5. ALCOHOL POLICY AND INTERVENTIONS
5.1 Situation analysis
5.1.4 Drink–driving countermeasures
Alcohol impairs drivers’ sensory, motor and intellectual capabilities, particularly when blood alcohol concentrations (BACs) reach the 0.05% limit. Sobriety checkpoints can use either selective breath-testing (i.e. testing the BAC of drivers who are suspected to be driving under the influence of alcohol) or random breath-testing (i.e. stopping and testing a random selection of drivers for BAC levels). Multiple systematic reviews support using sobriety checkpoints to reduce drink–driving harms (Bergen et al., 2014; Shults et al., 2001; Peek-Asa, 1999). It is estimated that these checkpoints can reduce fatal driving crashes by about 20% if they are publicized, highly visible and frequently used. Based on this evidence, WHO recommends establishing BAC limits (with lower limits for novice and professional drivers), promoting sobriety checkpoints and random breath-testing, administrative suspension of licences, graduated driving licences for novice drivers, and ignition interlocks to reduce alcohol-impaired driving (WHO, 2010).
Implementation of drink–driving policies were also common among reporting countries.
One hundred and fifty-five countries (89%) indicated that they had some type of drink–
driving legislation, while 20 (11%) reported no drink–driving legislation, including seven of the 11 countries with a total ban on alcohol. The Global Survey on Alcohol and Health 2016 included three indicators of drink–driving policies and countermeasures: BAC limits set at the national level for the general population, for young persons and for operators of commercial vehicles; drink–driving prevention measures; and penalties for drink–driving.
5.1.4.1 Blood alcohol concentration limits
Data on the maximum permissible BAC at the national level were available from 171 responding countries, including two countries with subnational policies. The Global strategy cites strong evidence in support of a low BAC limit (between 0.02% and 0.05%), and the majority of responding countries (70%) with an established BAC limit set at or below 0.05%. The most common maximum permissible BAC for drivers in the general population is 0.05% (51 responding countries), with 0.08% (37 responding countries) being the second most frequent (Figure 5.5). Fifteen countries reported zero as the maximum permissible BAC at the national level for drivers – in effect a ban on any level of alcohol detectable by routine methods for drivers in the general population. An additional 31 countries reported having a BAC limit between 0.01% and 0.05%, bringing the total number of responding countries with a maximum permissible BAC limit at or below 0.05%
to 97. However, 31 responding countries reported having no BAC limits at all.
Figure 5.5 Blood alcohol concentration (BAC) limits for drivers in the general population, 2016
(n = 171 reporting countries)
0 8501,700 3,400Kilometers
BAC limit Zero tolerance 0.01-0.04 0.05
>0.05 Subnational No BAC limit
* Zero tolerance includes countries that have BAC levels set at zero and countries that have a total ban
Data not available Not applicable
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Box 5.3 Community action in Porto Alegre, Brazil
Traffic crashes are the leading cause of death among young males in Brazil and 78% of drivers in fatal crashes test positive for alcohol. To combat these harms, Brazil lowered the maximum permissible blood alcohol concentration limit to almost zero in 2013 (penalties apply if a driver’s BAC is greater than 0.05%, based on the margin of error in the test). This law was coupled with severe sanctions, including a R$ 1915 (approximately US$ 1000) fine and suspension of licence for 12 months for drivers caught violating the law. However, awareness of the new law and accompanying sanctions was low, especially among Brazilians who drink and drive.
“Vida Urgente” is a community-based drink–driving campaign developed by the Thiago de Moraes Gonzaga Foundation, an organization that aims to promote awareness in ways that can facilitate behaviour change. This campaign is centered on Porto Alegre, which is the capital and largest city in the Brazilian state of Rio Grande do Sul. Research on reducing the risk of drink–driving requested by the Thiago de Moraes Gonzaga Foundation from the Catholic University of Rio Grande do Sul found that 85% of young people think applications are the best way to help them get home safely after drinking (Gonzaga, 2018). As a result (Gonzaga, 2018), Vide Urgente partnered with a taxi service to help facilitate safe alternatives to drinking and driving.
One way in which Vida Urgente helps link drinkers to the taxi service is through their signature blitzes, in which groups of volunteers perform in ways that highlight the preciousness of life and help bystanders consider their roles as pedestrians, drivers and passengers. Volunteers take the stage with high-energy performances while their colleagues circulate the crowd, offering breathalyzer tests and drawings for taxi service codes to travel home safely (Thiago de Moraes Gonzaga Foundation, 2018).
Vida Urgente had an impressive success during Carnival, one of the biggest Brazilian festivals, an event that is often marked by high rates of traffic crash fatalities (Gonzaga, 2018). During the “Buzoom” event, the campaign provided buses to transport more than 5000 young people between parties (Gonzaga, 2018). There was not a single road traffic fatality on the major roads near Carnival in Porto Alegre in the years that Buzoom was in place (Gonzaga, 2018).
This inspiring feat helped the project win a national award offered by an international vehicle manufacturer (Gonzaga, 2018).
The Vida Urgente campaign has helped Porto Alegre achieve sizeable reductions in traffic crash fatalities. The number of deaths from traffic crashes per 100 000 population is much lower in Porto Alegre (7.0) than Rio Grande do Sul (14.9) and Brazil as a whole (23.4) (WHO, 2010).
Research has estimated that countries experience a decrease in fatal and injury crashes of between 5% and 18% after reducing their BAC limit from 0.08% to 0.05%. In general, low-income countries have tended to lag behind the other countries in implementing lower BAC limits for drivers. Almost half (48%) of responding low-income countries did not have an established BAC limit for the general population. Among the low-income countries with established limits, 57% were at the 0.08% level, which was the most lenient standard reported. At the other end of the income spectrum, 82% of high-income countries had a national BAC limit at or below 0.05%.
Lower maximum permissible BAC limits for commercial or novice drivers were more common (Figure 5.6). Thirty-six responding countries set a lower BAC limit for commercial drivers than for the general population. More than half (58%) of established BAC limits for commercial drivers were at or below 0.05%, including 28 countries (16%) with
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zero-tolerance laws. Twenty-six countries had zero tolerance for young/novice drivers, and 29 countries set the BAC limit for young/novice drivers at 0.05%. Among countries that established a BAC limit for young/novice drivers other than 0.0% or 0.05%, similar numbers of countries set that limit above (40 responding countries) and below 0.05%
(42 countries).
Number of countries
0% 0.01–0.03% 0.04–0.05% 0.06–0.07% 0.08% Not
established Subnational BAC limit
60 50 40 30 20 10 0
15 26 28
25 37
44 57
34 29
4 4 3 2 3 2
31 31 31 37 35 34
Figure 5.6 Blood alcohol concentration (BAC) limits by driver type and number of countries, 2016
(n = 171 reporting countries except youth BAC limit [170]) General population Youth Professional drivers
5.1.4.2 Drink–driving prevention measures
The Global Survey on Alcohol and Health 2016 added a new question to determine whether countries’ drink–driving legislation was based on blood alcohol concentration (i.e. BAC) or breath–alcohol concentration values (BrAC) converted to BAC. Of the 141 countries that provided these data, 80 (57%) responded that they had legislation based on BAC values while 61 (43%) based their legislation on BrAC values converted to BAC values.
In addition, the Global Survey on Alcohol and Health 2016 asked about the use of sobriety checkpoints and/or random breath-testing to ascertain drivers’ BACs. The definition used for sobriety checkpoints in this context was “checkpoints or roadblocks established by the police on public roadways to control for drink–driving”. The definition used for random breath-testing was “that any driver can be stopped by the police at any time to test the breath for alcohol consumption”. Forty-five responding countries (26%) reported conducting random breath tests at roadside checkpoints but not sobriety checkpoints, while 19 responding countries (11%) had sobriety checkpoints but did not use random breath-testing (Figure 5.7). Seventy countries (41%) reported they used both random breath-testing and sobriety checkpoints, while 37 (22%) used neither strategy.
For the first time, the Global Survey on Alcohol and Health 2016 asked countries to report whether they use graduated licensing, defined as new drivers receiving a restricted licence with zero tolerance for drug and alcohol use and limits on the times of day when, and classes of roads where, one can drive. A minority of responding countries (33, or 19%) reported using these licensing policies. Of the countries with graduated licensing, 12 (36%) reported zero tolerance for young people driving under the influence of alcohol.
Fourteen (42%) had a BAC limit between 0.01% and 0.05%, four (12%) had a BAC limit at 0.08%, two (6%) had subnational BAC limits and one (3%) reported the BAC limit was not established.
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However, 12 responding countries that did not use graduated licensing also set lower BAC limits for young/novice drivers than for the general population. These trends were most common among countries with a maximum BAC limit of 0.05% for the general population;
none of the countries with a legal BAC limit above 0.05% for the general population set a lower standard for young drivers.
Effectiveness of BAC limits depends on the likelihood – or at least the perceived likelihood – of those limits being enforced. WHO asked countries to estimate the perceived level of enforcement of these policies on a scale from 0 to 10, with 0 indicating not enforced and 10 indicating fully enforced, and 146 countries did so. Figure 5.8 shows that the average perceived level of enforcement among all reporting countries was 6.4, which is a 0.6-point increase since 2012.
Fully 10 enforced
AFR AMR EMR EUR SEAR WPR World
WHO Region 9
8 7 6 5 4 3 2 1 enforcedNot
Average score across countries
0 4.4
5.9
4.3
8.4
5.0
7.3
6.4
Figure 5.8 Average perceived score on enforcement of maximum blood alcohol concentration (BAC) policies by WHO region, 2016
(n = 146 reporting countries)
5.1.4.3 Drink–driving penalties
Flat fines were the most common drink–driving penalties reported by countries and were the only penalty that was more commonly used for first offences (Figure 5.9) than for
Neither (37) Sobriety
checkpoints (19)
Random breath- testing only
(45) Both
(70)
Figure 5.7 Methods of enforcing the maximum legal blood alcohol concentration (BAC) by number of countries, 2016
(n = 171 reporting countries)
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repeat offenders. Other common drink–driving penalties included licence suspension, short-term detention, imprisonment and vehicle impoundment.
Flat fine
Type of penalty
Ignition interlocks Mandatory treatment Community/public service
Licence suspension Mandatory education
Penalty points Licence revocation Vehicle impoundment
Imprisonment Progressive fine
Short-term detention
Number of countries
First offence Repeat offence 160
140 120 100 80 60 40 20
Figure 5.9 Type of drink−driving penalties by type of offence and number of countries, 2016
(n = 151 reporting countries except 149 for mandatory education (first and second offences); 152 for imprisonment and licence revocation for first offences, and flat fines, progressive fines, penalty points and community service for repeat offences; 153 for vehicle impounded for first offences and licence suspension for second offences; 154 for flat fines for first offences, and short-term detention for first offences and vehicle impoundment and imprisonment for repeat offences; and 155 for short-term detention for repeat offences)
138
112
96 86 81
64 64
44 37 33 31
11
133 131
101 97
85 96
66
54 46
39 42
14 0