As part of IAPA’s Campaign against Drinking & Driving in India, a National Consultative Meeting on Prevention of Drinking and Driving was organized on 21^st April, 2006 at India Habitat Centre, New Delhi to discuss the strategies and recommendations on prevention of drinking and driving in India. Around 70 delegates representing various stakeholders including Ministry of Surface Transport, Police, Directorate of Prohibition, World Health Organization, World Bank, Indian Medical Association, Bar Council, Professional Institutions, Media, NGO’s and Agencies representing Public Transport, Automobile and other related industries participated. The meeting was inaugurated by Shri Yoganand Shastri, Hon’ble Minister of Health and Social Welfare, Government of Delhi. It provided a platform for various stakeholders to interact and share their views and experiences and identify their roles in the implementation of the project.

Inaugural Session

Dr. Arul Rhaj, Chairman IAPA, welcomed the delegates and briefly introduced the need for the Consultative Meeting. He outlined the goal of IAPA viz. working towards rational policy on alcohol related issues, so as to reduce alcohol related harm in the country. He also said that it may be proposed to develop an Alcohol Action Plan for in India, as developed in UK and Europe.

He shared his opinion that prevention of the harm related to drinking & driving seems to be one of the important activities as part of the overall plan. He mentioned that tobacco control had been more effectively possible once the evidence of passive smoking had been available and its public health importance had been recognized. He said that similarly when someone consumes alcohol and gets behind the driver’s seat, they are capable of causing considerable harm and hurt to other people on the road, and so it becomes a major health problem

Mr. Derek Rutherford, Chairman, GAPA (Global Alcohol Policy Alliance) said that drink driving is being viewed around the world as a public health issue, and tackling it becomes even more important because it is preventable. People who die tend to be innocent victims, pedestrians and co-passengers. Also 43.5% of the deaths on the roads, in the UK, are of young people under the age of 24 years!  He said that legislation is good, but it is strict enforcement that is key to effective prevention of drinking and driving. UK for instance has one of the highest permissible levels (0.08% BAC level) yet one of the lowest rates of drink driving incidents.

Shri Yoganand Shastri, Hon’ble Minister for Health & Social Welfare, NCT of Delhi, inaugurated the Consultative Meeting and in his address said that most of the people at the Forum were educated, intellectual, and understoo what limits meant, but one needs to go to the villages to see just how deep and serious the problem is. A bottle gets opened there and it has to be finished, the understanding of limits is very low. The issues being taken up by IAPA are very relevant and valuable for India.

He suggested that the recommendations of the meeting be submitted to the Government of India besides the Govt. of Delhi to make more effective legislation to be able to reduce incidents of drinking and driving. He expressed full support IAPA’s mission and, requested IAPA to also consider going to the villages and smaller areas in India with their messages.

In his Key Note Address, Prof. Dinesh Mohan, said that research studies show the death per day due to drink driving is 270 per day and serious injuries is approximately 5000 per day which is equivalent one air bus crash! Yet it is not sufficiently highlighted by the media and roads accidents go unnoticed. In a comparative study, the burden of road traffic injuries had been shown to amount to 3.2% of  India’s GDP. 

He also highlighted that, without appropriate action, by 2020 road traffic injuries are predicted to be the third leading contributor to global burden of disease and injury. He Referred to a study done from Bangalore, which had observed that two wheelers are most affected by drink driving accidents followed pedestrian, bicyclists, auto rickshaws, car and towards the end comes lorry drivers. He said that the police can work effectively only if public opinion is with them, so public opinion needs to change in India to support effective law and enforcement. 

He stressed that the need may for focus on the upper classes of society since, there is the perception of drinking being a “cool” and a fashionable thing to do, and driving after that is a commonly accepted practice. While it is easy to nab and punish the poor, this Page 3 culture that celebrates and perpetuates this myth is what really needs to be challenged in India.

He summarized the global experience on drives against drink driving as showing that the most effective measures are:

1. Stronger laws with Vigorous enforcement
2. Strong link between levels of enforcement and fatality rate - breath tests increase and alcohol related fatalities drop; tests dropped and alcohol-related fatalities increased
3. Changes in social norms about drinking & driving  

In a special address, Shri Narendra Kumar IAS, Deputy Commissioner  & Secretary, Revenue, Delhi Government based on his varied administrative experience in welfare and revenue sectors expressed reservation about the success of the total prohibition as a policy as followed in different states of India time to time. He felt that public opinion and strong people support with such movements like  ‘Mothers Against Drunk Driving’ (MADD) in the USA and ‘Citizens Against Drink Driving’ (CADD) in the UK are very powerful lobbies that help government, enforcement agencies and people to effectively check such incidents.

Session I - Drink Driving :  Current Scenario

This Session was chaired by Sri. Johnson J. Edayaranmula (Director, ADIC-India) and Dr. Vinay Aggarwal (National General Secretary, Indian Medical Association). Dr. Vijay Chandra (Regional Adviser, WHO-SEARO), Dr. Vivek Benegal (Associate Professor, NIMHANS), Mr. Ramesh Gupta (Chairman, Bar Council, New Delhi), Sri. Qamar Ahmed IPS (JCP-Traffic, Delhi) and Sri. Satish Mathur IPS (JCP-Traffic, Mumbai) were the resource persons. Experiences from Asia, India and places like Delhi, Mumbai, Kerala and Bangalore were shared by the speakers.

In India, rapid motorisation rates and ambivalent attitude towards alcohol consumption has led to ‘fashionable’ alcohol use, binge drinking and led to increase in drink driving as a major cause for road traffic injuries, especially in urban India.

In a report for WHO, a multi-centre collaborative study – ‘Injury and Alcohol’ at NIMHANS Bangalore it was found that the proportion of injuries ‘linked’ to alcohol use was 58.9% of all injuries with 24% due to own drinking and 35% due to others drinking. It was found that on the types of injuries amongst alcohol users, 46% was due to road accidents, 24% due to violence, 24% falls and 6% others.

A report titled “High spirits take toll on Bangalore roads” reveals that driving under the influence of alcohol is alarmingly high among the citizens in the pub capital of India. The highest number of road fatalities occurs on week ends between 6.00 - 10.00 p.m. and there is little reason to believe that this could be for any reason other than drink driving.

In a survey done at Delhi by the Directorate of Prohibition, it was found that 45% of vehicles are driven by drivers who had consumed alcoholic drinks. One third of the injured were two wheeler drivers under the influence of alcohol and 30% of the government hospital beds were  occupied by road accident victims alone.

In Delhi prosecution against drunk driving has increased from 1260 in 1995 to 1635 till 15^th April 2006. In 2006 alone, 960 two wheelers were involved in drunk driving as compared to only 245 trucks. The effective campaigns in Delhi were enforcement campaigns and random checks with alcometers from time to time.

In Mumbai  the campaigns programme has been. Regular checks at most vulnerable areas like: bars, pubs, ‘posh’ areas. Random checks with alcometers. Encouraging family (spouses and children) to put a lot of pressure on their families not to drink and drive. Public awareness campaigns

Studies conducted in Kerala showed that Kerala is the second most accident prone state in the country after Maharashtra and also has one of the highest per capita consumption of alcohol with 40% road accidents in the national highway related to drinking driving.

It was found that the following approach were effective and workable:

1. Strict enforcement programems with reasonably stiff penalties
2. Continuous, visible and uniform checks (all of the city)
3. Focused on 25-45 years age groups, (two wheeler, pedestrians, three- wheelers, cars and heavy vehicles).
4. Ensure public participation, awareness about enforcement – awareness campaigns for the citizens.  
5. Hospital based active surveillance system to report all road traffic injuries (on few vital parameters) to document long term changing patterns and to track the ongoing epidemic.  

The group discussed in detail the lessons learnt from the experience in India, in the context of the global experience. Rules and regulations in India regarding drink driving include: 

1. Under section 185 Motor Vehicle Act, 1988, the concentration of alcohol has been specified maximum as 30 mg/100 ml of blood detected in a test by a breath analyzer.
2. The penalty for the first offence is with imprisonment for a term upto 6 months or with fine upto Rs.2,000/- or both.
3. For second or subsequent offence (if committed within 3 years of the commission of previous similar offence), with imprisonment for a term upto 2 years or with fine upto Rs.3000/- or with both.
4. Arrest without warrant by a police officer in uniform under section 202 M.V. Act, 1988.
5. Procedure for breath and laboratory tests is specified under section 203 & 204 M.V. Act, 1988.
6. The offence is non-compoundable under section 200 M.V. Act, 1988 (all challans are sent to the Court for taking cognizance) 

Debating on the existing law, the legal experts felt that is the right time for IAPA to have had this meeting, because amendments need to be made to the law related to drinking and driving. Therefore it was proposed that 337, 338 and 304, amendments be added that under 337 (causing simple hurt) 338 (causing grievous hurt), 304 (causing death) – in all these, a Section A can be added that if a person is driving under the influence of alcohol, these will case of rash and negligent is automatically applied against him.

Session II - Future Possibilities 

Sri. George Tharakan (World Bank) and Dr. Shanthi Ranganathan (Secretary, IAPA) served as the Chairpersons.  Mr. Oystein Bakke (Secretary, GAPA) and Sri. Paramangshu Mukherjee (Miditech) were the speakers. It was suggested by the speakers that best practices would include:

1. Sustained enforcement with random breath testing, swift punishment, remedial programmes for recurring offenders.

2. Reduce per capita consumption: Evidence show a clear relationship between per capita consumption of alcohol and harm. This is also applies to traffic accidents.

3. Public awareness through publicity and media campaigns bringing about change in behavior, create support for effective measures; make drinking and driving socially unacceptable; publicize drink driving regulations.  

Comprehensive community based programmes can lead to cost effective reduction in accidents. Mobilisation of victims and their families to create emotional messages, like the MADD (Mothers Against Drunk Driving) in the US, CADD (Citizens Against Drink Driving) in the UK are very effective.

The World Bank takes the issue of road safety very seriously and is looking for Global Road Safety Partnership.

The problem faced in India is of behavior. Enforcement works if 95% of the people are abiding by the rules, but if the majority is not, then it is very hard for the police to do much except occasionally or symbolically, and that is the problem in India.

In developing countries like India, the vehicle is insured and not the individual. So it was suggested that India should have a driver insurance as well which goes up with every offence. So a clear link is established between the behavior on the road and consequences.

Discussion and Recommendations

Based on the presentations of Delhi, Mumbai Bangalore and Kerala and also deliberating with other stakeholders like alcohol advocacy groups, police, road safety and health research groups, medical fraternity, an action plan was discuss based on three dimension programme:  

1. Group consensus
2. Open Issues to future discussion
3. Controversial Issues  

Drinking and driving is already a serious public health problem, which is likely to emerge as one of the most significant problems in the near future. Some database & research evidence in India is available already, which along with the international evidence be adequate for “preventive action”, while the research & documentation is encouraged, specifically action research.

Strategies for prevention require to be inter-sectoral and multidisciplinary action plan-based. The various strategies for preventive action are seen as a “cascade of strategies”, starting with implementation, through development of consensus, amendments to enactment of new laws. 

Valedictory Session

Dr. L.M. Nath Former Director and Head Department of Community Medicine, AIIMS, New Delhi was the chief guest at the Valedictory Session. Dr. S. Arul Rhaj, Chairman, IAPA chaired the session.

Conclusion