlender 2009).

The exact fiscal impact of FAS/FASD in South Africa is difficult to calculate, largely because no studies have been conducted to determine the national prevalence rate or the economic cost of FAS/FASD for the state. Where the issue of FAS/FASD has been considered, it has been considered under the general cost of alcohol abuse or birth defects and genetic disorders to the country. The cost of birth defects and genetic disorders to the country in terms of burden of disease is estimated to run into several million rand annually (Department of Health 2001). Cost estimates done in the US, have estimated the annual cost for FAS to range from US$75 million in 1984 to approximately US$4 billion in 1998 (Abel & Sokol 1991; Elliott, et al. 2008; Harwood, Fountain & Livermore 1998). Cost components include the types of costs

90 associated with FAS such as special8 medical and education costs and the costs of social services and support for disabled persons and their families. It is therefore likely that the cost of drinking during pregnancy and FASD to the state is grossly underestimated.

Although parents and families will, in many cases, cover the costs of caring for a child with FAS, this is not always the case, especially where the family is poor or dependent on social assistance from the state. In terms of the Social Assistance Act (No 13 of 2004), physically or mentally disabled adults and parents or caregivers of children with physical or mental disability may apply for social assistance, in the form of a cash payment or grant. If the person with a mental or physical disability is a child, i.e. legally, younger than 18 years of age, the child’s parent, primary caregiver or court appointed foster parent can apply for a child dependency grant, if they are SA citizens or permanent residents who are living in the country. To qualify for the grant, the child must need full-time and special care. The applicant must submit a medical or assessment report confirming permanent severe disability. If the child’s parent or caregiver has an income above a certain level they cannot get the grant. They do not qualify if they earn more than R144 000 per year if they are single, and if married, their combined income should not be above R288 000 per year. The income limit does not apply to foster parents. The care dependency grant covers disabled children from birth until they turn 18 (South African Social Security Agency 2011). As at April 2012, the grant amount was R1200 per month. Over a five year period (2005-2009) the number of children accessing care dependency grants rose from nearly 86 000 in 2005 to an estimated 109 000 in 2009 (South African Social Security Agency 2009).

8 _{Special costs are costs over above ordinary costs and would include the (additional) costs for things}

91 According to the 2012 Child Gauge (Hall, Woolard & Smith 2012), 117 246 children with severe disabilities currently receive the care dependency grant.

Disabled adults may qualify for a disability grant. To qualify for a disability grant, a person must be between 18 and 59 years if they are female or 18 and 60 years if they are male and they must not earn more than R47 400 if single or R94 800 if married. The person’s assets must not be worth more than R792 000 if they are single or R1 584 000 if they are married. The applicant must either be a citizen, permanent resident or refugee and be living in the country and be unable to work because of a mental or physical disability. The applicant must undergo a medical examination where a doctor appointed by the state will assess the degree of disability (South African Social Security Agency 2010). As of 1 April 2013, the grant amounts to R 1260 per month. A person can get a permanent disability grant if their disability will continue for more than a year and a temporary disability grant if their disability will continue for a continuous period of not less than six months and not more than twelve months. A permanent disability grant does not mean that the person will receive the grant for life, but just that it will continue for longer than 12 months. The number of individuals receiving disability grants has more than doubled since 2000, rising to 1.4 million in 2008, and declining to 1.2 million recipients in 20109 (South African Social Security Agency 2010). As at 2011, a total of 1,200,431 beneficiaries received disability grants, representing 8% of the total (South African Social Security Agency 2010). A disabled adult who receives a disability grant, war veteran’s grant or grant for older persons, and is unable to care for him or herself owing to physical or mental disability, may qualify for an additional grant called a grant-in-aid. As at January

9 _{The growth between 2000 and 2008 has been attributed to the expanding number of AIDS-sick people}

who were unable to access ARVs prior to the incremental roll out in 2004 (see Seekings & Nattrass 2005 and Nattrass 2006).

92 2013 the grant was R280 per month. To qualify for the grant-in-aid, the disabled person must provide a medical or assessment report, which shows they need full-time care (South African Social Security Agency 2010). A person does not however qualify for either of these grants if he or she is in prison or living in any kind of state- subsidized facilities such as an old age home or psychiatric hospital or is receiving care from a treatment centre (South African Social Security Agency 2010).