“The automobile tragedy is one of the most serious…man-made assaults on the human body,” wrote Ralph Nader in 1965. “It is a lag of almost paralytic proportions that these values of safety…have not found their way into legislative policy-making for safer automobiles.”

Those words come from the preface of Unsafe at Any Speed, an expose of just how dangerous many midcentury cars were for their occupants, and helped usher in a revolution in automobile safety. In the post-Unsafe world, car makers now advertise protection against death or injury from accidents as one of the major attractions of their products, from arsenals of airbags to cutting-edge sensors that can avoid collisions to begin with.

But fifty years after that car safety revolution, we’re in desperate need of another one. The threat now isn’t the faulty design of cars: it’s the faulty design of streets.

The scope of the problem

Over the course of the 20th and early 21st centuries, American cities and suburbs transformed most of their streets from public spaces designed for walking, biking, and other kinds of transportation (as well as socializing, putting on public spectacles or demonstrations, or just watching the world go by) into highways that are dangerous for anyone not ensconced in a motor vehicle. The cartoon below, which was passed around the urbanist web a few months ago, may at first seem alarmist to many people—until you remember that on most American streets, stepping off the curb without a signalized intersection really would be courting death or serious injury.

Credit: Claes Tingvall
Credit: Claes Tingvall

Nor is this just a problem for postwar sprawlsvilles. Until recently, even New York City’s street design guidelines prioritized motor vehicle traffic over all other users of the public way, in ways that the city now acknowledges were extremely dangerous.

The result is that car crashes are one of the leading causes of unnecessary death and injury in the United States. In 2013, according to the CDC, there were 16,121 homicides nationally—to take an extremely serious problem that has received much attention in the past several years. In  In the same year, 33,804 people died in car crashes.

Even more alarmingly, many of those were children. For those under 25, car crashes are the leading cause of death.  Over 3,000 Americans age 19 and under died in car crashes in 2013. Many of them weren’t even in cars: almost 500 were simply walking down a sidewalk or crossing the street.

And if you add nonfatal injuries, the numbers are staggering. More than three million Americans were sent to the emergency room as a result of car crashes in 2013—more than half a million of them children and teenagers. It’s hard to imagine another part of our daily lives causing this much damage without an outcry to stop it. In fact, there isn’t much else that does: car crashes are the single most common cause of death for teenagers, and even one of the leading causes of death for children too young to drive.

The culpability of urban planning

True, some of this can be mitigated through changing behavior, in particular drunk driving and failing to wear seatbelts. But we shouldn’t be led to believe that these issues are behind all, or even most, of this public health crisis. According to the CDC, about 4 in 5 car crashes that result in the death of a child don’t involve drinking. And while wearing a seatbelt can reduce the risk of death in a car crash by about 50%, two-thirds of younger children, and nearly half of older children and teens, were wearing a seatbelt or appropriate booster seat at the time of the fatal crash.

The fact is that urban planning bears a major responsibility for the incredibly high numbers of serious injuries and deaths on our streets. We’ve known for years that relatively small increases in the travel speed have huge impacts on the severity of car crashes: A car that strikes a pedestrian at 20 mph has a 5% chance of causing a fatality; the probability of death rises to about 40% at 30 mph and more than 80% at 40 mph.

And yet the primary goal of street design, even in relatively densely-packed urban areas, has been to keep cars moving at high speeds. In cities like New York or Chicago, this has often been 30 or 35 mph—or more when drivers go faster than the speed limit. In many other cities, speed limits on arterial streets are 45 mph or more, virtually guaranteeing that full-speed crashes with pedestrians or bicyclists will be fatal.

Other measures, including narrow sidewalks or no sidewalks at all, and large distances between controlled intersections, also make roads more dangerous. These design choices result in cases like that of Raquel Nelson, who in 2011 was convicted of vehicular homicide because a driver hit one of her three children as they crossed the street. Prosecutors accused Nelson of recklessness because she wasn’t in a crosswalk—but there were no crosswalks anywhere nearby.

Nor is all of this some inevitable byproduct of modern life in a developed country. The United States has one of the highest rates of traffic deaths adjusted for population in the rich world: more than twice that of Spain, three times greater than that of the United Kingdom, and four times more than Sweden.

Even if you adjust for the fact that Americans drive more, the United States’ roads still stand out as some of the most dangerous: 20% worse than Germany, 40% worse than Denmark, and 71% worse than Norway.

As we’ve noted before, this is one of the cases where cities and urban living are the solution.  Because people drive less and drive more slowly in cities, traffic death rates are lower in more urbanized places.

Nor are dangerous streets an unchangeable part of national culture. In 1990, the US and UK had almost identical road fatality rates. But since then, the US has made much slower progress—and today, we suffer 71% more deaths for the same amount of driving. The difference is worth 14,000 American lives every year.

The good news is that we have examples to follow, both abroad and in our own country. American cities have begun to adopt the Vision Zero program pioneered in Sweden with a proven track record for improving safety. The program includes shifting infrastructure to prioritize safe mobility, rather than pure speed; using new technologies; and changing transportation management and regulation, including lowering speed limits where appropriate, such as New York City’s recent move from 30 mph to 25 mph on many streets.

We know these measures are effective at saving lives and preventing serious injuries. Given the state of American road safety, the only question is what we’re waiting for.