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228Natural and human-made disastersLegislationprohibiting drinkingand driving isincluded in mostcountries’ trafficlaws; butenforcement islacking and publicawareness is poorconsumption, injury, infirmity, fatigue, the natural ageingprocess and distractions including mobile phone use, or acombination of these factors. A recent global reviewindicates the role of impairment as a cause of trafficaccidents. 66 In Bangalore (India), 28 per cent of crashesinvolving males over the age of 15 were attributable toalcohol. Roadside breath tests conducted as part of the sameproject concluded that 30 to 40 per cent of night-timedrivers were in a state of intoxication. One study inColombia found that 34 per cent of driver fatalities and 23per cent of motorcycle fatalities are associated with alcohol.They also report that a study in Argentina found 83 per centof drivers acknowledge that they drink and drive.Substance abuse is also a key cause of road accidents.A recent study in France of drivers aged less than 30 andkilled through road accidents indicates that as much as 39per cent of the drivers had consumed cannabis. 67 The studyhighlights the increasing prevalence of substance abuseamong French drivers, especially drugs such as cannabis,amphetamines and cocaine. While legislation against drivingunder the influence of drugs has been introduced by theFrench government, the need for greater public sensitizationthrough campaigns and roadside testing is noted. 68 Similarly,a study of fatally injured drivers in Sweden between 2000and 2002 showed a significant increase in the detection ofillicit drugs, from 5.4 to 10 per cent. 69Fatigue caused by overwork, excessive hours ofdriving, lack of rest and lack of nourishment may also causedriver impairment. In Ghana, demands for increased returnsby transport owners force drivers to speed and work whenexhausted. 70 In Kenya, on average, a public minibus (ormatatu) driver works 14 hours a day for seven days a week.Traffic regulations in many countries often limit driving timefor commercial drivers, including coach and bus drivers. Aswith drinking and driving, enforcement is greatly improvedby information campaigns.A global review of alcohol-, drug- and fatigue-relatedimpairment found systematic data collection, comprehensivelegislation and rigorous enforcement lacking in most middleandlow-income countries. 71 Only in Latin America was itcommon to find a government agency with responsibility forcoordinating road safety: Colombia, Argentina, Brazil, Chile,Costa Rica and Mexico all have an institutional frameworkbased on a National Road Safety Council, with Costa Ricaleading in a national campaign to reduce drinking anddriving.Legislation prohibiting drinking and driving isincluded in most countries’ traffic laws; but enforcement islacking and public awareness is poor. In many countries, alegal alcohol limit is in force, backed up by frequent publicinformation campaigns and enforcement operations by thepolice. In Australia, since 1993, random breath testing hasled to an estimated reduction in alcohol-related deaths ofaround 40 per cent. In some countries, such as the US,lower thresholds are in force for younger and inexperienceddrivers. Information campaigns are used to increase awarenessof the risks of driving after drinking alcohol and of thelegal penalties imposed, but can also help to make drinkingand driving less socially acceptable. Legislation for othercauses of driver impairment is less advanced and, alongsideenforcement mechanisms, represents a major area forenhancing road safety.The limited existing levels of engagement withimpaired driving in developing countries suggests that thereis significant scope for reducing traffic accidents throughcontrolling drinking, drugs and fatigue through education,legislation and enforcement. Small reductions in the amountof drunk driving can result in significant reductions in theincidence of traffic accidents. Drivers’ perceptions of risk,police powers and monitoring equipment all need to play arole in reducing impaired driving. While most countries havelegislation in place, coordination that can bring political willto this area is lacking. Political will is needed if the scope ofeducation, legislation and enforcement is to reach beyonddrunk driving to include other causes of impairment, such asfatigue, and new causes of distraction, such as mobile phoneuse.Accident response and recoveryFirst responses are critical in reducing loss from trafficaccidents. The capacity to respond to traffic accident injuryand to minimize bodily harm varies according to levels ofeconomic development. Half of all fatalities in Europeancountries occur at the scene of the traffic accident or on theway to the hospital, while death before arrival at the hospitalcan be as high as 80 per cent in low- and middle-incomecountries. 72Trained first-aiders not only save lives, but alsoprevent unnecessary injury sustained through inappropriateaction taken following an accident. As with disasterpreparedness work, the piggybacking of transport first-aidskills onto more established public service or civil societydelivery programmes is cost effective. In low- and middleincomecountries, there is little access to emergencyvehicles, increasing the benefits from widespread publiceducation programmes in first aid. Such training has beengiven to police in Uganda and the general public in India. 73Traffic managementBasic traffic regulations and signage to manage traffic areessential instruments for enhancing road safety.Enforcement of such regulations remains a key challenge incities worldwide. Table 9.5 makes a sharp distinctionbetween Kuwait, the US and the UK, where regulation andenforcement for road users is in place, and other countrieswhere road safety is yet to have been addressed comprehensively.Mortality as a proportion of car ownership rates is anorder of magnitude lower in the former group of countries.This is a clear indication that traffic mortality is a product ofsocial policy and cultural context as much as engineering. 74Managing traffic safety in the future will need to considerthe specific characteristics of the automobile culture of eachcountry.