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The Pedestrian Drinking Problem
In 2003, the Department of Transport released figures to show that drunk driving caused half of South Africa’s accidents. Statistics continually prove that drunken pedestrians are also an ongoing problem on our roads.
Drinking and road usage has received the benefit of considerable funding and concern in recent years, but the figures are still escalating. Are we treating the symptoms and not the cause when we endeavour to keep heavy drinkers off the roads? What is it that causes so many people to drink so heavily? Where many pedestrians are concerned, it can be assumed that most would benefit if the money they ‘sink into drink’, was used more meaningfully.
But the poor and unemployed are not the only people drowning their sorrows on a regular basis. Car owners/drivers behave just as badly. Their sin is generally considered worse, because the influence of their alcohol is backed by the sheer weight of heavy machinery. Since previous strategies appear not to have worked, how then, do we plan to improve the status quo?
Call to action
The good news came in the form of an open letter from the Minister of Health (Mercury 22/12/2004). She acknowledged the report from the United Nations General assembly stating that road safety has received insufficient attention at international and national levels and that multi-disciplinary collaboration is needed to tackle it effectively. Lack of political responsibility was also cited.
She wrote that she believes that an increase in road accidents is synonymous with development, an attitude that many would consider defeatist – development should surely encompass all spheres of life. Despite this, she agrees that the Department of Health must become involved in primary prevention strategies, including public campaigns to reduce alcohol intake and encourage behavioural change.
Welcome news, no doubt, for Transport, which has been trying to achieve a level of intra-departmental co-operation since the start of Arrive Alive in 1997. The minister further explained that “Health has a social responsibility to prevent injuries due to the enormous amounts of taxpayer money that are spent on emergency care, hospital care, rehabilitation and social security grants.”
It was gratifying to note that the Minister intended to rally her department to achieve the World Health Organisation 2004 objectives regarding road safety. A year later, few can see any sign that her department remembers her promise to help turn a growing national drinking problem around? Does she need more motivation to act?
Effective research has repeatedly highlighted the effects of alcohol on both body and brain. Only two examples are noted here, since they are considered sufficient to highlight interesting facts of which every drinker should be aware.
The first part of the brain to be affected by alcohol is the frontal lobe, which controls conscience and executive control (including co-ordination and dexterity). This obviously means that drinkers are less able to control machinery or react in sufficient time to avoid accident situations, but that they have also lost any natural urges to behave well or to evaluate their behaviour with honesty. This can be seen in their assurances that they are ‘just fine’ to drive or walk home, even after several drinks.
The cerebellum is the next part of the brain to feel the effects of alcohol consumption. It controls coordination of all types, but especially hand/eye co-ordination. After a few drinks, the drinker slurs his/her speech, suffers memory loss and double vision, though it appears to him-/herself that there is no more than a warm, fuzzy, comfortable haze in the atmosphere.
After a big night out, even after blood and breath alcohol levels have returned to normal, the brain still has not recovered its former capacity to perform normally. Hangovers translate into ‘still drunk’. Due to alcohol’s dehydrating effects, the brain shrinks and a hangover is actually part of the recovery process. Until the fluids in our bodies have completely returned to normal, our reactions and judgement are severely affected, though reaction improves before our judgement does.
“Researchers from the Institute of Psychiatry at Kings College, London found that women are now more likely than men to indulge in regular binge drinking (Binge drinking ladettes at risk, Daily News, 22/1/2004). A five-year study into the drinking habits of 20 000 adults between 20 and 60 showed that deaths from alcohol abuse among women trebled in only seven years.
One in five women can be considered a binge drinker – the result of greater financial and general independence. Because female hormones do not process alcohol as well as those of men, their livers are more vulnerable than those of the men who match them drink for drink.
Interestingly, during drinking sessions, female testosterone levels escalate four to five times faster than those of males. Their sex drive rises and they find it difficult to keep their urges and impulses under control. Others appear to be more attractive than they actually are, so women are likely to link up with men who, in sober circumstances, they might avoid or not spare a second glance. This information becomes fascinating when related to young girls who accept lifts from men who are not fit to drive and those who develop trust for male acquaintances after only a few drinks.
The article also reported that heavy drinking in women can be linked to breast cancer and that women are more likely than men to suffer brain damage induced by binge drinking. Good enough reason not to need to say about your teenage daughter, “She’s going to do it anyway”?
Every year in South Africa, too many babies are born with foetal alcohol syndrome, a condition that stunts their growth, health and brain capacity. It results from maternal drug and alcohol intake during pregnancy and very often the babies, who are born, already ‘damaged’, will receive as little care and attention throughout their lives as they received consideration, during the gestation period.
Very often, they become part of the growing orphan problem; their mothers dumping them as soon as they realise that their children are not normal. There are insufficient orphanages and special schools for them and they seldom find secure surroundings where they can develop to their limited potential. Moreover, alcoholism, besides being a certified illness, is also an expensive habit. Even if their mothers keep them, many have been repeatedly raped and/or sodomized before the authorities step in.
Despite the fact that drunken pedestrians are not essentially part of the drunken driving problem, they are a very real cause of accidents, serious injuries and fatalities on South African roads. The effects of alcohol on body and mind relate just as much to the ability of drunken pedestrians to cross a road in safety, without endangering vehicular traffic (and themselves) as they do those who get behind the wheels of their cars when ‘under the weather’.
Although many would argue that the pedestrian is far more vulnerable and does not, as such, control imminently dangerous machinery, every drunken pedestrian who is a danger to him-/herself, is as much of a danger to vehicular traffic. When motorists hit drunken pedestrians, there are no statistics to show how many vehicles have already managed to avoid the same person. When a motorist is unable to avoid a drunken pedestrian, the lives of everyone in his vehicle, and in surrounding vehicles, are also put at risk.
It is realistic to suggest that a single drunken pedestrian on the road, could ultimately be liable for the death of an entire minibus taxi or bus full of passengers. In fact, in some cases, where tragic bus accidents have claimed the lives of several passengers, it is unlikely that evidence proving the presence of a drunken pedestrian would surface, despite investigation after the incident.
Arrive Alive figures for 2002 reported 126 drunken pedestrian fatalities. In the first ten months of 2003, 56 drunken pedestrian fatalities were reported. It should be remembered here that people who die after admission to hospital are reported initially as ‘serious injury’ cases and fatality figures could have risen during the days after the accidents.
An article, Pedestrian injuries – some of the facts (Peden & Van der Spuy, Trauma and Emergency Medicine, June/July 1996) reported on the Adult Pedestrian Alcohol Survey undertaken by National Trauma Research: all of 196 consecutive adult pedestrians who presented to Groote Schuur over a nine-week period, in 1993, were clinically assessed, had specimens taken for blood-alcohol analysis (BAC) and had breath alcohol levels determined.
A staggering 61.2% of the total had taken alcohol; only 2.6% had BACs in the 0.01-0.07g/100ml range. 18.4% were between the levels of 0.08-0.15g/100ml, while 40.3% were 0.16g/100ml or higher (more than three times the legal limit for drivers). The mean BAC, for those who had taken alcohol, was 0.19g/100ml.
Not surprisingly, there is a cluster of such injuries over weekends, particularly on Saturdays and most can be linked to paydays. The most common were lower limb injuries (contact with bumpers causing the primary injury) and pelvic lesions, which were usually fractures. Next most common were head injuries, caused by victims falling and hitting their heads. No mention was made of whether victims might have fallen before being hit by a vehicle.
A clear trend of alcohol consumption was apparent. Findings also mentioned the fact that the drunken pedestrians were not conspicuous. This angle has been argued extensively. Frankly, light clothing seldom makes pedestrians visible enough at night, to avert disaster. Only retro-reflective devices are likely to alert drivers within sufficient time, to slow down in order to avert a collision. Table 1 illustrates the pedestrian injuries that can be expected at two different impact speeds, one slightly above and another below our urban speed limit, even before darkness or alcohol become part of the equation.
Impact speed % Deaths % Injured % Uninjured
65 km/h 85 15 0
50 km/h 45 50 4
Source: Urban safety and Calming, Tiwari & Patel
Table 2 depicts the blood alcohol levels measured during the adult pedestrian alcohol study. Further annual drink-rate surveys undertaken by the Council for Scientific and Industrial Research, on behalf on DoT, showed that, in several metro areas, of adult pedestrians walking about after office hours, but not involved in collisions, 10-13% were found to have blood alcohol levels > 0.08g/100ml (these surveys were undertaken before the legal limit was reduced to 0.05g/100ml). This highlights a tragedy – over 10% of urban pedestrians are in no fit state to cross a road alone, on many evenings.
It is a miracle that no more are hit by passing vehicles.
Table 2: Proportion of pedestrians seen at Groote Schuur with blood alcohol levels of >0.08g/100ml
Description of injuries % Pedestrians with blood alcohol levels >0.08g/100ml
In-hospital deaths 70
Severe injuries 61.2
Lesser injuries 50.9
Source: Adult Pedestrian Alcohol Study, National Trauma Research
The results of the adult pedestrian alcohol study also showed, in Table 3, that patients with substantially raised alcohol levels, increased patient management requirements. In other words, nursing became more complex – the drunker the pedestrian, the more attention and skill were needed to nurse and subsequently to rehabilitate him. Alcohol presence also impacts on the use of drugs and anaesthetic and the ability of patients to recover from emergency surgery.
Table 3: Proportion of pedestrians seen at Groote Schuur with blood alcohol levels >0,08g/100ml
None 15 (12.5%) 12
Short term ( 8 weeks) 33 (27.5%) 21 (27.6%)
Permanent (such as severe closed head injuries, amputations, etc.) 18 (15%) 7
Died in Hospital 7 (5.8%) 3
Source: Adult Pedestrian Alcohol Study, National Trauma Research
From the sample included in the research, pedestrian injuries and deaths appeared to be predominantly adult, black male. Injuries were severe, cost of treatment is high and alcohol plays a major role in both deaths and injuries. The consequences of drunken pedestrian collisions are serious – to the pedestrian, the vehicle driver, the health-care system and to the state.
Given that pedestrians are, on occasions, the cause of their own deaths and the cause of accidents in which others are killed and severely injured, should they not also contribute to the RAF coffer? Drivers are the group who bear the entire responsibility for eventual payouts. Should drivers forever be expected to fund the claims of those who carry a proportion of guilt?
The generous and timely sponsorship of the RAF towards road safety at the advent of the Arrive Alive campaign failed as an exercise in claims reduction. Seasonal promotion is also insufficient to change the bad habits of any individual. Advertising and PR spend does not guarantee change of attitude or behavioural change among road users.
Serious, ongoing, formal, social education is possibly the only strategy that will affect the habits of people, aside from prohibitive legislation. The dangers of alcohol consumption, in general, do not appear to have caught the public imagination. Or that of the DoH: it doesn’t take a rocket scientist to realise that alcohol addiction must cause at least as much misery in this country as tobacco addiction – ask any family member of a ‘mean’ drunk…
Nobody, no body or organisation, seems to feel a responsibility towards drunkenness, other than Road Safety, Traffic and Alcoholics Anonymous. The sensitivities of the liquor and hospitality industries, the profits at stake and their individual rights, are still considered fairly sacred. Smoking reform was considered a priority, where alcohol consumption is not.
There is no reason why alcohol abuse (in general) could not face a similar onslaught to that which tobacco has survived. Yet the ill effects of alcohol abuse on those who do not drink, are considered by many to be far worse than the ill effects of smoking on those who do not smoke. South Africans do love their pariahs, and here is a cause that does not discern between race, colour creed or political affiliation!
Previous strategies for limiting drinking and road usage have not worked. A full-scale nationwide campaign against the misuse of alcohol is warranted and DoT should not be afraid to take the lead in respect of persuasion, due to the appalling statistics concerning drinking and road usage.
Teaching individuals to know when they have had enough, when alcohol is poisoning their systems and when regular intake is jeopardising their jobs and destroying their health and families, would be no easy task, since every situation is so individual, but there is no reason why a similar strategy as that used against smoking could not be taken by the government. As an illness/disease, alcoholism is the direct responsibility of DoH.
Sufficient proof of the consequences of alcohol abuse should be easily garnered from organisations such as the MRC, child and family help lines, child/gender abuse centres, places of safety and trauma centre/hospital records, to ensure a persuasive proposal for the attention of the State President and the National Minister of Health.
Having publicly aligned herself to the cause of road safety and promised follow-up, immediate action could have been expected from the Minister of Health. The objective for lobbyers should be to clarify the costs to Health of drunken behaviour, in general, and drunken driving/walking, in particular.
It is the culture of drinking that causes these problems, not the culture of transport/traffic. Random breath testing amongst pedestrians should become the norm, since pedestrian enforcement has long been neglected. Why the alcohol levels of pedestrians are considered a traffic/transport ailment, when they are clearly far more a social ailment, seems strange.
If restaurateurs and hoteliers are expected to clamp down on smoking, why should they not also police alcohol consumption? Why not limit public consumption as is done on beaches? As smokers have learned, it only takes one really determined National Minister of Health to turn a status quo inside out and re-channel history, should she choose – and she claims to choose.
Legislative changes (not only in the interests of road safety, but also in the interests of general population health) should consider cost to the economy of consequential social programmes, emergency services and rehabilitation. A legal limit for pedestrians should be legislated. Since passengers are also pedestrians either side of their trip, it would also apply to them.
Limiting the amounts of alcohol served per customer in any public place would be an essential element and all public venues where alcohol can be purchased could be required to stock pocket breath-testing kits. Customers could be obliged to buy them to prove their sobriety before their orders are taken (pub crawling was invented by those who did not wish to be seen to be over-imbibing) and the price of the kit could be charged to the customer.
New drinkers enter the system continually, as they come of age, so no initiative could be considered short-term – at least for several years – until lower drinking levels among all South African road users becomes a way of life. It’s the week before Christmas. Let us hope that by this time next year, someone will have considered doing something rational to help drunken pedestrians help themselves.
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