Cycling and safer roads: Improving public health through urban planning

Editor’s note: This is the second in a two-part series on road safety and public health. Part 1, Public health and urban planning go hand in hand. Why aren’t we doing more to promote cycling?, can be found here.

More than 50 per cent of road fatalities are vulnerable road users, including pedestrians, cyclists and motorcyclists, who are disproportionately from lower incomes; more than 50 per cent of our urban landscape lacks the basic infrastructure to support all forms of transport. Health-care professionals and their institutions have the knowledge and moral authority to help reveal and curtail the inequities and harms (climate change, sedentary lifestyle, collisions, financial costs, etc.) behind this urban landscape.

To best accommodate all road users, there are two major elements to ensure safety for all:

  1. Traffic calming and protected infrastructure.
  2. Revealing motonormative blind spots and victim-blaming language.

As said by Milton Friedman: “One of the great mistakes is to judge policies and programs by their intentions rather than their results.” There are numerous examples throughout history of unexpectedly negative consequences originating from “good ideas,” such as the display of traffic deaths on electronic warning road signs that counterintuitively increased the number of collisions and fatalities. As such, these concepts should not be universally applied without careful contextual evaluation.

Traffic calming and protected infrastructure

Making transportation safer is not about “bad drivers,” “inattentive pedestrians,” or “crazy cyclists,” but rather about bad design that encourages dangerous behaviours for a given environment, namely “stroads,” as well as the overemphasis of stop signs and the lack of protected infrastructure.

Stroad” is a term coined by Strong Towns combining street and road:

–   Street: A destination that produces wealth and maximizes the value of the space available through interactions between people and businesses. These are low-speed, complex environments that are welcoming to people and have multiple entrances/exits and parking.

–   Road: A space that is meant to move cars quickly between destinations and cities and thus is more forgiving to prevent collisions through (1) straighter and wider paths; (2) gentler curves when curves are necessary; (3) a lack of obstacles; (4) larger distances between entrances and exits to limit conflict points; and (5) larger signs that can be read at a distance and at higher speeds.

In combining these two concepts, stroads, with their higher speeds and multiple conflict points (four-way junctions, multiple lanes, lane changes, entrances and exits, etc.), are hostile to all users while also being cost inefficient and expensive to build and maintain. The long distances between crosswalks; crosswalks themselves that span multiple lanes; signs that are out of proportion to human-scale to accommodate fast-moving cars; and trees removed due to their collision risk make these environments dangerous.

As such, streets should be used within cities; roads between cities.

Current traffic calming measures in North America tend to overuse stop signs that frustrate road users with frequent starts and stops, lead to desensitization and, ultimately, to a disregard for them and other traffic rules and signs. In addition, stop signs increase peoples’ top speeds as drivers accelerate more than they would normally to make up for lost time, even though speeding saves the average person two minutes per week at the expense of further increasing the negative externalities of cars. Psychologically, stop signs displace a road user’s focus from yielding and looking out for others to the act of stopping itself while also giving road users, particularly children, a false sense of security. Stop signs should be restricted to junctions with high speeds/traffic volumes, low visibility and a history of crashes. Instead, proper traffic calming should force people to pay attention via stimuli that keeps speeds low to the point where stop signs are no longer needed and/or replaced with yield signs. Traffic calming comes in three forms:

  1. Vertical deflections: Speed bumps, particularly before crossings and/or intersections, are effective. The use of continuous sidewalk crossings (car lanes are raised to sidewalk levels at intersections rather than sidewalks going down to the level of car lanes) act as significant speed bumps and reinforce the idea that this is a space for walking. They also are easier to navigate for individuals in wheelchairs and aren’t tripping hazards, particularly for those with physical disabilities or who are blind/partially sighted. Brick roads on residential streets make people more aware of their speed through increased road noise and, psychologically, are associated with walking.
  2. Horizontal deflections: These can be chicanes and/or roundabouts. The latter can replace expensive traffic lights ($400,000 per light and $10,000/year in electricity), while also reducing congestion, while being safer for everyone by avoiding the most severe impacts (T-bone collisions). However, roundabouts can increase collisions for bicycles if a protected bike lane isn’t present (addressed later).
  3. Narrowing: Narrow lanes and the introduction of trees, despite the reduced space, are in fact safer than wider, tree-free spaces. The confined space provides a sense of enclosure, gives a sense of speed and forces a reduction in speed. Narrowing can be in the form of curb extensions and refuge islands that shorten crosswalks, decrease a person’s exposure time in the intersection, accommodate slower individuals and reduce conflict points by allowing people to look only one way at a time. Similarly, turns should be made sharper for cars to encourage drivers and cyclists to slow down. In the same vein, slip lanes should not be installed and right turns on red lights should be prohibited. Eye-tracking studies have demonstrated a leftward bias, meaning a driver’s focus is on incoming cars rather than people crossing from the right, ultimately increasing crashes with pedestrians by 69 per cent.

In addition, parked cars should be removed at the ends of a crosswalk since they block visibility for all road users. For those that decry the removal of parking, keep in mind that parking minimums and their positive feedback loop increases housing prices by 30 per cent (an important social determinant of health) and also inflates rent by $400 per month per parking spot. “I don’t see why people have to pay market rents to live in the neighbourhood, but the cars should live rent free,” says Donald Shoup, Distinguished Research Professor in the Department of Urban Planning at UCLA. “You have expensive housing for people and free parking for cars. You’ve got your priorities exactly the wrong way around.”

To protect cyclists, we refer to Shifter’s bike-lane ranking that takes into account safety and usefulness:

1)         Painted bike lanes: These offer no protection and only give a false sense of security as drivers tend to pass close to cyclists. For the winter months, non-protected bike lanes are often not cleared and serve as a place to store snow and/or parking since the bike lane markings are covered.

2)         Multiuse pathway: These are often treated as recreational paths and thus can be ineffective for transport as they may not take people to where they want to go, or they do so in an indirect way.

3)         Two-way protected bike lane/one-way protected bike lane: Protected bike lanes reduce the risk of injury by 90 per cent. Though not ideal, one method to quickly and inexpensively create a makeshift protected bike lane is to have parking limited to the left of the bike lane to form a barrier, as was done with much of Montreal’s Réseau Express Vélo (REV).

In addition, bikes should have an accessible, convenient, and secure place to be stored as bike parking is the second most cited reason for why people don’t bike and is the No. 1 reason people who bike don’t do so more often. Bike theft impacts 2 million North Americans/year, is increasing, and remains under investigated with only a 2.4 per cent stolen bikes recovery rate.

As such, fewer people using any form of transportation is not due to disinterest but is rather a product of the environment and its safety and efficiency. As explained through induced demand/Braess’s paradox in Part 1, implementing traffic calming and protected infrastructure will likely reduce commute times rather than increase them.

Revealing motonormative blind spots and victim blaming language.

The media and health-care professionals can play a role in challenging society’s motonormativity, car-centric blind spots, and the special pleading fallacies. In collisions, news articles’ sentence structure often place the focus and blame on victims by mentioning how they could have prevented the crash while minimizing the responsibility of the person driving. Object-based language is often used for the driver (car, vehicle, etc.) while human-based language is used when referring to the victim (cyclist, pedestrian, person, etc.). More than 25 per cent of articles don’t mention a driver at all.

Part 1 covered the misconceptions of helmets and cyclists as rule breakers, but an additional misconception is the shame associated with people crossing at “non-designated” areas and being labelled “jaywalkers.” The term has dubious origins that stem from early automobile industry lobbying. In the early 20th century, roads were dominated by horses and people and people could cross anywhere. As cars became dominant and collisions with people increased, the automobile industry campaigned to shift the blame and labelled those who didn’t cross at designated areas as jaywalkers. Though common in North America, the concept of jaywalking is not universal, with some countries not having these laws at all or not enforcing them. In 2023, California’s Freedom to Walk Act went into effect and allowed people to cross a road if it’s safe. This was instituted to:

  1. Make streets safer and more accommodating for pedestrians since current crosswalk designs are often dangerous and impractical due to the distance between crosswalks (stroads), or there may be no crosswalks at all.
  2. Prevent targeting of people of colour as they were 4.5 times more likely to be stopped than whites, resulting in friction between police and minorities that escalated into loss of life.
  3. Free up police and community resources.

Health-care professionals are educators and advocates at heart and are adept at explaining counterintuitive principles, such as surgically removing pieces of lung from a patient with reduced lung function (i.e. lung volume reduction surgery). In both Part 1 and here, counterintuitive principles are presented. These might initially result in some “bikelash,” but just as how we need to inform and educate before we cut to heal, the bikelash will subside as fears such as increased traffic or loss to businesses subside and, ultimately, society as a whole reaps the benefits.

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Adamo Anthony Donovan


Adamo Anthony Donovan, is a McGill PhD student in Experimental Medicine with a research focus on the diaphragm muscle in respiratory disease. He is passionate about humanizing medicine and city design.

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