Broken hearted cities -Why driving is the new smoking

Alex Dyer
12 min readDec 4, 2020


A city roadway heat map with an impression of a human heart in the centre. Electric bolts surround the heart.
Too many cars are giving our cities (and people) heart attacks around the world.

Unnecessary driving of cars is a major public health issue.

The adverse public health effects of too many cars, and the need for intervention is comparable to the ongoing challenge to reduce smoking.

Watch this post delivered as a talk.

This is not about shaming people who currently drive. Blame and guilt achieves nothing.

It is only now, years later with vastly shifted understanding and perspectives of smoking that it might seem like an attempt to undermine those who drive. I’m not trying to do that.

This is about raising awareness and a sense of urgency to bring change to the misuse of dangerous, unsustainable, life-threatening products that harm large numbers of people.

While confronting to associate driving with smoking, the parallels between how smoking was perceived, and how driving now is, are, to my mind; conspicuous.

Harmful product nonchalance. Left: Smoking in flight. Right: Cars and kids.

To be clear: when I say ‘driving’ — I am not referring to all use of private motor vehicles.

There are entirely appropriate scenarios to employ such tools. Disabled mobility especially, emergency vehicles access, large goods delivery, heavy construction, rural work, etc.

I am talking about all the journeys that could be made with healthier devices or methods, or not taken at all. I’m talking about unnecessary driving.

One-sixth of household car trips (trip chains) in New Zealand are under 2km long and almost half are less than 6km long. Ministry of Transport, Household Travel Survey, 2003–2009

A significant proportion of journeys are driven not because people choose to, but because they are effectively deprived of other choices.

We may look back in twenty years time and ask;

I hope for this future.

But it won’t happen unless we begin changing the mobility landscape and shifting perception and awareness of unnecessary driving now.

Reframing how we view the health impacts of unnecessary driving requires us to reshape widely held views of a commonplace product.

We must have faith in people’s intrinsic sense of decency to each other and commonly held values to care for children, others and the environment.

It is about properly acknowledging a common source of injustice, inequity, and harm, and forming more human friendly mobility norms. Especially in cities.

I want to live in a world where families can participate freely in cities in healthy, life-affirming ways that help maintain a sustainable shared future.

This is what cities free from heavy traffic are. Cities with healthy circulation, and low levels of personal and collective harm.

All children should be able to safely and independently engage in their neighbourhoods as they grow. For this, they need more than road safety. They deserve freedom from traffic.

I hope that, as a society, we may more readily turn to effective measures to mend our broken hearted cities.

I hope we can choose to heal our cities using preventative health strategies, rather than forever electing to reopen invasive surgery that leaves giant scars and creates ongoing complications and unaffordable dependencies.

Left: Open heart surgery. Right: Open city surgery — aerial photograph of the destruction of downtown Wellington to make way for the urban motorway. Alexander Turnbull Library. August 1969.

The harmfulness of driving

Heavy vehicles harm in sometimes acute, graphic, and sudden ways, but also frequently in obscure, insidious ways.

The less obvious ways that driving harms are more clearly similar to how smoking harms.

Consumer harm

Driving kills. Since the year 2000, more Americans died in traffic crashes than were lost during both World Wars.

Occupants of cars are exposed to higher levels of air pollution than people outside, as fumes and harmful particulates become concentrated in enclosed spaces.

Mortality from the worst non-communicable diseases would be significantly reduced if people who drive would cycle or walk for more of their journeys. For instance: commuting by bike can reduce the risk of heart disease by 46% and lower the risk of developing cancer by 45%!

From a comparison of active transport scenarios with previously modelled tobacco interventions. From Potential of active transport to improve health, reduce healthcare costs, and reduce greenhouse gas emissions: A modelling study by Dr Anja Mizdrak, Department of Public Health, University of Otago, Wellington


Driving is addictive. Once you own a car, driving tends to become difficult to give up.

Private motorised vehicles are as seemingly pervasive as cigarettes once were. Users can become agitated if they might have to walk further to their cars and are comforted by being able to keep them close by. Present bias plays into how habitual cars often are.

Driving is an expensive habit. Smoking a tank of petrol or diesel every other week can quickly put a big dent in back pockets.

There is also an enormous public bill for this addiction. Building and maintaining infrastructure, servicing the cost of ownership, and cushioning health and safety effects is significant, and contributing to intergenerational debt.

If someone really wants to quit driving there are often significant barriers that require will, creativity, and perseverance to overcome. Intervention helps.

Projected harm

Driving harms others. A significant aspect of the demise of smoking was the second-hand smoke issue, or ‘passive smoking’.

Inconsiderate jerk! © Andy Singer

I think of passive smoking as a form of ‘projected harm’ — where harm is done to others in an arbitrary, oblique way.

It is (now) unacceptable that smoking — an activity someone chooses to engage in — should expose others to serious health risks.

Are cars really so different? They are literally creating a passive smoke injustice in a majority of cities.

While electric cars reduce tailpipe emissions, they still generate lung-damaging particulate emissions from tyre, brake, and road wear.

Children are unwittingly exposed to air pollution when they are transported by car. Only the source and type of smoke from this passive smoking is different.

You might be thinking:

‘but smoking is a recreational product, it’s totally different’

Does having a less recreational purpose for a product make any harm they inflict more acceptable? I’m not sure it does. Especially if that harm is to others.

Driving of private motor vehicles also projects harm onto others in ways other than air pollution.

Excessive car traffic in cities and residential areas creates a significant barrier for many to lead active lifestyles. In this way, driving is projecting harm through health risks due to inactivity.

This problem is also particularly unjust to children.

Driving also harms others through road violence. According to the World Health Organisation, 26% of deaths from road violence around the globe are people who were walking or cycling. Figuring out who does the killing is an interesting topic.

(Spoiler: It’s people driving heavy motorised vehicles)

Some other projected harms from driving:

  • noise pollution
  • light pollution
  • near misses and traumatic experiences
  • visual obstruction
  • constricted space for people
  • heightened caregiver anxiety and effort
  • reduced green space
  • suburban sprawl
  • social disconnection, mental health impacts
  • wildlife loss of habitat
  • dead animals
  • climate breakdown
Total annual deaths — comparing smoking and driving and divided by user harm and projected harm. The absolute total number of deaths from secondhand smoking is less than from projected harm from driving. Deaths related to climate change attributable to driving are rather small at this time, but this could become a large contributor if unmitigated.
Annual global deaths relative percentages — comparing proportions of causes of deaths between smoking and driving. The projected harm from driving is over half the total. Secondhand smoking was a significant motivator in choosing to reduce smoking rates — especially in public. What amount of projected harm from driving is needed until we feel the same urgency?

The health of cities

Crippling congestion of too many cars is to a city what a heart attack is to a person.

Dividing cities into sections. © Andy Singer

As a city’s transport corridors are filled with larger vehicles in less free flowing streams of traffic, the risk of clogged arteries grows.

On-road car storage is to city streets as plaque is to arteries. It builds up and slows the flow. If untreated road plaque increases the risk of traffic clotting and stopping the healthy circulation of people.

Cars create more distance than they overcome. As our addiction to cars grows, our cities expand, pushing people further from each other and exacerbating mobility challenges.

The analogy between city congestion and human biology has been employed before to illustrate this problem, but we need to shift our perspective of how to address it.

Cities stand to contribute a great deal in mitigating climate breakdown by transforming the mix of transport.

Profit before everything

Car dependency is a complex problem. The weight of political and commercial inertia makes change in this area extremely challenging. The Political Economy of Car Dependence is holding back the ability of cities to flourish.

Political dependency

The inertia of political, and infrastructure interests behind motor vehicles is daunting.

Urging people NOT to consume is political. © Andy Singer

Lobbying and influence of public institutions around the world have tended to favour business interests when it comes to cars since their invention. The road building industrial complex, the freight & trucking lobbies, planning, engineering & road design standards — they all find it difficult to move away from the status quo.

The amount of investment that individuals make in owning a car can create serious anxiety of stranded assets, making choosing change in a democracy harder.

It seems to me that there must be a high degree of sunk cost anxiety, or ‘escalation of commitment’ for users and industry. We have put so very much of our collective resources into trying to make cars work — that we cannot pivot when they obviously don’t.

These fears and interests are effectively limiting political action, a problem not unfamiliar with the history of smoking products. Every step along the way to properly controlling cigarettes has had to reconcile against the attraction of ‘economic opportunity’.

The difficulty for politicians to introduce effective change in this area is worrisome. Political acceptability is a real threat to achieving timely, effective change.

It doesn’t have to be though. Leaders who are bringing decisive, transformative change to cities by reducing car use are being rewarded with political success.

Economic dependency

Our economic system is also stuck escalating the provision of cars.

There are many concessions for business when it comes to heavy vehicle use. Taxes and incentives need to change to support better mobility outcomes and make it obvious that business activity adapts too.

Transitioning away from these products will require us to be mindful.

Recently, the car industry famously cheated public perception of their negative externalities. The tobacco industry did similar things for many years.

The advertising dilemma

People are currently receiving highly mixed messages when it comes to cars.

Car emissions cause fatal lung diseases. Pic:

A lot of quality journalism highlighting the challenges of mitigating climate change are frequently accompanied by ads for SUVs, double cab utes, and other powerful motorised vehicles and their fuels.

These products will need to face advertising regulations in the near future in ways we saw taken to dampen the smoking market.

As we stand, the opposite seems to be happening. An ad for ‘Vanmoof’ eBikes was recently banned on France TV because it dared to illustrate some of the ways cars harm.

We can’t continue to hope that the Invisible Hand of capitalistic ideals still has our best interests at heart with these products.

To my mind, mobility choice shouldn’t be a level playing field.

It should be normal for most to employ healthy, sustainable, and socially enriching mobility.

It should be normal to expect that, for most, our cities are accessible, healthy, full of connectedness and community, and generally enrich our welfare. Using dangerous, ecocidal, community degrading products should be a rare, expensive, cumbersome rigmarole. It should be the exception, not the norm.

Regulations should reserve the right mobility tools for specific scenarios, such as certain disabled access needs.

Junk mobility

Unnecessary driving is junk mobility.

The common discussion out there about the damaging availability of poorly nutritious foods and sugary drinks could be accompanied by an acknowledgement of the excessiveness of unhealthy mobility products.

Anti-social effects

Unnecessary driving, like smoking before it, can contribute to social challenges and ill effects.

Success & status

Smoking was for a long time sold by appealing to an individualistic sense of status.

Owning expensive, dominating, new private motor vehicles has become a de facto symbol of success, wealth, and societal superiority. Older cars, smaller vehicles, fewer vehicles, no vehicle, are somehow socially ‘less than’.

Your choice of car says something about how much you prioritise yourself. And how much society must prioritise you too.

Successful man. Unsuccessful man. © Andy Singer

Advertising frequently reinforces this; boosting the promise of status through the purchase of their products.

The status of motoring is reinforced in the built environment as well; where every affordance is given to perfect the ‘level of service’ offered to motor users.

Traditional forms of mobility have been progressively pushed to the side, even eradicated. A profusion of private heavy vehicles has made the mobility landscape more classist.


When cigarettes were regulated to include filters, tobacco marketers scrambled to reframe what had been considered a feminine way to smoke. The Marlboro Man ads painted filter cigarettes as compatible with tough guys.

While cars have been generally implementing more safety features and generally facilitating driving in cities for a majority domestic activities and trips, car design has been marketed more towards appearing tough and macho.

A staple of car marketing is designed to appeal to people’s (especially men’s) desire to project strength or give a misplaced sense of capability and resilience — even as these products undermine the very things that provide resilience and safety.

In another disturbing parallel: SUVs are no safer for users and others (they’re actually more dangerous) just as filters do not make cigarettes safer.

Gaslighting and peer pressure

Both cigarette and car marketing have delivered a steady diet of messaging that makes customers second guess themselves. (it’s fitting that this behaviour is called gaslighting if you ask me).

Cars: You’re too weak to ride a bike. It’s going to be sooo hard to do it any other way than by owning this 7-seater. You’re going to get stranded if you don’t buy the extra powerful version. How will you transport that new fridge-freezer you buy every other week? How will you drive through all the floods and firestorms coming due to climate breakdown?

Cigarettes: You’ll get fat unless you smoke. Smoking is a sign you are: successful, cool, desirable (and you’re the opposite if you don’t).

What to do about it

I’m not an expert here. We need representatives and authorities to listen to experts and instigate measures that will be effective in lowering car dependency.

Tax incentives, regulations, built environment change, and more, accompanied with strong leadership and communications.

Through recent efforts with Covid-19 in New Zealand we have witnessed just how important and effective coordinated measures, accompanied with well crafted, consistent communications can be in mitigating major health challenges.

I think we need to see a similar scale of intervention for the problem of car dependency.

  • Set a goal
    Set an ambitious goal to lower car use like we have with the SmokeFree 2025 initiative. How about; CarFreeCities 2030.
  • Change the environment
    We must prioritise space for healthy transport options much more than we have for a long time. And fast.
  • Make car users pay
    Make the costs of driving reflect the true costs.
  • Incentivise non-car / shared car use
    Make public, active, sustainable transport options and human scale cities the cost effective, attractive choice they should be.
  • Regulate car advertising
    Stop promoting and glamourising cars as personal consumer products.
  • Measure car dependency
    If we can measure car dependency at a national level we will be in a better position to effectively reduce it over time.
  • Define and communicate appropriate driving scenarios
    Defining acceptable reasons to drive could help clarify for people the jobs that heavy motorised vehicles are the right tool for.


To realise mobility in cities that works better for people, New Zealand needs to approach unnecessary driving as a major public health issue.

Driving is hurting us.

Cars are hurting their users. They are hurting others.

They are anti-social. Our political and economic systems struggle to contain them sustainably.

Decades of subsidising and prioritising junk mobility has resulted in many people getting hooked. Our streets are awash with a damaging product and if we’re not careful, our cities will overdose.

I guess I am just skeptical that how most people get around should be as open to personal preference and consumer behaviour as it is.

People overwhelmingly want to do the right thing by each other, the planet, and our shared future. The problem is we have left the door open to abuse by private corporations selling dangerous products to distract and exploit.

It is time to contain this chronic addiction and start healing our hearts and the hearts of our cities. Healthy air, a stable environment, and safe and accessible cities should be afforded to all communities.

Driving is the new smoking.




Alex Dyer

Passionate about healthy streets and cities for people. On Twitter as @AxleRyde