摘要：Objectives. We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany. Methods. Secondary data from national travel and crash surveys were used to compute fatality trends from 1975 to 2001 and fatality and injury rates for pedestrians and cyclists in The Netherlands, Germany, and the United States in 2000. Results. American pedestrians and cyclists were much more likely to be killed or injured than were Dutch and German pedestrians and cyclists, both on a per-trip and on a per-kilometer basis. Conclusions. A wide range of measures are available to improve the safety of walking and cycling in American cities, both to reduce fatalities and injuries and to encourage walking and cycling. Improving conditions for walking and bicycling in our cities is vital for America’s public health. The measures described in this article would not only reduce pedestrian and cycling fatalities and injuries but also allow millions of people, many of them dangerously overweight, to bike or walk for some of their short trips and thus obtain healthful exercise in the course of daily life. More walking and cycling would yield further public health benefits by reducing the use of automobiles, thus diminishing air and noise pollution and the overall level of traffic danger. The United States is gripped by a worsening epidemic of obesity. Nationwide surveys based on self-reported weight and height indicate an increase in obesity from 12% of adults in 1991 to 20% in 2000. 1 Estimates of obesity based on clinical measurements of weight and height are considerably higher, indicating that in 2000, 31% of the adult population was obese (body mass index [BMI] ≥ 30) and 64% was overweight (BMI ≥ 25). 2 Many studies suggest that lack of physical exercise is one important reason for the alarming trend toward increased obesity. Several articles and editorials in the leading medical and public health journals have explicitly advocated more walking and cycling for daily travel as the most affordable, feasible, and dependable way for people to get the additional exercise they need. 3– 7 Similarly, the US surgeon general specifically recommends more walking and cycling for practical, daily travel as an ideal approach to raising physical activity levels. 8 Even in the sprawling metropolitan areas of the United States, 41% of all trips in 2001 were shorter than 2 miles, and 28% were shorter than 1 mile. 9 Bicycling can easily cover distances of up to 2 miles, and most people can walk at least a mile. 10 Yet Americans use their cars for 66% of all trips up to a mile long and for 89% of all trips between 1 and 2 miles long. 9 Clearly, there is enormous potential for increased walking and cycling over these shorter trip distances. There are 2 problems with proposals to increase walking and cycling: their current danger and inconvenience in most American cities. As documented in this article, walking and cycling in the United States are much more dangerous than car travel, both on a per-trip and per-mile basis. Moreover, the lack of proper pedestrian and bicycling facilities makes walking and cycling not only unsafe but also inconvenient, slow, unpleasant, and unfeasible in most places. The good news presented in this article is that it is indeed possible to achieve safe and convenient walking and cycling conditions, as demonstrated by the experience of Germany and The Netherlands. Those 2 countries have implemented a wide range of policies over the past 2 decades that have simultaneously encouraged walking and cycling while dramatically lowering pedestrian and bicyclist fatalities and injuries and keeping auto use at only half the American level. The Netherlands and Germany provide valuable lessons for integrating more physical exercise into the lives of Americans. This article first examines variations in walking and cycling levels among North American and Western European countries and then focuses on The Netherlands, Germany, and the United States in particular. We examine differences in travel behavior, fatality and injury rates, and trends over time. Most importantly, we describe the 6 categories of policies in The Netherlands and Germany that have made walking and cycling such safe and attractive alternatives to driving: better facilities for walking and cycling, urban design sensitive to the needs of nonmotorists, the traffic calming of residential neighborhoods, restrictions on motor vehicle use in cities, rigorous traffic education of both motorists and nonmotorists, and strict enforcement of traffic regulations protecting pedestrians and bicyclists.
