S-1992-01-1992_OVE

L’ASSOCIATION MEDICALE MONDIALE. INC LA ASOCIAaON MEDICA MUNDIAL. INC
THE WORLD MEDICAL ASSOCIATION, INC.
P.O. Box 63 – 28. Avenue du Alpes
01212 FERNEY·VOLTAIRE Cedex, France
Telex : 38S7S5F WMASFVF
Cable Address: WOMEDAS, Ferney-Voltaire
September 1992
Telephone: 5040 7575
Telefax: 5040 5937
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OriginaJ: English
WORLD MEDICAL ASSOCIATION STATEMENT
on
ALCOHOLANDROADSA~
Adopt~~ ~y ~~e ~th. W~rtd MedicaJ Assembly
Adopted by the 44th Wortd MedicaJ Assembly
MarbeJla, Spain, September 1992
Preamble
Death and injury from road crashes and motor vehicle collisions with pedestrians
constitute a major public health problem. Because so many of those killed and
maimed on the roads are young, the years of expected life lost as the result of motor
vehicle crashes and collisions rivaJ what occurs with the major modern epidemics of
cardiovascular disease and cancer.
In many countries, where the consumption of alcohol is accepted as part of everyday
life, it has been shown that alcohol impaired drivers of motor vehicles are responsible
for about half of aU motors vehicle related deaths and serious injuries.
From this it follows that measures ensuring that alcohol impaired persons never drive
will result In a very significant improvement in road safety. and a marked reduction in
those killed or maimed on the roads.
Driving a vehicle involves accepting a degree of risk. Prudent drivers constantly
monitor the risks they are meeting, and act to ensure that the level of risk never
becomes SUbjectively unacceptable. AJcohol alters the driver’s SUbjective estimate of
risks, so that risk taking behaviour becomes more likely, at the same time as
objectively measured driving skills are deteriorating due to sedation. This is what
leads to alcohol related road crashes.
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The person who has been drinking and is making a decision to drive is faced with an
analogous decision about risks. The risks to be considered include negotiating the
roads safely. The sUbjective assessment of such risk is progressively distorted by the
effects of atcohol. It is therefore necessary to ensure that drivers consider whether
they wiu drive or not before sufficient alcohol has been consumed to materially affect
such jUdgments. This implies that legal limits on blood alcohol concentration in
drivers must be set low, at the level indeed where subjective assessment of risks
remains realistic in virtually all people.
Serious public health problems demand coordinated approaches. The detail of any
successful approach must be based upon an analysis of the problem as it affects a
particular country and culture. In most countries road crashes involving alcohol
involve adolescents and young adults disproportionately and special efforts to reduce
atcohol consumption by this group will be relevant. In many such examples the
problems of alcohol on the road are mirrored by problems associated with alcohol in
the workplace or in social or domestic environments.
Successful programmes will involve:
education of the population concerning the seriousness of the problem and of
the reasons why alcohol is dangerous to the driver, with the aim of changing
the attitUde of the populanon to drinking and driving; ..
underpinning these attitudes with appropriate enforcement policies and legal
sanctions; and .
identification of problem drinkers in whom additional measures may be
required,
RECOMMENDATIONS
HII:(;OMMENDATlONS
The World Medical Association urges aU National Associations to promote the
following principles:
1. Alcohol related road traffic crashes constitute a major preventable public
health problem. Public health resources commensurate with its seriousness
must be directed to this problem.
2. Detailed prevention measures necessitate a good understanding of the age
and social groups involved and the social forces that prevail to create the
problem in these groups. Research that details these issues must be
undertaken. Where particular social groups are found to be involved.
comprehensive strategies must be undertaken to deal with their problem. This
may involve limiting the availability of alcohol to that group and ensuring that
those involved in the sale of alcoholic beverages share some liability for the
consequences of the saie, There must be education aimed at attitudinal
change, backed by sanctions if necessary, and attention given to the
elimination of alcohol from the workplace.
3. An aJcohol related road crash must be seen as one of the inter-related alcohol
problems that may affect an individual, · the others include work accidents,
domestic disharmony and violence. and personal alcoholic disease. The legal
and medical treatment of individuals must reflect this.
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b)
a) No opportunity to rehabititate a person who abuses alcohot should ever
be lost. Any driver convicted of driving under the influence of alcohol or
with excessive blood (or breath) alcohol should be assessed for other
alcohol related problems. and where appropriate. entered into a
rehabilitation programme.
Rehabilitation programmes for such purposes should be publicly
funded. in view of the significant risk to the public wellbeing of
unresolved alcohol dependence.
4. Education of the population must ensure that the progressive effect of alcohol
on both driver skills and the assessment of risks is well understood. The
effects of alcohol abuse on health generally must not be forgotten. and there
should be a better appreciation by the public of the greater likelihood of
medicaJ complications when a drunk person is injured.
a. The primary health message should be that the drinking of alcohol
should always be in moderation.
b. The specific message should be that driving should not be undertaken
by one who has beendrinking.
c. The special problem of adolescent and young adult drivers who drink
must be addressed by educational programmes on the effects of alcohol
that extend through school years and promote responsible attitudes to
drinking and driving. Other issues to do with alcohol should be
simUltaneously addressed.
5. Doctors should endorse the need for a low legatly permissible blood alcohol
concentration in drivers, certainly not greater than 50mg/1 OOml of blood, or
comparable. breath c.onc~ntr~…_. ~. __._. ~._ ………..~, I VVII” VI ~IUUU. UI
comparable breath concentrations.
a) Low legal limits are of limited effect if enforcement is uncertain. National
Associations should carefullyconsider the advisability of insisting:
i) that every driver involved in a significant crash be tested for
blood (or breath) alcohol concentrations.
ii) that there be random testing of drivers, either generally, or at
those times when research has indicated that alcohol related
crashes are particularlylikely to occur.
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