Policy Tag: Road Safety

Adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992
Revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016

 

INTRODUCTION

Deaths and injuries resulting from road crashes and collisions are a major public health problem. The World Health Organization’s 2015 Global status report on road safety indicates that the total number of road traffic deaths per year has reached 1.25 million worldwide, with the highest road traffic fatality rates in low-income countries.

Driving while under the influence of alcohol has caused a large number of the deaths and injuries resulting from road crashes. The prevalence of drinking and driving is increasing worldwide each year.

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.

CONSEQUENCES OF DRINKING AND DRIVING

Driving a vehicle implies the acceptance of a certain number of risks. The careful driver will always be aware of the risks but also ensure that the level of risk never rises to an unacceptable level. Alcohol not only impairs one’s ability to drive, but it also alters a driver’s subjective assessment of risk so that he or she drives more recklessly.

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. Thus, one’s driving ability remains impaired long after he or she has stopped drinking.

Alcohol abuse has both short- and long-term neurological and psychiatric consequences that can 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.

RECOMMENDATIONS 

1. The WMA reaffirms its commitments to work for reducing excessive alcohol consumption and for fostering harm-reduction policies and other measures (WMA Declaration on Alcohol, October 2015.)

2. Physicians and National Medical Associations should play an active role in promoting and advocating for the development of evidence-based government policies to reduce alcohol use and driving:

Policy interventions

3. At the present time, permitted blood alcohol levels while driving vary from country to country. Even small amounts of alcohol have a direct effect on the brain, with disturbances noted at levels as low as 0.3 grams per litre. Therefore, it would be desirable to lower the maximum permissible level of blood alcohol to a minimum, but not above 0.5 grams per litre, which is low enough to allow the average driver to retain the ability to assess risk.

4. The especially high prevalence in certain countries of driving while under the influence of alcohol may justify more coercive policies, which physicians and National Medical Associations should play an active role in supporting. For example, the driver may be declared unfit to drive for a period of time sufficient to ensure he or she will no longer be a threat to road safety in the future.

5. Government officials should consider implementing restrictions on the sale or affordability of alcohol, perhaps through taxation, licensing systems, and/or limits on the days and hours of sale. Restrictions on the promotion of alcoholic beverages, including advertising and event sponsorship, should also be considered.

6. A minimum legal age for alcohol purchase and consumption should be adopted in each country. Government officials should consider implementing a separate, lower or zero blood alcohol content law for young drivers.

7. There should be strict consequences to selling alcoholic beverages to individuals under the age to purchase and consume alcohol. These laws should be properly enforced.

8. Any driver who has been in a road traffic crash must undergo a blood alcohol concentration test or a breath test.

9. 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.

10. Devices that prevent individuals with an unauthorised level of blood alcohol from starting the engine of or operating the vehicle should be developed and experimented with.

Educational interventions

12. Educational interventions should promote moderation and responsibility in the consumption of alcohol and seek to reduce the likelihood that someone will consume alcohol and drive afterwards.

13. The information dispensed by physicians and other health professionals should be aimed at making everyone aware of the dangers of driving under the influence of alcohol. 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.

14. 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. The problem of alcohol consumption in adolescents and young adults and its relation to road safety should be addressed in the school curricula so that a responsible attitude becomes the norm.

Clinical and rehabilitative interventions

15. 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.

16. Alcoholic subjects should be given access to rehabilitation services. When drivers 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.

17. Road crashes 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.

Community interventions

18. Strategies should be developed by relevant stakeholders to ensure safe transportation home in situations where alcohol consumption occurs.

19. Eliminating alcohol from the workplace and in situations where consumers must drive should be a goal of organizational policies. The promotion of non-alcoholic drinks is an important tool to facilitate these policies.

Adopted by the 42nd World Medical Assembly, Rancho Mirage, CA., USA, October 1990
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

 

PREAMBLE

Serious injuries and mortality in road collisions are a public health problem with consequences similar to those of major diseases such as cancer and cardiovascular disease. Worldwide, about 1.2 million persons are killed each year on the roads, and an additional 20-50 million are injured. By 2020, road traffic injuries are expected to be the third largest contributor to the global burden of disease and injury.

In addition to the immeasurable personal and social price paid by road crash victims and their relatives, traffic injury has a significant economic impact. The economic costs of traffic injury and disability, including emergency and rehabilitative health care, costs of disability and disability adjusted life years (DALYs), amount to 1% of the GDP of poorer countries and 1.5-2% of wealthier countries. Much of this burden is borne by the health sector.

Road injuries continue to increase in many countries, particularly in low- and middle-income nations which currently account for 85% of all road traffic deaths, and are the second leading cause of death among youth worldwide.

Most traffic injuries could be prevented by better countermeasures. Combating traffic injury is the shared responsibility of groups and individuals at the international, national, and community levels, including governments, NGOs, industry, public health professionals, engineers and law enforcement personnel.

Speed is widely recognized as the most important determinant of road safety, affecting both the likelihood that a crash will occur and the severity of a crash. On average, an increase in speed of 1 km/h is associated with a 3% higher risk of a crash involving injury and a 5% higher risk of serious or fatal injury.

However, efforts to decrease road crashes and injury also require a “systems approach” that recognizes and addresses the many factors that contribute to the risk of traffic crashes and resulting injury, including human, vehicle and road design variables.

Preventing traffic injury requires addressing the social determinants of health—the social, economic, environmental, and political factors in society that influence a population’s health. Low- and middle-income countries, where there is less safe infrastructure, fewer minimum standards on vehicle safety, and poorer quality emergency care, experience the greatest number of traffic injuries. In this way, human, vehicular and environmental factors interact before, during and after a collision. Intervention at each of these stages will help reduce crashes and injury. Effective intervention requires public education as well as professional involvement in the fields of engineering, law enforcement and medical care.

Pre-collision intervention is aimed at preventing crashes and reducing risk factors. Examples include preventing drivers from driving when fatigued (especially drivers of heavy vehicles), distracted or under the influence of drugs or alcohol. Necessary policies may include prohibiting the use of hand-held cellular phones and night curfews or graduated licensing for young drivers. Pre-collision intervention also includes setting vehicle design standards that ensure that vehicles are roadworthy and cannot be driven at excessive speeds. Other interventions include setting and enforcing appropriate speed limits, installing speed cameras, and optimizing road design and layout to prevent crashes.

A second level of intervention is aimed at preventing or reducing injury during the crash. Such interventions include: enforcing the use of seat belts and child restraints; requiring helmets for cyclists; manufacturing vehicles equipped with safety devices and crash-protective design; lowering and enforcing speed limits; and removing heavy, rigid objects such as concrete or metal dividers, light posts and abutments from the sides of roads.

Post-crash intervention is aimed at maximizing life-saving and injury-reducing treatment and includes improved pre-hospital and emergency trauma care and rehabilitation.

RECOMMENDATIONS

  1. The WMA supports the findings and key recommendations of the WHO’s 2015 Report on road traffic injury prevention and calls for their implementation by its member National Medical Associations and their governments and relevant bodies.
  2. Physicians must view traffic injury as a public health problem and recognize their responsibility in fighting this global problem.
  3. National Medical Associations and their member physicians should work to persuade governments and policy makers of the importance of this issue and should assist in adapting empirical and scientific information into workable policies.
  4. National Medical Associations and physicians should be key players in public education and should include road safety in health promotion activities.
  5. Physicians should be involved in the collection and analysis of data regarding road crashes and concomitant injuries, including injury surveillance systems.
  6. Physicians should work toward changing the public attitude of road travel, including pressing for improved public transportation, bicycle paths and proper sidewalks to encourage less car use and the adoption of healthier options such as walking and cycling.
  7. Physicians should address the human factor and medical reasons for road crashes, including, but not limited to, the use of prescription drugs or medical conditions that may impair driving ability, and explore ways to prevent and reduce the severity of injuries.
  8. Physicians should lobby for the implementation and enforcement of the measures listed above, which have been shown to decrease the risk and severity of vehicle crashes, and the evaluation of their impact.
  9. National Medical Associations and their member physicians should encourage the research and development of improved training systems and medical care at all stages, including effective communication and transport systems to locate and evacuate the victims, emergency medical care systems to provide life-saving first aid services, and expert trauma and rehabilitative care, and should lobby for increased resources to help provide these services.