Neglected Global Epidemics: three growing threats this epidemic under control can succeed, but it will need intersectoral collaboration, targeted policies and national action plans. With an estimated 1.3 million fatalities each year fre road traffic injuries, the opportunity of saving so many lives must be grasped. Sharing responsibility for safety Evidence from developed countries shows that crashes are preventable and interventions have already saved hundreds of thousands of lives. The existing data highlight the need for approach to road safety which recognizes that the driver, the vehicle, and the built environ ment make up three components of a dynamic system within which safety is a shared respon- sibility. This approach seeks to identify all sources of error or design weakness that contribute to road traffic injuries and then tries to mitigate the consequences (31) In many developed countries, the past few decades have witnessed many improvements in fety measures for vehicles, roadways and drivers. Innovations in cars include impact absorbing front ends, collapsible steering columns, seat belts, integral head-rests, airbags and child seats. Roadway designs have been improved to place barriers between traffic moving in opposite directions and to eliminate highway intersections. Pedestrians have been separated from vehicles by roadside barriers, street lighting has been improved, and speed bumps have been created to slow the traffic. The wearing of seat belts for drivers and passengers and helmets for motorcyclists has been made obligatory, and strict laws for speeding and drink driving have been introduced and enforced. Hundreds of thousands of lives have been saved as a result of these measures. For example, death rates related to motor vehicles dropped the United States by more than 40% between 1966 and 1997. Proven cost-effective interventions in developed countries can be effective for low-income countries too. For maximum impact, all prevention strategies should be used in conjunction ith effective law enforcement (32) While the data on safety interventions are compelling, existing knowledge needs to be adapted so as to underpin successful interventions in developing countries. The unique road safety circumstances of each country and region are important subjects for research. Lifestyle and other factors behind the contrasting patterns in road casualties between poor and rich coun- tries also need to be better understood. For example, in wealthier countries, most people injured in a crash are inside the vehicle. In poorer countries, however, the majority of victims are the most vulnerable road users: pedestrians, cyclists, and passengers on public transport(33) In many countries, bicycles and motorcycles are the cheapest and most dangerous form of transport(34), sharing the road with cars, buses and trucks. Cyclists, motorcyclists and their passengers are very vulnerable to speed and poor visibility, and those without safety helmets or other protection are particularly at risk. Brain injuries are a common cause of death in road crashes involving two-wheeled vehicles. The use of lights during the daytime shows promising results, as they make the cyclists and motorcylists more conspicuous. Mobilizing action Many political leaders are not fully aware of the magnitude and severity of road traffic inju ries. Long-term awareness and advocacy campaigns are required to generate immediate and sustained action to promote global and national road safety. WHO has been increasingly involved in road traffic injury prevention in recent years. In 2001 it developed a five-year strategy for road traffic injury prevention to provide guidance to researchers, practitioners nd policy-makers and to raise public awareness of road traffic injury prevention(35). ThisNeglected Global Epidemics: three growing threats 97 this epidemic under control can succeed, but it will need intersectoral collaboration, targeted policies and national action plans. With an estimated 1.3 million fatalities each year from road traffic injuries, the opportunity of saving so many lives must be grasped. Sharing responsibility for safety Evidence from developed countries shows that crashes are preventable and interventions have already saved hundreds of thousands of lives. The existing data highlight the need for an approach to road safety which recognizes that the driver, the vehicle, and the built environ￾ment make up three components of a dynamic system within which safety is a shared respon￾sibility. This approach seeks to identify all sources of error or design weakness that contribute to road traffic injuries and then tries to mitigate the consequences (31). In many developed countries, the past few decades have witnessed many improvements in safety measures for vehicles, roadways and drivers. Innovations in cars include impact￾absorbing front ends, collapsible steering columns, seat belts, integral head-rests, airbags and child seats. Roadway designs have been improved to place barriers between traffic moving in opposite directions and to eliminate highway intersections. Pedestrians have been separated from vehicles by roadside barriers, street lighting has been improved, and speed bumps have been created to slow the traffic. The wearing of seat belts for drivers and passengers and helmets for motorcyclists has been made obligatory, and strict laws for speeding and drink￾driving have been introduced and enforced. Hundreds of thousands of lives have been saved as a result of these measures. For example, death rates related to motor vehicles dropped in the United States by more than 40% between 1966 and 1997. Proven cost-effective interventions in developed countries can be effective for low-income countries too. For maximum impact, all prevention strategies should be used in conjunction with effective law enforcement (32). While the data on safety interventions are compelling, existing knowledge needs to be adapted so as to underpin successful interventions in developing countries. The unique road safety circumstances of each country and region are important subjects for research. Lifestyle and other factors behind the contrasting patterns in road casualties between poor and rich coun￾tries also need to be better understood. For example, in wealthier countries, most people injured in a crash are inside the vehicle. In poorer countries, however, the majority of victims are the most vulnerable road users: pedestrians, cyclists, and passengers on public transport (33). In many countries, bicycles and motorcycles are the cheapest and most dangerous form of transport (34), sharing the road with cars, buses and trucks. Cyclists, motorcyclists and their passengers are very vulnerable to speed and poor visibility, and those without safety helmets or other protection are particularly at risk. Brain injuries are a common cause of death in road crashes involving two-wheeled vehicles. The use of lights during the daytime shows promising results, as they make the cyclists and motorcylists more conspicuous. Mobilizing action Many political leaders are not fully aware of the magnitude and severity of road traffic inju￾ries. Long-term awareness and advocacy campaigns are required to generate immediate and sustained action to promote global and national road safety. WHO has been increasingly involved in road traffic injury prevention in recent years. In 2001 it developed a five-year strategy for road traffic injury prevention to provide guidance to researchers, practitioners and policy-makers and to raise public awareness of road traffic injury prevention (35). This