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Road Accident Prevention Research Unit, Department of Public Health, The University of Western Australia, Nedlands WA 6907, Australia
Information regarding the size of the drink-driving problem in the countries of the Western Pacific region is rather sparse. Reliable data on the extent of the involvement of alcohol in crashes is almost universally lacking. Some data is available from research and other reports, which suggests that there is a large variation in the size of the problem of drinking and driving in different countries throughout the region. Among the most important factors involved in the drink-driving problem appear to be the number of motor vehicles in use, the availability and use of alcoholic beverages, the laws regarding drinking and driving and the level of enforcement. Since drink-driving is a problem with multiple facets, a multi-disciplinary approach on an inter-sectoral basis is important for developing successful alcohol and drink-driving countermeasure programs. The problem of drink-driving is a subset of a larger road safety problem and overlaps with wider community concerns about excessive alcohol consumption. Therefore, programs which address the broader alcohol-related issues will help reduce drink driving and its effects, and, conversely, programs aimed at reducing alcohol consumption in general will have an effect on reducing the level of alcohol-related road traffic crashes. In the Western Pacific region, each country has its own particular range of circumstances and therefore needs to develop its own particular range of solutions, while taking advantage of the opportunity to share resources, eg of equipment and training, at both regional and national levels.
In motorised countries it has long been recognised that alcohol is a major risk factor in the occurrence of road traffic crashes (World Health Organisation, 1984). In Australia for instance, it has been found that while about 3% of drivers not involved in crashes have a blood alcohol concentration (BAC) above the legal limit, about 10-15% of injured drivers and about 50% of drivers involved in fatal crashes have similar levels (Holubowycz and McLean, 1989). In other words, drivers with elevated BACs are disproportionately involved in severe and fatal crashes.
Information about the size of the drink-driving problem in the countries of the Western Pacific region is rather difficult to find. Routine data on the extent of the involvement of alcohol in crashes is almost universally lacking. In most countries it is therefore not possible to determine the size and nature of the problem with any reliability. The only data readily available comes from research studies and anecdotal reports.
A study of motor-cycle crashes in four countries found that the prevalence of drinking amongst riders admitted to hospital was highest in Adelaide, Australia (33%) and lower in Singapore (10%), Kuala Lumpur (4%) and Suita, Japan (2%) (McLean et al, 1990). In Papua New Guinea, 85% of fatally injured drivers were found to have consumed alcohol, as had 18 of 20 fatally injured pedestrians (Sinha et al, 1981). About 48% of crashes resulting in at least one person attending a hospital in Port Moresby were alcohol-related (Posanau, 1994). In a roadside survey on weekend nights in Port Moresby, 24% of drivers were found to have BAC above 0.08g/100ml (Amini and Thompson, 1991). Also in Papua New Guinea, police estimated that alcohol may have been a factor in about 10% of all crashes reported (Royal Papua New Guinea Constabulary, 1989). This is probably an under-estimate as police are known to be conservative in making these judgements. In Tonga, a pathologist reported that alcohol was present in about 50% of road traffic fatalities (Ryan, 1990). A study in Singapore indicated that about 30% of fatally injured drivers had elevated blood alcohol concentrations (Chao, Khoo and Poon, 1984). Anecdotal evidence suggests that the prevalence of alcohol in road traffic fatalities in very small island communities, such as Kiribati, may be disproportionately large, although the actual numbers involved may be quite small. This scanty evidence suggests that there is a large variation in the size of the problem of drinking and driving in different countries throughout the region.
Among the most important factors involved in the drink-driving problem appear to be the number of motor vehicles in use, the availability and use of alcoholic beverages, the laws regarding drinking and driving and the level of enforcement. In Australia, for example, where there is about one car to every two people, cars are used as the common mode of transport for most social occasions and alcohol plays a significant part in many social functions. Therefore, it is not surprising that a significant number of drivers involved in crashes are found to have a high BAC, despite the relatively high level of enforcement, which includes chemical testing of both blood and breath for alcohol.
In contrast, Papua New Guinea has about one motor vehicle to every 100 or so people. However, excessive consumption of alcohol is widespread, with considerable adverse consequences for social welfare and public order (Marshall, 1988). Although the police force is well trained, breath testing for alcohol is not yet available. The combination of these factors results in a very high involvement of alcohol in crashes, higher even than Australia. In other countries such as Singapore and Malaysia, where the use of alcohol does not play a large part in social life and the policing of road laws is energetic, the prevalence of alcohol in crashes appears to be low, even though the motor vehicle population is proportionately quite large.
In some smaller countries it is not possible to carry out breath testing or laboratory estimations of blood alcohol concentration, and the police must therefore rely on clinical assessments of impairment of driving ability. Because these are open to challenge in court, and therefore convictions are difficult to obtain, police are reluctant to prosecute. Also, the traffic police are often under-equipped, consequently the enforcement of the existing laws is not strong.
The development of effective countermeasures against drink-driving first requires accurate information to identify the size of the problem and the groups of drivers involved. The routine collection of data identifying the frequency of drink-driving in traffic crashes is essential for the design of effective programs. This information can also be used for the evaluation of those programs that are implemented.
It is important to obtain, at the highest level of government, the recognition and acknowledgment of the magnitude of the number and the cost of alcohol related crashes to ensure that sufficient resources are allotted to the programs that are initiated.
The effective implementation of drink-driving programs requires a multi-disciplinary and intersectoral approach, with cooperation between the police, health, education, road transport and legal sectors. It has been found that an intersectoral committee which can coordinate community awareness and enforcement campaigns is most important in ensuring and enhancing the success of drink-driving programs.
Specific countermeasures available to control drink-driving include reducing the availability of alcohol, setting limits to the blood alcohol concentration permitted while driving a motor vehicle, providing education to the community aimed at changing attitudes and behaviour, and deterring drivers from driving after drinking by punishment or by the threat of apprehension.
The availability of alcohol can be reduced by increasing the price through increasing taxes, and by limiting the number of outlets and the times and conditions under which alcohol can be sold. These measures have had some effect in Papua New Guinea (Marshall, 1988) and in the Kimberley region of north Western Australia (Douglas, 1995).
The risk of becoming involved in a crash increases markedly at blood alcohol levels above 0.05-0.08g/100ml. May countries have now set limits, at about these levels, to the blood alcohol concentration permitted for driving a motor vehicle. Measures which are aimed at reducing drink-driving among young and inexperienced drivers, who have been found to be most at risk, include the introduction of very low permitted levels of BAC (0 or 0.02g/100ml) for holders of learner and probationary licences. Along with setting limits for BAC, the appropriate equipment and training must be provided so that measurements of breath and blood alcohol can be performed quickly and accurately. In this way, the provision of objective evidence then becomes an essential part of enforcement.
The main aim of community education is to encourage individual responsibility and behaviour change by providing information on the effect of alcohol on driving ability, and the personal and social costs of injury, and by promoting strategies to minimise the effect of alcohol, such as not drinking on an empty stomach, using more dilute drinks, drinking slowly, and using other forms of transport. Education programs can also be aimed at encouraging community responsibility, including the responsible serving of alcohol in licensed premises. Education appears to be most effective when carried out in conjunction with an enforcement campaign by, for instance, providing information on the risk of being apprehended and the penalties involved, among other information
The aim of deterrence is to increase the driver's perception of the risk of being caught, if he drives after drinking, to the point where he will not take that risk. One of the most effective measures has been that of blood and breath testing of drivers who have either been involved in a crash, or whose behaviour suggests some impairment. In Australia much emphasis has been placed on random breath testing. This involves setting up mobile breath testing stations and testing a sample of drivers passing the site. The intention is not so much to catch drivers who have been drinking as to make the operation highly visible so that drivers passing the site are further deterred. To be effective this countermeasure requires an appropriate legal framework, effective enforcement, and widespread publicity.
It is evident from this review that the problem of drink-driving varies in magnitude in different countries of the Western Pacific region, and that there is a universal need for the routine collection of data on the frequency of involvement of alcohol in road traffic crashes. With the help of this data programs designed to reduce the frequency of drink-driving can be more soundly based and their degree of success evaluated. Since drink-driving is a problem with multiple facets, a multi-disciplinary approach on an inter-sectoral basis is important for success. The cooperation of government agencies and community organisations in planning and developing programs is essential. A minimum set of strategies would include community education programs, setting limits to the permitted BAC for drivers, providing chemical testing of breath and blood, and setting up a continuing enforcement program.
The problem of drink-driving is a subset of a larger road safety problem and overlaps with wider community concerns about excessive alcohol consumption. Therefore, programs which address the broader alcohol-related issues will help reduce drink-driving and its effects. Specific road safety measures such as those which increase the level of seat belt wearing will prevent injury in alcohol-related as well as other crashes, and therefore reduce the effect of drink-driving. Conversely, programs aimed at reducing alcohol consumption in general will have an effect on reducing the level of alcohol-related road traffic crashes.
While the experience of other countries can provide a guide in choosing successful strategies, each country of the Western Pacific region has its own particular combination of circumstances and therefore needs to develop its own particular range of solutions, while taking advantage of the opportunity to share resources, eg for equipment and training, at both regional and national levels.
Amini BK, and Thompson NM. Roadside alcohol survey in Port Moresby. Presented at AIPRC/PIARC XIX World Congress, Marrakesh, Morocco. 1991.
Chao TC, Khoo JH, Poon WN. Road traffic accident casualties in Singapore (with special reference to drivers and front seat passengers). Annals of the Academy of Medicine; 1984 13(1):96-101.
Douglas M. Halls Creek District Hospital, Western Australia: Personal communication 1995.
Holubowycz OT and McLean AJ. Drink-driving behaviour in South Australia. In: Proceedings of International Workshop on High Alcohol Consumers and Traffic, Paris: L'Institut National de Recherche sur les Transports et leur Securite, 1989; 227-237
Marshall M. Alcohol consumption as a public health problem in Papua New Guinea. The International Journal of the Addictions; 1988 23(6):573-589.
McLean AJ, Chen PCY, Wong TW, Ukai T. Comparative study of motorcycle accidents. Adelaide: NHMRC Road Accident Research Unit; 1990. Report No.: 2/90.
Posanau CS. Alcohol and motor vehicle accidents in the National Capital District of Papua New Guinea. Medicine and Law; 1994 13:399-406.
Royal Papua New Guinea Constabulary. Road Accidents Papua New Guinea 1987. Port Moresby: Department of Transport, 1989.
Ryan GA. Prevention and control of road traffic accidents, Tonga. Manila: World Health Organisation, Regional Office for the Western Pacific; 1990 Oct.
Sinha SN, Sengupta SK, Purohit RC. A five year review of deaths following trauma. Papua New Guinea Medical Journal; 1981 24(4): 222-228.
World Health Organisation. Road traffic accidents in developing countries. Geneva: The Organisation, 1984.