Traffic crashes, particularly those involving an alcohol-impaired driver, are a significant impediment to good health. They are a leading cause of death, and impaired drivers are involved in about one-third of these crashes. According to the American Public Health Association (APHA), public health is the practice of preventing disease and promoting good health within groups of people, from small communities to entire countries. Clearly, traffic safety and specifically impaired driving deserve the attention of the public health community.
In his presentation for the 2012 annual meeting of the Governors Highway Safety Association, APHA Executive Director, Dr. Georges Benjamin, listed the following lessons for applying the public health model to highway safety: (1) use a comprehensive approach; (2) set national targets for safety improvements; and (3) use proven science to reduce injuries and fatalities.
We at the National Transportation Safety Board (NTSB) agree.
In May, the NTSB recommended a set of targeted interventions that will prevent crashes, reduce injuries and save lives. We took a comprehensive approach, identified science-based countermeasures, and called for targets that would drive our nation towards zero deaths from alcohol-impaired driving. In some cases, the interventions we recommended are in use, but need to be expanded; for other interventions, we have identified innovative new approaches. But all these interventions are proven to reduce impaired driving, crashes, injuries and deaths.
We recommend interventions that focus on the four million individuals who have admitted to driving after believing they have had too much to drink. Lowering the per se blood alcohol concentration (BAC) limit, conducting high-visibility enforcement, and employing passive in-vehicle systems are designed to have a broad deterrent effect that will discourage driving after drinking in the first place. The fact is that impairment starts with the first drink; by the time a person reaches a BAC of 0.05, that person is 38 percent more likely to be in a crash than a sober driver. Fatal crashes decreased 18 percent in Queensland and eight percent in New South Wales after those Australian states lowered their per se BAC limits from 0.08 to 0.05. A review of 12 studies evaluating the effectiveness of sobriety checkpoints in the United States found that well-implemented and publicized checkpoint programs reduce alcohol-related fatal and injury crashes by about 20 percent.
There are also recommended interventions for those drivers who choose to drink and drive and are arrested. Authorizing administrative license revocation (ALR) at the time of arrest provides swift enforcement. ALR laws are associated with reducing alcohol-related fatal crash involvement by five to nine percent, representing at least 800 lives saved per year in the United States. In addition, expanding the use of ignition interlocks ensures that convicted offenders will drive sober. If all drivers with at least one alcohol-impaired driving conviction within the previous three years had used zero-BAC interlocks, approximately 1,100 deaths, or about 10 percent of fatalities associated with alcohol-impaired drivers, could have been prevented in one year.
Finally, for the small population who are resistant to changing their behavior and for whom other countermeasures are not effective, we recommend targeted programs that include Driving While Impaired Courts. A recent meta-analysis of drug courts and DWI courts estimated the relative recidivism rate for DWI court participants was lower than for non-participants.
Most Americans think we’ve solved our nation’s drunk-driving problem. We haven’t come close. Every hour, on average, one person is killed; 20 others are injured. Over the course of one year, that adds up to 10,000 deaths and more than 173,000 injured, 27,000 of whom suffer incapacitating injuries. Since 1995, impaired driving deaths as a percentage of total highway fatalities have stubbornly remained at around 30 percent. With the numbers resistant to change, it is time to ask ourselves, "What more can be done?" The answer: To make a bold difference requires bold action. We may not all agree on every intervention, but we can all agree that alcohol-impaired crashes are not accidents. They are crimes. They can — and should — be prevented. The tools exist. What is needed is the will.
This blog post was prepared by Deborah A.P. Hersman, Chairman, National Transportation Safety Board.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.