Motor vehicle crashes result in some 1.2 million deaths and many more injuries worldwide each year and is one of the biggest public health problems facing societies today. This article reviews the history of, and future potential for, one important countermeasure-designing vehicles that reduce occupant deaths and injuries. For many years, people had urged automakers to add design features to reduce crash injuries, but it was not until the mid-1960s that the idea of pursuing vehicle countermeasures gained any significant momentum. In 1966, the U.S. Congress passed the National Traffic and Motor Vehicle Safety Act, requiring the government to issue a comprehensive set of vehicle safety standards. This was the first broad set of requirements issued anywhere in the world, and within a few years similar standards were adopted in Europe and Australia. Early vehicle safety standards specified a variety of safety designs resulting in cars being equipped with lap/shoulder belts, energy-absorbing steering columns, crash-resistant door locks, high-penetration-resistant windshields, etc. Later, the standards moved away from specifying particular design approaches and instead used crash tests and instrumented dummies to set limits on the potential for serious occupant injuries by crash mode. These newer standards paved the way for an approach that used the marketplace, in addition to government regulation, to improve vehicle safety designs-using crash tests and instrumented dummies to provide consumers with comparative safety ratings for new vehicles. The approach began in the late 1970s, when NHTSA started publishing injury measures from belted dummies in new passenger vehicles subjected to frontal barrier crash tests at speeds somewhat higher than specified in the corresponding regulation. This program became the world's first New Car Assessment Program (NCAP) and rated frontal crashworthiness by awarding stars (five stars being the best and one the worst) derived from head and chest injury measures recorded on driver and front-seat test dummies. NHTSA later added side crash tests and rollover ratings to the U.S. NCAP. Consumer crash testing spread worldwide in the 1990s. In 1995, the Insurance Institute for Highway Safety (IIHS) began using frontal offset crash tests to rate and compare frontal crashworthiness and later added side and rear crash assessments. Shortly after, Europe launched EuroNCAP to assesses new car performance including front, side, and front-end pedestrian tests. The influence of these consumer-oriented crash test programs on vehicle designs has been major. From the beginning, U.S. NCAP results prompted manufacturers to improve seat belt performance. Frontal offset tests from IIHS and EuroNCAP resulted in greatly improved front-end crumple zones and occupant compartments. Side impact tests have similarly resulted in improved side structures and accelerated the introduction of side impact airbags, especially those designed to protect occupant's heads. Vehicle safety designs, initially driven by regulations and later by consumer demand because of crash testing, have proven to be very successful public health measures. Since they were first introduced in the late 1960s, vehicle safety designs have saved hundreds of thousands of lives and prevented countless injuries worldwide. The designs that improved vehicle crashworthiness have been particularly effective. Some newer crash avoidance designs also have the potential to be effective-e.g., electronic stability control is already saving many lives in single-vehicle crashes. However, determining the actual effectiveness of these new technologies is a slow process and needs real-world crash experience because there are no assessment equivalent of crash tests for crash avoidance designs.