Objectives This study develops an assessment tool to measure how ready a country is to adopt road safety measures.

Background Strong states can centrally implement broad reforms, but can inhibit agenda setting by civil society. Weak states allow a variety of actors to set the agenda, but seldom exhibit coherence in addressing public health problems. The interplay between state and society is determinative of the effective enactment of safety measures.

Methods A consortium led by a multinational agency has begun a 5 year project to improve road safety in China, India, Kenya, Turkey, Egypt, Mexico, Russia, Vietnam and Cambodia. This study examines each country's recent history of public health activism for road safety in both civil and government sectors. Consortium members will be holding stakeholders meetings from February to May 2010 and key informant interviews will be conducted. A road safety readiness index will be calculated prospectively for each country and later follow back studies can examine how the success of the initiative was related to political culture.

Results Preliminary work on the index has identified the key following factors: (a) constitutional degree of centralisation of state power; (b) degree of engagement in road safety by the political elites; (c) media coverage of road safety issues; (d) Existence of local champions.

Significance Road safety is characterised by profound mismatch between high disease burden and low levels of social engagement compared to other public health research. New insights from political science can help inform current interventions to close the gap.