America’s car crash epidemic

Marina Bolotnikova is a deputy editor for Vox’s Future Perfect section. Before joining Vox, she reported on factory farming for national outlets including the Guardian, the Intercept, and elsewhere.

Driving is the most dangerous thing most Americans do every day. Virtually every American knows someone who’s been injured in a car crash, and each year cars kill about as many people as guns and severely injure millions.

It’s a public health crisis in any year, and somehow, the pandemic has only made it more acute. Even as Americans have been driving less in the past year or so, car crash deaths (including both occupants of vehicles and pedestrians) have surged.

Cars killed 42,060 people in 2020, up from 39,107 in 2019, according to a preliminary estimate from the National Safety Council (NSC), a nonprofit that focuses on eliminating preventable deaths. (NSC’s numbers are typically higher than those reported by the National Highway Traffic Safety Administration (NHTSA) because the NSC includes car deaths in private spaces like driveways and parking lots, and it counts deaths that occur up to a year after a crash.)

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That increase occurred even as the number of miles traveled by car decreased by 13 percent from the previous year. It was the biggest single-year spike in the US car fatality rate in nearly a century, and 2021 is on pace to be even worse.

Between January and June of this year, NSC reports that car fatalities increased by 16 percent from the same period last year, with areas as diverse as Texas and New York City reporting sharp increases. If the trend continues for the rest of the year, nationwide deaths would reach the highest level since 2006. The NHTSA’s preliminary data estimate a lower but still dramatic 10.5 percent increase in car deaths between January and March 2021 compared to the same months last year.

According to several traffic experts I spoke with, the explanation for the 2020 fatality spike is relatively straightforward: With fewer cars on the road during quarantine, traffic congestion was all but eliminated, which emboldened people to drive at lethal speeds. Compared to 2019, many more drivers involved in fatal crashes also didn’t wear seat belts or drove drunk.

But why has the surge persisted and worsened this year, even as traffic has been picking back up and nearing pre-Covid-19 levels? We don’t entirely know, but it seems to have something to do with the pandemic altering traffic patterns.

The Covid-driven surge in car deaths shouldn’t obscure what was already a disquieting fact before the pandemic: American automotive deaths — both of pedestrians and of people in cars — are a public health emergency.

Investigators at the scene of a crash between an SUV and a semi-truck near Holtville, California, on March 2. At least 13 people were killed when a vehicle packed with passengers, including minors, collided with the large truck.

In a recent report on car fatality rates in OECD nations, the US ranked among the worst. Most of America’s peers have shown a clear downward trend in car fatalities over the past two decades: Belgium, France, Spain, and the Czech Republic all had per capita car death rates comparable to the US in 2000 and have since more than halved them. America’s fatality rate has decreased, too, over the same period but not by nearly as much, and it’s started to show signs of ticking back up in the past decade.

And like so many other major causes of mortality, people of color are disproportionately affected. Cars last year killed 23 percent more Black Americans and 11 percent more Native Americans than they did in 2019 (compared to a 4 percent increase for white Americans).

All this isn’t an inevitability — traffic safety experts know the policy interventions needed to fix the problem. The continuing surge in pandemic-era car deaths should focus national attention on implementing them.

The tragedy of road deaths

If the federal government undertook a national project to dramatically cut the number of people being killed by cars, one compelling starting point could be preventing pedestrian deaths. Pedestrians are our most vulnerable road users, and they walk in many of the same environments that are dangerous for drivers. A pedestrian-first focus would also make motorists safer.

The past decade has seen an extraordinary increase in the number of people killed by cars while walking, so much so that pedestrians account for most of the recent increase in car fatalities. Cars killed 6,205 people walking in 2019, an increase of 51 percent from 4,109 in 2009, according to the NHTSA. (The National Safety Council estimates a higher number, 7,700 pedestrians killed in 2019.)

People who can’t afford cars are also less likely to live in neighborhoods where it’s safe to walk. Black Americans, Native Americans, wheelchair users, and people walking in low-income areas are much more likely to be killed by a car, a structural disparity that worsened during the pandemic.

But for all the vulnerabilities of pedestrians in any given incident, most American car deaths don’t involve them. More common are crashes of two or more cars, or just one car crashing into an object like a tree, post, or storefront (something that happens with bizarre frequency in the US).

Emergency workers investigate the scene of a car that crashed into pedestrians in New York’s Times Square on May 18, 2017.

A makeshift memorial was created in Times Square for Alyssa Elsman, a young woman who died when a car crashed into pedestrians on May 18, 2017.

During the pandemic, car fatalities worsened across all regions of the US. Deaths spiked by about the same percentage in both urban and rural America, according to the NHTSA, though rural areas have always been highly overrepresented and remained so in 2020. In the region comprising Texas, New Mexico, Oklahoma, Louisiana, and Mississippi, which already has above-average fatality rates, deaths rose by 7 percent in 2020 and 11 percent in the first quarter of 2021. In New England, which has the country’s lowest car fatality rates, deaths increased by 9 percent in 2020 and increased by 1 percent in the first quarter of this year.

The tragedy of high road death rates isn’t uniquely American. Worldwide, the car death rate is even higher than in the US, and it’s especially bad in the Global South. Cars kill 1.3 million people worldwide every year, more than murders and suicides combined, and most victims are pedestrians, bikers, and motorcyclists — not car passengers, who tend to be wealthier.

Poor- and middle-income countries have more dangerous road infrastructure, older cars with fewer safety features, higher motorcycle ridership, and less physical separation (like bike lanes) between different types of traffic, says Renato Vieira, an economist at the Catholic University of Brasília.

Passengers travel atop a truck surrounded by motorcyclists in Maharashtra, India, earlier this year.

“Motorcycles will usually circulate in between the cars, so it’s much more dangerous,” Vieira says. “The accident ratio with motorcycles is much higher, and the fatality ratio as well.”

If the world is to meet the World Health Organization’s goal of halving car fatalities by 2030, then it has much work to do. In the US, that can start with refining our crash prevention strategy, which too often lays the blame on bad drivers while encouraging safer behaviors among individuals. These tactics have their place, but the priority ought to be on the highest-impact intervention: building roads that are safer for everyone.

America’s dangerous road design, explained

American roads have been designed for the convenience of drivers, which means they’ve been engineered for speed.

And speed is the decisive factor in a car crash’s severity. Everything else — drunk driving, distracted driving, bad weather — makes crashes more likely to happen, but speed is the difference between life and death, especially for pedestrians and bikers, who don’t have the armor of a car. A pedestrian has a 10 percent chance of dying when hit by a car at 23 miles per hour, a 25 percent chance at 32 mph, and a 75 percent chance at 50 mph.

One type of roadway that’s especially dangerous is what Charles Marohn, a municipal engineer and urban planner, calls a “stroad”: places that try to be both a street, with access to shopping and leisure, and a road, where drivers move from place to place at high speeds, but do neither well.

Stroads are pervasive throughout America. Think of the wide arterial roads, lined with strip malls and big-box stores, that dominate the country. These environments combine 30- or 40-plus mph speeds with frequent turns, stopping points, and shared traffic with pedestrians and bikes, which creates many opportunities for crashes. “When we mix high-speed cars with stopping and turning traffic, it is only a matter of time until people get killed,” Marohn writes in his recent book Confessions of a Recovering Engineer, which explores the failures of America’s car-dependent transportation system.

Stroads, or wide arterial roads lined with stores, are pervasive throughout America.

In the postwar period, “they were taking this new idea of highways, commuters, suburbs, and they said, ‘We’re going to do this everywhere,’” says Marohn. “If you’re trying to build a whole new version of America in two or three decades at scale across an entire continent, what you do is you adopt really dumb, nonflexible standards, and you just repeat them over and over and over again. That’s what we did.”

Auto-centric design didn’t just create unsafe “stroads” in the suburbs and exurbs; it also made them pervasive in city centers, where roads accommodated commuters arriving by car.

And when there’s little traffic in the way, as has been the case during most of the pandemic, the overly wide design of stroads encourages people to drive very fast, regardless of the speed limit.

One victim of stroads in an urban environment was Hermanda Booker, a 29-year-old special education teacher in Brooklyn. One day in 2017, when Booker was walking the three blocks from her home to catch a bus to work, an SUV turned left at a crosswalk and struck her, and then a school bus ran her over. “I can’t even imagine those last moments for her, of just terror,” her sister, Rhondelle Booker, told me.

It was a notoriously dangerous intersection of two wide, high-speed roads, where pedestrians are forced to spend a long time in the crosswalk. Neither of the drivers were held responsible for Hermanda’s death, her sister says. It was deemed a “tragic accident,” just an inevitable part of how driving in America works.

Though more Americans are driving regularly this year than in 2020, fewer people are driving during a predictable rush hour compared to before the pandemic, Marohn says. This has made roads less jammed even as total traffic volumes return to normal, which results in faster driving and puts drivers and pedestrians like Booker at higher risk.

“Everything that we said was happening last year — where instead of having congestion, calm traffic, you have people who are driving on roads that are over-engineered [for speed] and they’re driving fast because nothing is slowing them down — what you have now is more drivers, a higher volume of drivers, having that same experience,” Marohn says.

Stroads are common in rural America, too, and rural areas face unique challenges, like relatively empty roads that encourage fast driving, which make their car death rates much higher than in urban areas. Unlike interstates, rural highways often have no physical barrier between lanes of opposing traffic traveling at 40, 50, 60 mph or higher — a ridiculously dangerous situation that shouldn’t exist anywhere.

How to bring down car deaths

Controlling speeds on roads is the most important goal of any car safety strategy. There are two main ways to do that: change the physical design of the road with “traffic calming” measures that encourage slower driving, like narrowing lanes and adding speed bumps, or change the legal speed limit, which is easier and inexpensive but less effective.

Some cities that have committed to eliminating car fatalities have shown promising results. New York City’s traffic deaths reached a low of 200 in 2018 (the lowest in a century), down from 299 five years before, after making major citywide changes: lowering speed limits to 25 mph, installing speed cameras, and testing traffic calming measures, like these posts installed at dangerous turns. The suburban city of Fremont, California, decreased fatalities and severe injuries by 45 percent between 2015 and 2020.

Other ideas have proven promising. Installing roundabouts instead of traditional intersections is highly effective at saving lives in US rural areas, which have death rates far above the national average because of their high speeds and lack of physical barriers between lanes. Deaths can be dramatically reduced with the addition of medians or central turn lanes.

The concept of a “road diet” has also shown particular promise in mitigating the dangers of roads in sparsely populated areas. Road diets add complexity to roads by removing some traffic lanes, creating central turn lanes to more safely manage left turns, and adding features like bike lanes and shoulders, which are often missing from rural roads, resulting in fatal single-car crashes. And maybe most important, it does all this while slowing down traffic.

Reconfigure the lanes and the traffic will calm.

But the US should also look beyond its borders for solutions. Some of the most transformative recent case studies come from abroad, and they have much to teach Americans about what’s possible.

Fortaleza, Brazil, a city of 2.7 million, cut its traffic deaths nearly in half between 2014 and 2019 by lowering speeds, narrowing lanes, and adding complexity to roads, like raised pedestrian crossings. In 2015, São Paulo, Brazil, decreased speed limits on its urban highways and major roads, a reform that reduced crashes by 21.7 percent, according to a recent study by Vieira and economists Amanda Ang and Peter Christensen. “The evidence we have from São Paulo is very clear,” Vieira says. “Speed limits are very effective.”

São Paulo’s speed limits are automatically enforced by traffic cameras, so drivers are highly incentivized to comply. “If you’re driving in São Paulo and you go above the speed limit, you’re sure you’re going to get a ticket,” Vieira says. “I was surprised when I was [in America] that you don’t have automatic enforcement.”

Oslo, incredibly, virtually eliminated traffic deaths in 2019 by aggressively reducing speeds, banning cars from the city center, and building out a robust bike path network. Very slow speeds and car-free zones are becoming the norm in many European cities.

Americans might imagine that Europeans are somehow naturally predisposed to dense development that deprioritizes cars, but that isn’t exactly true. Car-centric development came to Europe in the mid-20th century, just as it did to the US.

The Netherlands’ car fatality rate was once higher than America’s; now it’s one-third of it. In the 1970s, a citizens movement called “Stop de Kindermoord,” or “Stop Murdering Children,” protested the country’s epidemic of death by cars. “They were just sick and tired of kids being killed in the streets,” says Jason Slaughter, a Canadian immigrant in Amsterdam who runs Not Just Bikes, an urban planning YouTube channel. Combined with the 1973 oil crisis, public outcry helped transform Dutch streets.

A brick-paved city intersection without cars shows parked bikes and people cycling. — Daily life in De Negen Straatjes in Amsterdam on August 7.

The Dutch example illustrates why street design is probably more important than legal speed limits. “When you have a big, wide, straight road in the middle of the city, you’re going to drive faster,” Slaughter says — it’s an ingrained, subconscious part of how we drive.

Dutch streets would be unrecognizable to most North Americans. They’re narrow and built with plenty of traffic-calming features, like curves and landscaping, making people naturally drive slower. They often have a flipped design that puts the pedestrian experience at the center. Continuous sidewalks go straight through intersections, which puts the onus on cars to stop for pedestrians rather than the other way around.

This design style recognizes that humans make mistakes, instead of expecting drivers to make split-second decisions in dangerous environments. While it’s unlikely that pedestrian-first streets are going to become the norm across the US overnight, similar principles can work in the country’s more car-dominated settings.

The policy challenge

For all of the energy around finding solutions to America’s road death emergency, the challenge of actually scaling up effective policies remains steep.

According to Bloomberg’s CityLab, many American cities pursuing “Vision Zero” — a strategy advocated by the traffic safety nonprofit Vision Zero Network to eliminate traffic fatalities and severe injuries — have not yet shown overwhelming success. The pandemic has further complicated their efforts; New York City traffic deaths, after years of sustained progress, shot up last year.

Local opposition among drivers to any perceived inconvenience can be fierce. But state restrictions have also prevented cities from going as far as they’d like to. To change a traffic law, local governments have to cut through a morass of federal and state rules, and the funding that’s tied to them.

Under state law, New York City can’t reduce most of its speed limits below 25 mph, which is still too high for streets shared with many pedestrians and bikers (activists have backed a bill that would change that, which recently passed the state Senate).

“The cities need better partners at the state level and at the federal level,” says Leah Shahum, founder and director of Vision Zero Network. “They can’t do this on their own.” And states are given little incentive to reduce fatalities; federal transportation money keeps flowing to them regardless.

“I would love it if states were actually penalized for rising crash rates,” says Courtney Cobbs, a co-founder of the nonprofit Better Streets Chicago. While states are required to set safety performance targets, Shahum calls them “really embarrassingly lax”; they function less as death reduction goals than as forecasts of how many people will be allowed to die. “They are literally planning for more traffic deaths,” Shahum says.

New York Police and Fire Department investigate the site of a car collision in Manhattan on March 5. Six people, including two children, were reported injured after a two-car collision saw one car mount a sidewalk and destroy an outdoor dining structure.

Federal standards don’t just fail to set ambitious goals — they also make it exceedingly difficult for communities to make sensible design changes, says Marohn, complaining about the stroad in front of his house in the town of Brainerd, Minnesota. “If you narrowed the lanes and made the speeds lower, it would become way more safe just overnight, immediately. But no city, no state is really allowed to do that.” Roads have to adhere to the rulebook that has dictated bad, speed-first design for decades, or risk losing federal transportation aid, Marohn says.

Deviating from the rules can also put local governments legally on the hook for crashes, which creates a strong incentive to comply even if the established standards aren’t keeping people safe.

Tying federal transportation funds to state death rates might be an effective idea, Marohn says, but only if we also throw out that rulebook.

As more cities become serious about slashing their death rates, that could actually become feasible. Americans are only at the beginning of embracing a people-focused road system, and their successes — convincing state policymakers to change street designs and speed limits — can create a positive feedback loop that inspires higher-level reform.

Marina Bolotnikova is a journalist in Madison, Wisconsin.

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America’s car crash epidemic