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Action on alcohol and road accidents.

In 1907 a leading article in the Lancet drew attention1 to the dangers of driving under the influence of alcohol "with the ever growing numbers of motor omnibuses hurtling through our streets" and remarked that "the appalling risks that may arise from the intoxication of an engine driver or chauffeur are too obvious to need mention." Seventy years later alcohol has become the most important single factor in determining risk of road accidents in most technically developed countries. At the Seventh International Conference on Alcohol, Drugs, and Traffic Safety, held at Melbourne earlier this year, very few countries reported any real progress in dealing with the problem. The most depressing development has been the shift downwards in the age at which alcohol is being abused by drivers-and in particular by men. In the year after the Road Safety Act of 1967 (which introduced in Britain a legal blood alcohol concentration limit of 80 mg 100 ml and screening breath tests) the proportion of drivers in the 20-40 age group killed in road accidents and found with an excess of alcohol fell from just under 400'SO to 20°,,. By 1974 it had risen2 to nearly 500,0. Road accidents now account for more than 400% of all male deaths between the ages of 15 and 24 in England and Wales.3 How long can public health authorities continue to ignore the problem as being within the responsibility of the authorities concerned with road safety ? The Melbourne conference showed very clearly that one of the main reasons for failure to control drinking drivers is their extremely small risk of being caught while driving with above the legal limit of alcohol. Professor H L Ross4 of Denver made a detailed analysis of casualty savings after the 1967 legislation and concluded that "the risk of apprehension for a drinking driver in Britain is realistically quite minute, and this fact is increasingly being learnt by the public, who are adjusting their behaviour in consequence." Awareness of this problem has led many countries to consider the introduction of what are wrongly termed "random tests" allowing a police officer to obtain a screening breath test from a driver entirely at the officer's discretion. The report of the Australian Law Reform Commission,) which considered this approach in considerably more depth than our own Blennerhassett Committee,6 came out against such tests. The distribution of very high blood alcohol concentrations among the driving population is highly selective, and the introduction of random tests would not therefore be cost-effective. This is the heart of the problem. The main contributor to