The United States was the first country to experience deaths and injuries from motor vehicle crashes in large numbers. As other countries motorised, they, too, experienced large numbers of crash deaths and injuries. Early efforts to address this problem were based largely on guesswork, with the principal focus on educating motorists. This simplistic and narrow approach continued for decades, even though the numbers of crash deaths and injuries continued to grow.1

In the 1960s a public health approach to the problem emerged in the United States and other motorised countries. Under this new approach, the available prevention options greatly expanded, and the effectiveness of countermeasures was scientifically evaluated before widespread adoption. This emphasis on evaluation was important because the earlier efforts continued for decades without evaluation, and when some of these programmes were eventually evaluated there was no evidence of effectiveness.2

Today motor vehicle crashes are causing substantial numbers of deaths in countries that are relatively new to motorisation.3 A key question is how these countries can avoid the many unnecessary deaths and serious injuries that occurred in today's motorised countries during the decades that motor vehicle use was rapidly expanding, ineffective countermeasures were in place, and potentially effective countermeasures were being ignored.