The World Health Organization (WHO) released the “Drink Driving – A Road Safety Manual for Decision-Makers and Practitioners” to help countries prevent driving under the influence of alcohol (DUI).
Road traffic accidents are a significant public health issue and a leading cause of death and injury worldwide. Road accidents claim the lives of about 1.3 million people annually, with millions more suffering injuries or disabilities. Most of these accidents occur in low- and middle-income nations.
Road traffic injuries have a significant negative impact on economies and health systems, in addition to causing substantial harm to individuals, families, and communities. The costs to countries, many of which already face difficulties with economic development, might reach 5% of their GDP.
The World Report on Road Traffic Injury Prevention, released in 2004 jointly by the World Health Organization and the World Bank, identified improvements in road safety management and specific actions that have resulted in significantly lower rates of road traffic fatalities and injuries in industrialized nations that are actively involved in road safety – among them alcohol policy solutions.
The United Nations General Assembly has passed a number of resolutions focusing on global road safety that further encourage member states to implement recommendations in The World Report on Road Traffic Injury Prevention.
This manual is one of a series of manuals developed by the World Health Organization, the Global Road Safety Partnership, the FIA Foundation, and the World Bank to contribute to the UN resolutions on road safety.
Campaigns to reduce alcohol-impaired driving, and enforcement of DUI laws have led to reductions in DUI crashes. However, more needs to be done.
This manual provides:
- Advice and examples to reduce DUI crashes,
- Recommendations for DUI laws and how to monitor and evaluate them, and
- Guidance on implementing interventions that include legislation, enforcement, and public education/ advocacy measures.
The manual is aimed at policymakers and road safety practitioners and draws from good practice examples, specifically from low and middle-income countries.
This manual is based on the Safe Systems Approach. This approach recognizes that road transport is a complex system and places safety at its core. It also recognizes that humans, vehicles, and the road infrastructure must interact in a way that ensures a high level of safety.
According to the WHO, between 5% and 35% of fatalities on the road worldwide are caused by alcohol.
About 20% of fatally injured drivers in the majority of high-income nations have blood alcohol concentrations (BAC) that are higher than the permitted limit.
According to studies conducted in low- and middle-income nations, between 8% and 29% of drivers who sustained non-fatal injuries and between 33% and 69% of drivers who sustained fatal injuries had consumed alcohol before their collisions.
Economic impact of road crashes due to alcohol
Despite well-documented risks and harms, road traffic crashes due to alcohol remain highly prevalent around the world.
The estimated economic costs of DUI are also significant.
For instance, in the United States, the total economic cost of motor vehicle crashes in 2000 was estimated at US$ 230.6 billion, with DUI-related crashes accounting for US$51.1 billion, or 22% of all economic costs.
In South Africa, road crashes due to alcohol cost the health system alone around US$14 million yearly.
In Thailand, where at least 30% of crashes are linked to alcohol and the total cost of road crashes is estimated at $US3 billion crashes involving DUI cost approximately $US 1 billion.
But case studies show that when WHO-recommended alcohol policy solutions are implemented, road safety improves.
For example, in 2017, the state of Utah, USA passed a law to reduce the state blood alcohol content (BAC) limit for driving to be 0.05. A recent study released by the National Highway Traffic Safety Administration (NHTSA) showed that traffic fatalities, fatal crashes and rate of crashes involving alcohol decreased in 2019 after the law came into effect, compared to 2016 before the law.
The new findings expose the aggressive Big Alcohol campaign against road safety as propaganda.
Interventions to prevent reduce alcohol impaired driving
Over recent decades, many countries have been successful in reducing the number of DUI-related crashes. While some adaptation may be required to suit different contexts, experiences from countries that have succeeded in reducing DUI-related deaths and injuries (generally high-income countries) can be used to guide programmes in low- and middle-income countries where alcohol plays a significant role in road crashes.
Success in addressing driving under the influence of alcohol requires:
- strong political commitment;
- legislation that clearly defines illegal (for driving) BAC levels and a tiered suite of supporting penalties for driving under the influence of alcohol offences;
- strong, well-publicised, highly visible and sustained enforcement through high visibility random or compulsory breath testing (RBT/CBT) resulting in swiftly applied penalties when caught breaking the law;
- targeted social marketing campaigns to change attitudes and behaviours – the public must:
- know why driving under the influence of alcohol is both unsafe and anti-social;
- be aware that there are laws in place;
- perceive a high risk of being caught if they break the law; and
- know that if they are caught, there will be a heavy price to pay that cannot be avoided.
The most effective interventions for reducing alcohol-impaired driving outlined in the manual are:
- Legislation
- Setting BAC limits – e.g. BAC limit for the general population not exceeding 0.05g/dl; BAC limits for other driving groups (young/novice drivers, professional/ commercial drivers not exceeding 0.02g/dl).
- Penalties that reflect the seriousness of the offense (higher penalties for higher BAC levels), and that are graduated for recidivists.
- Enforcement of BAC levels
- Random breath testing (preferred).
- Sobriety checkpoints.
- Restrictions on young/inexperienced drivers
- Licensing restrictions – e.g. graduated driver licensing (GDL), including lower/zero BAC for young drivers.
- Offender management
- Alcohol ignition interlocks.
- Alcohol rehabilitation and/or treatment programs.
Other effective legislative measures include:
Restrict availability and affordability of alcohol: Approaches such as increasing taxes on alcohol, regulation on point of sale, density of locations of sale, and minimum age for purchase and consumption of alcohol can assist to reduce the level of harm created by alcohol consumption and driving under the influence.
- Increasing alcohol taxation to reduce alcohol affordability.
- Limiting alcohol availability, such as through
- Alcohol licensing laws.
- Minimum legal age for alcohol use.
- Limits on alcohol use in public.
- Restrictions on alcohol sales points.
Additionally, consideration should be given to making it an offence to sell or supply alcohol to an intoxicated person. More details about these issues as well as topics such as national control of production and sale of alcoholic beverages, common sense limits on alcohol use in public, comprehensive regulation of alcohol marketing, including alcohol product placement and alcohol sales promotions, alcohol warning labelling, and responsible beverage service training can be found in the Global status report on alcohol and health
The manual also provides a selection of the best available promising interventions for preventing and reducing alcohol-impaired driving:
- Offender management
- Offender programs.
A range of engineering treatments and considerations for post-crash care are also important considerations in reducing the harm caused by alcohol-impaired driving.
The manual also informs policy makers about interventions that have insufficient evidence or are proven ineffective:
- Public education
- Designated driver programs.
- Public awareness campaigns (alone).
Designated Driver programs take many forms and have been tried in many countries. The alcohol industry is often found to push such programs, to avoid focus on the most cost-effective interventions. Evaluation findings generally indicate no impact on driving under the influence of alcohol rates or on involvement in alcohol-related crashes.
A substantial body of evidence indicates that public education and awareness campaigns are important tools to:
- inform the community about the risks of unsafe road use,
- inform the community about road safety laws and the consequences (penalties) of not complying with them,
- promote the general deterrent effect of enforcement activities by informing the community that laws are actively being enforced, and in doing so, raising the ‘perceived risk of being detected’ among the community.
However, education, alone, is not effective in changing DUI behaviour and must work in tandem with effective enforcement of the most cost-effective legislative interventions to reduce the incidence of driving under the influence of alcohol.
Why enforcement of DUI intervention matters and how it can be done
For a DUI law to be effective, the community must understand and believe that if they consume alcohol and drive, there is a strong likelihood of detection, prosecution and receipt of penalty.
The principal objective of police intervention is to save lives and prevent and reduce DUI-related road trauma. Apprehending offenders is a by-product of the intervention, not the main objective.
Enforcement methods that have been used successfully to change driver behaviour include alcohol screening of drivers (random and based on “good cause to suspect”), and targeted enforcement based on intelligence. These enforcement methods are not mutually exclusive and should ideally be employed in combination to achieve maximum effect. Ranked from most to least effective are the following enforcement actions:
- Random breath testing (RBT): based on the principle of ‘anywhere at any time’; RBT can occur when there is the statutory authority for an enforcement officer to stop a vehicle and test the driver at random, without need to establish that the driver committed another offence, nor that the driver showed any signs of impairment prior to being stopped;
- Sobriety checkpoints: where police are required to form a suspicion of alcohol impairment before they can administer a breath test (less objective and less efficient than RBT);
- Targeted programmes: for example, waiting for drivers to leave bars and then testing them. This approach is least effective because it impacts on a very small number of drivers and should be a lesser focus than an RBT programme
Highly visible, high volume random breath testing reminds drivers of the possibility of being detected if they have been consuming alcohol and provides an effective deterrent to motorists who are not stopped.
The points listed above form the basis of an intervention strategy that can be highly successful in bringing about a general perception that drivers or riders can be tested anywhere, any time.
A dedicated alcohol intervention unit
Many countries that have succeeded in reducing the prevalence of driving under the influence of alcohol have dedicated alcohol intervention units within the police. These units are responsible for the coordination of policing efforts and countermeasures relating to DUI. A dedicated unit provides the benefits of centralised coordination and ability for expertise to be established.
It should be responsible for:
- Integration with other road safety strategies for road trauma reduction;
- Facilitating education, awareness and social marketing campaigns directly supporting enforcement;
- Facilitating training for general police personnel;
- Gathering statistical data and intelligence to improve enforcement and detection methods;
- Working with private and public sector organisations in the provision of education, seminars and workshops on the effects of driving under the influence of alcohol.
- The dedicated unit can provide comprehensive advice and education to assist in reducing DUI in these organisations and their employees;
- Developing partnerships with government, semi-government agencies and large representative groups such as those within the transport industry and professional drivers.
- DUI is a community problem needing community-based solutions. Police cannot and should not be expected to achieve the results without a cooperative and consultative approach.
- Maintaining direct links to research organisations.
- This will enable police to seek independent evaluation and research before, during and after implementing any programmes.
Major flaw in the manual – the role of the alcohol industry in road safety interventions
On page 57, as part of the chapter on “Implementing evidence-based DUI interventions”, the manual also seems to give the alcohol industry – producers, distributors, and retailers – a role in implementing DUI-counter measures. This is take up in table 5.
But the manual contradicts itself. It also provides a brief note about evidence proving that alcohol industry DUI programs do not reduce DUI-related harm.
A review of the literature reveals that there is significant investment by the alcohol industry in activities that are claimed to be part of the industry’s corporate social responsibility initiatives,” according to the Fact Sheet produced by the Global Road Safety Partnership.
However, the majority of initiatives supported by the alcohol industry are not evidence-based and do not reduce alcohol-related harm. Most initiatives claimed under the banner of corporate social responsibility serve as marketing opportunities for the alcohol industry in order to maximise profit.
Effective investment by the industry should focus on supporting evidence-based interventions that demonstrably reduce alcohol-related harm; for example, through commitments to a minimum alcohol pricing structure, and commitments to support reductions in illegally traded alcohol rather than through alcohol marketing, ineffective drink driving control measures, and/or influencing policy to maximise profit.”
The Global Road Safety Partnership. Fact Sheet: Alcohol Industry [Internet] March 2021. https://www. grsproadsafety.org/wp-content/uploads/Alcohol-Industry-Fact-Sheet-.pdf. Accessed September, 07, 2022.
Movendi International is regularly reporting on alcohol industry activity to oppose life-saving road safety solutions. As part of the reporting, Movendi International curates a resource page about how the alcohol industry attempts to hijack the road safety agenda to further its private profits agenda.
Scientific analysis has revealed that the role of the alcohol industry in road safety is counter-productive and harmful.
There are examples from around the world that reveal how the alcohol industry operates to exploit the road safety agenda for their private profits interests, how they lobby against the most cost-effective and well-proven road safety alcohol policy solutions, and why Big Alcohol opposes WHO-recommended road safety measures.
Recommended citation
Drink Driving: a road safety manual for decision-makers and practitioners. 2022. Global Road Safety Partnership, International Federation of Red Cross and Red Crescent Societies, Geneva.