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A certain number of injuries are the inevitable consequence of enhanced mobility provided by high speed motor vehicle travel, but as a society we tolerate many more injuries than need occur. Vehicles and roadways can be made safer, and there are many effective, but underused ways to change driver behavior. This underuse of behavior change strategies is illustrated in the United States by recent Insurance Institute for Highway Safety ratings of state laws in the areas of alcohol-impaired driving, young driver licensing, seat belt and child restraint use, motorcycle helmet use, and red light camera use.1 Research has indicated that all of the laws rated are effective in reducing the problem, but many states either do not have the laws or have weak versions of them. The majority of the ratings are either poor or marginal.
There is a certain amount of public apathy about highway safety. People generally consider motor vehicle crashes and injuries to be a societal problem, but one that does not particularly affect them. To some extent this is because most people think they are better than average drivers2 and that it is the other driver who is the problem.
Public indifference translates into a lack of political will to more fully apply countermeasures known to be effective. In turn, motor vehicle injury prevention efforts are woefully funded compared with other major health problems, and the scarce resources limit research and the implementation of programs.
Occasionally, societal movements arise that greatly increase concern about the highway safety problem among the public and policymakers, and this can produce large societal gains. Three such movements in the United States are noteworthy. One occurred in the 1960s when federal hearings resulted in the National Traffic and Motor Vehicle Safety Act, which authorized the federal government to set …