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.