We examined road safety policies and trends in road traffic injuries (RTIs) in Japan between 1970 and 2008 from the viewpoints of population and high-risk-individual approaches to see what lessons can be learned from the example of a country that experienced a decline in RTIs following comprehensive road safety policies.

We reviewed research papers and policy documents, obtained from relevant ministries, decade by decade. We obtained data on RTIs from police and from vital statistics.

Japan started the Fundamental Traffic Safety Program to combat the increase in RTIs, and succeeded in reducing both RTI mortality and morbidity rates in the 1970s by implementing vast road safety improvements, using population approaches with a particular focus on protecting the most vulnerable population groups at that time. However, RTIs increased again in the 1980s because of increasing traffic volume. In the 1990s and 2000s, safety policies targeted at high-risk driving behaviors succeeded in reducing RTI mortality rates but failed to change morbidity rates.

To achieve a safer road environment, more emphasis is required on population approaches that reduce risk among the whole population, with a balance between population and high-risk-individual approaches.