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Adopted by the 44th World Medical Assembly
Marbella, Spain, September 1992 and
Revised by the WMA General Assembly, Pilanesberg, South Africa,
October 2006
Introduction
- On a worldwide scale, the anticipated growth in the number
of vehicles in circulation (barely 1% per capita in China in
2001, 74% in the United States) has led the World Health Organisation
(WHO) to forecast a considerable rise in the global death toll.
Road crashes are set to become the 3rd greatest cause of death
in the world by 2020, whereas in 1990 they were in 9th place.
The WHO estimates that during this period the number of road
deaths will fall by 30% in rich countries, while lower and middle
income countries will see an increase of 20%.
- Deaths and injuries resulting from road crashes along with
collisions between vehicles and pedestrians are a major public
health problem. In many countries where alcohol consumption
is an integral part of daily life, driving while under the influence
of alcohol has been shown to be the cause of around half of
all the deaths and serious injuries in road crashes.
- A change in the behaviour of road users with regard to alcohol
consumption would appear to be the most promising approach to
preventing traffic deaths and injuries. Measures forbidding
driving while under the influence of alcohol will lead to a
considerable improvement in road safety and an appreciable reduction
in the number of dead and injured.
- Driving a vehicle implies the acceptance of a certain number
of risks. The careful driver will always be aware of the risks,
while at the same time ensuring that the level of risk never
rises to an unacceptable level. Alcohol alters a driver's subjective
assessment of risk so that he or she drives more recklessly,
while at the same time the ability to drive is impaired.
- Irrespective of the amount of alcohol consumed, the maximum
concentration of alcohol in the body is reached:
- after half an hour when taken on an empty stomach;
- after an hour when taken with a meal.
On the other hand, it takes the body a long time to eliminate
alcohol. An individual in good health eliminates alcohol at
a rate that reduces blood alcohol concentration by 0.1 to 0.15
gram/litre/hour.
- At the present time, permitted blood alcohol levels vary
from country to country. It would be desirable to introduce
a uniform maximum permissible level of blood alcohol of 0.5
gram per litre, low enough to allow the average driver to retain
the ability to assess risk.
- The information dispensed by health professionals and physicians
should be aimed at making every driver aware of these risks.
When motorists have been thus informed, it is important that
they make the decision whether or not to drive before consuming
alcohol in sufficient quantities to alter their perception.
- Alcohol is a psychotropic substance that acts on the central
nervous system. In essence, alcohol abuse or drug dependency
are addictive practices that can lead to neurological or psychiatric
difficulties, which can in turn trigger a sudden alteration
in brain function and thus endanger road safety. Certain drugs
interact negatively with alcohol, and in particular some combinations
are known to reduce alertness. When drugs, whether legal or
illegal, are taken with alcohol, the effect of the latter is
intensified. This mixture can trigger mental dysfunctions that
are extremely dangerous for road users. Physicians should be
educated and informed about these pharmacological facts.
- When physicians and other health professionals issue fitness-to-drive
certificates, they can use this opportunity to educate road
users and pass on a message of prevention and personal responsibility.
In certain countries, the significant public health problems
caused by alcohol on the roads justify more coercive policies
requiring the co-ordination of different initiatives. Physicians
could also play a part in this, by complying with current legislation
and by exercising the high level of vigilance required by the
scale and seriousness of the road safety issue. In the event
of a second offence, or of heavy dependency on alcohol indicating
regular excessive drinking, the driver may be declared unfit
to drive for a period of time sufficient to ensure that when
he is again certified fit to drive, he will no longer be a threat
to road safety.
- In most countries, road crashes linked to alcohol consumption
affect adolescents and young adults to a disproportionately
high degree, and every available resource should be mobilised
to reduce their consumption of alcohol. Physicians should also
be involved in reducing the likelihood of impaired driving by
participating in the detoxification and rehabilitation of drunk
drivers. These initiatives should be based on a detailed analysis
of the problem as it manifests itself within each country or
culture. Generally speaking, however, alcoholism is a medical
condition with concomitant psychological or social and interpersonal
difficulties that affect the family, work or social environment.
- In order to be effective, educational and preventive initiatives
should:
- Educate the population, especially young people, about
the seriousness of the problem and the dangers of drinking
and driving, with the aim of changing individual attitudes
and behaviour in terms of driving and consuming alcohol
and/or drugs;
- Support this change in behaviour by implementing appropriate
legal expectations and coercive measures, such as fines
or the revocation of licenses;
- Identify alcoholic subjects, which requires setting up
practical measures such as a questionnaire, psychological
tests and random checks;
- Restrict the promotion of alcoholic beverages, including
advertising and event sponsorship.
Additional measures should be examined and adopted as appropriate.
For example:
- Development of strategies to assure safe transportation
home in situations where alcohol consumption occurs;
- Experimenting with devices that prevent individuals with
an unauthorised level of blood alcohol from starting the
engine of or operating the vehicle;
- Wider use of breath alcohol tests (chemical or electronic);
- Adoption of a minimum legal age for alcohol purchase
and consumption in each country; countries should also adopt
policies that penalize the driver and withdraw the driver's
license if the driver is under legal age and is convicted
of driving under the influence of alcohol.
Recommendations
- The WMA urges National Medical Associations and individual
physicians to continue promoting the following principles:
- Road accidents linked to the consumption of alcohol are
a major but avoidable public health problem. The authorities
should allocate public health resources that are proportionate
to the scale of the problem.
- When preventive measures are introduced and followed
through, a good understanding of age and social groupings
involved is required, as well as a grasp of the social conditions
which often lie at the root of their problems.
- Where specific social groupings are concerned, overall
response strategies should be set up that could include
limiting the consumption of alcohol and asking those involved
in selling alcoholic beverages to take on a share of responsibility
for the consequences of selling such products. Education
and policies should promote moderation and responsibility
in the consumption of alcohol and seek to reduce the likelihood
that someone will consume alcohol and drive afterwards.
In particular, eliminating alcohol from the workplace and
in situations where consumers must drive after drinking
should be a goal of organizational policies. The promotion
of non-alcoholic drinks is an important tool to facilitate
these policies.
- Road accidents linked to the consumption of alcohol can
be considered as possible predictors of other addictive
and violent behaviours. This should be taken into consideration
in the medical treatment of the patient.
- Alcoholic subjects should be given access to rehabilitation
services. When motorists are found to have excess alcohol
in their blood (or their breath), other factors linked to
their excessive drinking should be examined and included
in a rehabilitation programme. These rehabilitation programmes
should be publicly funded.
- Educating the population about alcohol should focus on
making people aware of alcohol's negative influence on one's
ability to drive and one's assessment of risk. The public
should understand the risks and medical complications linked
to drinking while under the influence of alcohol.
- The problem of alcohol consumption in adolescents and
young adults and its relation to road safety should be addressed
in the school curricula and in community preventive measures
and policies so that a responsible attitude becomes the
norm
- As even small amounts of alcohol have a direct effect
on the brain, with disturbances noted at levels as low as
0.3 gram per litre, physicians should argue the case for
setting the blood alcohol level considered acceptable to
drive a vehicle as low as possible and no higher than 0.5
gram per litre.
- Any motorist who has been in a road traffic accident must
undergo a blood alcohol concentration test or a breath test
- The practice of random driver testing for breath alcohol
levels should become more widespread, and there should be
further research into other ways to test urine, breath and
saliva to identify impaired drivers and prevent subsequent
operation of motor vehicles.
14.10.2006
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