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Keynote Address, 16th Annual Daniel J. Raskin Memorial Symposium on Injury Prevention, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Deborah A. P. Hersman
Keynote Address, 16th Annual Daniel J. Raskin Memorial Symposium on Injury Prevention, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD

Thank you, Dean Klag, for that gracious introduction. It is an honor to be here at the Bloomberg School, and to be with so many public health professionals.

If Danny Raskin had lived, we could have been colleagues at the NTSB.

From my colleagues who worked with Danny, I know that he was bright and curious-good qualities for a human performance investigator. He dedicated his life to saving lives and preventing injuries, both at the NTSB and as a member of the Chestnut Ridge Volunteer Fire Company.

As a firefighter, Danny ran toward problems. And, as public health professionals that's what you do -- you see a problem and you run to it … to contain or extinguish it with an arsenal of tools, techniques and tactics - the public health model.

And, what an honor to share the podium today with Professor Sue Baker. Throughout her career, she's taken on entrenched interests in occupant protection, trauma treatment, pedestrian and aviation safety, and more. It's only fitting to see your portrait here at the Bloomberg School. That is a real testament to your accomplishments on the development of injury prevention as a public health discipline.

Yes, Sue Baker possesses the courage to tackle tough issues that endanger our health and well-being. Some are well known, but others are unrecognized. Those less appreciated dangers remind me of what mapmakers used to put on uncharted territory so many centuries ago: "Here Be Dragons."

Here be dragons.

Along with Sue, many of you are dragon slayers taking on formidable public-health dragons that would otherwise kill, maim and injure. And, in so doing, make the world a safer and healthier place.

And, that's what I want to talk about today. Dragon slaying. And about the sleeping dragon of alcohol-impaired driving … and about why you, public health professionals, can - and must - slay this dragon that causes so many senseless deaths and injuries.

Why do I say alcohol-impaired driving is a sleeping dragon?

Because so many think this dragon has been vanquished. That we have done all that can be done.

And, looking back over the past 30 years, much HAS been done.

In 1982, the first year for reliable counts of traffic fatalities, nearly one-half of traffic deaths involved alcohol-impaired drivers. Today, it is one-third.

Today, every state has a BAC limit of 0.08. Those with the long view will recall how hard it was and long it took to get it from 0.15 to 0.10 and then to 0.08.

Today, there are increased penalties for repeat DWI offenders.

Today, the minimum drinking age is 21.

Today, "designated driver" is in our vernacular.

Today, the women who founded Mothers Against Drunk Driving may be grandmothers.

But, here's why I say alcohol-impaired driving is a sleeping dragon.

Alcohol-impaired driving is responsible for the completely preventable deaths of about 10,000 people every year. In addition, another 173,000 people are injured every year, including 27,000 who suffer incapacitating injuries.

This spring I was at a meeting in Rhode Island. A woman handling logistics for the conference approached me after my remarks. She told me about her friend's college-age daughter, with her life ahead of her, who was hit by a wrong-way driver.

After the crash, the young woman was paralyzed. The family sued the restaurant that served the impaired driver. The settlement they received enabled them to purchase a wheel-chair lift car and construct a handicap accessible entrance so they could bring their daughter home. But it wasn't nearly enough to cover the medical expenses and the lifetime of care for someone that cannot walk or feed or clothe themself.

The woman speaking to me recalled that she went with her friend to the sentencing of the driver - a young man in his 20s, with a young wife, who was holding their baby girl in her arms in the courtroom, a young family with their lives ahead of them. The drunk driver was sentenced to seven years behind bars.

Seven years later, the young man was out of prison. But she couldn't help but think that seven years later, that young man, the young wife and their young child she had seen in the courtroom, that their lives had also been changed forever. And for that young woman, seven years later, still paralyzed--her life and her family's lives were also changed forever. The sleeping dragon rearing its head in those families – reminding them every day--so much lost, by so many, for a few drinks.

That's just one story. Multiply that times 27,000.

Every year.

Here's what is really frustrating. It's 2013. Because of the work of your predecessors, our society now benefits from so many 20th century public health achievements - like the eradication of smallpox and polio, safer and healthier foods, the recognition of tobacco use as a health name just a few.

Yet, here we are in the 21st century ... with all the public-health progress from the last 100 years that has added 25 years to the U.S. life expectancy ... and the percentage of traffic fatalities involving alcohol-impaired driving has been stuck at about one-third for almost two decades.

Ten thousand deaths a year is not a public health victory. Year-in and year-out, five times the enrollment of the Bloomberg School of Public Health dies in traffic crashes due to alcohol-impaired driving.

Year-in and year-out, as many people as are employed by Johns Hopkins University suffer life-altering injuries.

Year-in and year-out, the economic cost of alcohol-impaired driving totals some $130 billion, more than the combined state budgets of Maryland, Massachusetts and Michigan.

The United States prides itself on being a leader in transportation safety, but, when it comes to alcohol-impaired driving, our nation is woefully behind many of our international counterparts.

The alcohol-impaired driving dragon is well known to Sue Baker and the Bloomberg School. In 2002 – or about 110,000 alcohol-impaired driving fatalities ago – your school and the Insurance Institute for Highway Safety conducted an important study on impaired drivers. They found that a substantial number of drivers with high BACs who are killed in automobile crashes are not problem drinkers.

Yet, the myth that the-alcohol-impaired-driving-problem is solely due to hard-core drinkers persists.

With this myth and the myth of responsible drinking and those 10,000 annual fatalities last year, the NTSB decided to take a fresh look at this dragon.

We started with a two-day forum in May 2012. We brought together the experts on the science, the technology and with the experience to address impaired driving.

As a result of what we heard during the forum, we recommended that the National Highway Traffic Safety Administration - NHTSA - provide states with best practices on how to obtain more complete data in fatal crashes. We also called on NHTSA to develop uniform protocols for collecting data on drug use in fatal crashes - a growing, but little-acknowledged, problem.

Then, we completed a special investigation report on wrong-way driving. On the interstates at highway speeds, wrong-way driving can have dramatic and deadly results. The leading cause of these crashes? You guessed it: alcohol-impaired driving.

So we called for design changes of roadways and for technology in cars - such as alcohol-ignition interlocks for all DWI offenders and accelerated development of the Driver Alcohol Detection System for Safety, or DADDS. As Danny Raskin knew, the most effective fire safety tool is prevention. DADSS is an extremely promising passive alcohol-detection technology. Whether it is touch- or breath-based, DADSS will be able to prevent alcohol-impaired individuals from operating their vehicles.

At some point, DADSS could be to alcohol-impaired driving what immunization was to smallpox: the ultimate vaccine.

But, there are at least 10,000 reasons, every year, not to simply wait for the vaccine to be developed and accepted.

As any reader of fairy tales knows, there's more than one way to slay a dragon. And, as every public health professional knows, the public health model involves evidence-based prevention strategies and multiple stakeholders. Our team's findings complemented the 2002 Bloomberg/IIHS study, which said prevention efforts should target a wide spectrum of drinking drivers in addition to the so-called hard-core offenders.

Following our year-long study, this May we released a report with 19 recommendations targeted at stronger laws, swifter enforcement and expanded use of technology.

Of the 19, which recommendation do you think got the most attention?

Lowering the legal BAC limit to 0.05 or lower.

In our report, we cited research that clearly shows drivers with a BAC above 0.05 are impaired and at a significantly greater risk of being involved in a crash where someone is killed or injured. That's why we recommended that states set their BAC limits at 0.05 or lower.

This recommendation, like a fire-breathing dragon, unleashed a firestorm of response. The American Beverage Institute called the recommendation "ludicrous" and said that, "Moving from 0.08 to 0.05 would criminalize perfectly responsible behavior." Incidentally, they used the same language when fighting the move from 0.10 to 0.08.

We heard from organizations, opinion leaders and individuals. There were editorials, letters and emails. We heard about individual rights. We were accused of trying to bring back prohibition.

Even some organizations that have historically worked so hard to slay this dragon were not ready to support the move to 0.05.

But, because more than 100 countries on six continents already have a BAC of 0.05 or lower – and can demonstrate measurable and significant results – I am convinced that the U.S. will eventually adopt safer limits.

Yet, here's the silver lining in the backlash to stricter BAC limits: It makes the other 18 recommendations more palatable.

But, the pushback also tells us what a big task is ahead in slaying this dragon.

I don't have to tell an audience of public health professionals that these are long engagements. It's not just a skirmish or two to address seemingly intractable problems; it takes decades to solve public health epidemics.

But it can be done. I know. I've seen it in my lifetime. Sue, this one is for you.

When I was growing up, there were no child safety seats. When we visited relatives in West Virginia we weren't restrained riding in our old Ford LTD wood-paneled station wagon. I remember one time my dad, a pilot, hit a dog that ran across the road. My sister, Val, and I were upset as we saw the dog limp away. We asked Dad why he didn't stop before he hit the dog.

Today, I understand just how quick those fighter-pilot decision-making skills were. After he found the dog's owner, he explained to us that he made a choice between the dog and Michelle, our toddler sister, who was perched on the armrest in the front seat between my parents.

Now, I'm a certified child safety technician and my three sons have been safely restrained during every car ride since the day they left the hospital. Parents today don't have to choose between their child's safety and emergency braking.

Here's another major public health achievement I've seen in my lifetime. When I was young, one of my chores after parties was to clean the fancy ashtrays. My father was an attaché at an Embassy and we did a lot of entertaining.

Today, if my kids saw an ashtray, I doubt they would even know what it was!

During college, I interned for a member of Congress. One of my jobs then was to greet visitors to the office and there was a gentleman, let's call him John Black, from a tobacco organization. Each week, he would visit the office bearing cartons of cigarettes.

Less than ten years later, I was still working on Capitol Hill when the tide turned against big tobacco. That was in the 1990's when the public started being concerned about the health risks of not just cigarettes, but of second-hand smoke; when tobacco executives testified that smoking was not addictive; when the tobacco industry was sued and reached a record $368 billion settlement. It wasn't long before John Black and his colleagues became pariahs and Member of Congress stopped accepting contributions from the industry that had once been a top campaign donor. But how long did the public health battle against the smoking dragon take?

One of the early skirmishes was right here at Johns Hopkins. In 1938, Dr. Raymond Pearl reported that smokers do not live as long as non-smokers. The first Surgeon General warning citing the health risks associated with smoking was in 1964. The second Surgeon General warning – that secondhand smoke may cause lung cancer – was in 1982.

It was the public health model of partnerships– health professionals, researchers, legislators, educators, policy makers – who made a difference and helped tame the smoking dragon.

That's because big change in behavior takes time. And, it takes concerted effort. And, slaying public health dragons requires public health professionals.

People like you.

Slaying the alcohol-impaired driving dragon won't be easy. Just like with smoking, there's big business and industry that wants to keep the status quo. There's the tacit acceptance or tradeoff – I want to be sociable so I'll take the risk of drinking and driving. That's the myth I mentioned of responsible drinking.

Then, there's the American libertarian streak. Don't tell me what I can and cannot do. Dr. Barron Lerner, who wrote "One for the Road," said "Saving thousands of lives annually should trump their arguments."

Now there is an undeniable truth!

How do we slay this dragon and address this problem which appears to be so intractable?

Almost every culture has a dragon slaying myth, many of which are about St. George. And, as with any myth, there are differing versions of St. George's encounter with the dragon.

One of these versions tells us that in his first encounter with the dragon, St. George actually loses the battle. He retreats and wanders down to a river. There, he contemplates his challenge. After some time, St. George removes his armour and melts it down, forming a box. And into that box, he places his fears and doubts. He goes off again, confronts the dragon without his armor, and quickly vanquishes the dragon.

The mythologists tells us that the moral of this particular version is that it's our fears and doubts which prevent us from overcoming seemingly impossible obstacles.

Vanquishing the dragon of impaired driving may seem insurmountable. I've outlined the many challenges that are out there. But there are 10,000 reasons why we can't allow this dragon to scare us away from doing what is the right thing.

Today, St. George is the patron of many of Europe's great cities, in part because they celebrate his valor and determination against the odds. Your own hallways here at Johns Hopkins are lined with the portraits of modern day heroes: the men and women who faced similar insurmountable obstacles but persevered because they knew that what they were pursuing was the right thing in order promote a better public health, a better society.

Who among you today is another dragon slayer? Who among you is the modern version of St. George, sitting by the river and contemplating? My message . . . my challenge to you today is simple: Melt down your armour and vanquish the dragon!