The story of global health over the last few centuries has generally been one of great progress — vastly longer lifespans, far fewer women dying in childbirth, many fewer children dying from miserable diseases like measles and smallpox. But there is one often overlooked feature of modernity that has brought a new and enormous degree of mortality and injury to everyday life, a risk that falls most heavily on the world’s poorest people. It kills about as many people as the world’s deadliest infectious disease — tuberculosis — and it’s the leading cause of death globally for people in the prime of their lives, aged 5 to 29. It is one of the defining technologies of modern life, one of the 20th century’s most dangerous gifts: the car. 

Around 1.19 million people globally are killed by road crashes every year, according to estimates from the World Health Organization (some estimates put the number higher), and many times more — likely between 20 and 50 million — are injured, sometimes leaving them with life-altering disabilities. More than 90 percent of those deaths occur in low- and middle-income nations, although these countries contain only around 60 percent of the world’s cars. 

This century, humanity has halved the mortality rate for children under five and reduced AIDS-related deaths from their peak by 70 percent. But the number of people killed by cars has remained roughly the same for the last 20 years. As motor vehicles spread around the world — the total fleet has doubled over the past 20 years — the burden of those deaths has shifted increasingly to lower-income countries. Despite all the progress we’ve made against ancient natural killers, we’re making little against a killer we engineered ourselves. 

That’s not for a lack of known solutions, but rather because there’s been comparatively little attention paid to car crash deaths as a real global health issue until relatively recently. Unlike deadly maladies that are purely bad, cars do add value to society. Perhaps as a result, even though wealthy countries have brought down per capita road fatalities over the course of decades, deaths by car have still often tended to be discounted by policymakers and the general public as the price of progress and economic growth. It’s “one of the few public health problems where society and decision makers still accept death and disability on such a large scale as inevitable,” the late Dinesh Mohan of the Indian Institute of Technology wrote in 2019. 

“You can become very depressed,” James Leather, director of transport at the Asian Development Bank, told me in a recent conversation at the International Transport Forum summit (an event sometimes called the Davos of transportation). “Why is no one taking this seriously?” 

Of course, it’s not that literally no one is taking it seriously, but rather that cars have long been an underrated threat to human well-being. But that is, perhaps, slowly beginning to change. 

Why cars kill so many people in countries with so few of them

I am sometimes known as a bit of a car hater, devoting a lot of my consciousness to thinking about how the United States got locked into car dependence. Our car-oriented development pattern is part of the reason the US has one of the highest road fatality rates of any wealthy country. (But, listen, I own a car too, and benefit greatly from it! I am American, after all.) 

US car fatality rates may be an outlier by wealthy-country standards, but most low- and middle-income nations face far greater risk. Haitians and Ethiopians are more than three times more likely to be killed by a car than an American; Kenyans, Bolivians, and Thais are more than twice as likely. 

That alone is worth dwelling on. If you live in the US, consider that you probably know at least several people who’ve been killed in a car crash or who have loved ones who have, and that this proximity to sudden, violent loss is felt even more acutely in most of the world. Road deaths account for around 1 percent of all deaths in the US; globally, that figure is about 2 percent, and in a typical middle-income country like Vietnam, it is more than 3 percent. 

That might sound a bit surprising — and feels all the more unfair — in light of the fact that poorer nations do not have anywhere close to as many cars as wealthy ones do, and their residents travel fewer miles by car than people in rich countries do. If cars kill so many Americans because we simply drive so much, in the developing world, the problem is almost the inverse: A minority of people who can afford it ride in private cars, while everyone else walks, bikes, or rides a motorcycle, scooter, or three-wheeled vehicle like an auto rickshaw. And those outside of an automobile — known as “vulnerable road users” — often share space in the road with cars and are at high risk of being hit. 

Cars themselves in developing nations are often more dangerous for their occupants than vehicles in rich countries are, too. Weaker car safety standards and a reliance on imported old cars mean that people sometimes travel in vehicles that lack safety features long taken for granted in rich countries, including airbags and frames designed to absorb the force from a crash. 

Amid all this, cars and other motorized vehicles are spreading rapidly in the Global South — much more quickly than that transition took place in North America and Europe — and doing so before governments have built safer roads, vehicle standards, adequate trauma care, or robust traffic regulations. Many nations lack comprehensive laws governing what the WHO considers the five key behaviors that shape road fatalities: high speeds, drunk driving, seatbelt use, helmet use for motorcyclists, and child restraints in cars.  

In Southeast Asian countries, which have seen a massive proliferation of motorized vehicles since 2010, “maybe the infrastructure was designed when you didn’t have so many cars, and now all of a sudden you have twice the number of cars that you did before,” Nhan Tran, the WHO’s head of violence and injury prevention, told me. Road crashes are a major burden on the medical systems of these countries and exact staggering economic costs, amounting to about 5 percent of national GDP in Vietnam, for example. 

Meanwhile, as the total number of global road fatalities has stayed roughly constant for the last few decades, the gap between poor and rich countries has widened. Between 2010 and 2021, high-income countries, particularly those in Europe, saw dramatic decreases in car crash deaths, while deaths in the vast majority of low-income nations (which are predominantly in sub-Saharan Africa) increased, according to the WHO’s most recent report on global road safety. Across lower-middle-income nations, like India, the aggregate number of deaths and the per capita fatality rate stayed roughly flat. 

I asked Leather whether there was an easy, no-brainer intervention that could make a big dent in these deaths. He pointed, among other things, to helmets — in the Philippines, where he lives, national law now requires that helmets be made available with every new motorcycle purchase, though for that to work, people of course actually have to use them.

“If you go to New Delhi today, nearly every motorcycle rider wears a certified full-faced helmet. This was achieved through strong enforcement,” Kavi Bhalla, a professor at the University of Chicago’s Department of Public Health Sciences and an expert on global road safety, told me in an email. “In contrast, most other cities in India don’t enforce the helmet law, have very low helmet use, and this leads to many unnecessary deaths.”  

Poor countries don’t need to wait their turn for safer roads

Twenty years ago, two US economists published what became one of the most influential papers in the field of global road safety, on the relationship between a nation’s wealth and its traffic fatality rate. As countries get richer, they argued, motor vehicle ownership rises, and per capita car deaths rise in tandem. Eventually, as countries become wealthier — and as safer roads, vehicles, and traffic policies catch up with motorization — fatality rates start to fall, as they did across much of the industrialized world beginning in the early 1970s. That tipping point, the authors found, comes at around $8,600 (in 1985 international dollars) of per capita GDP. 

But this “economic determinism,” as Bhalla has described it, might be the wrong way of looking at the problem. It contributes to a sense that traffic carnage is inevitable until a nation becomes rich. But we would never argue that maternal mortality or malaria deaths can’t be significantly mitigated in low-income countries; in fact, we already know they have been. Although Europe, the US, and other high-income nations have steadily reduced car death rates over the last 60 years, Bhalla told me “it is a mistake to think that this has much to do with these countries being rich.”

Instead, “safety improved in these countries once they established national road safety agencies, gave them the authority to regulate what happens on the roads, and gave them a dedicated funding stream,” he wrote to me. “These agencies did what you would expect agencies to do. They identified the most common traffic safety risks in the countries, undertook investigations on how best to address these, and then made investments for large scale interventions focused on safer designs of cars and roads, coordinated enforcement programs, and emergency medical systems. Low and middle income countries can and should do this now.”

The WHO and other global organizations, along with some philanthropies, have been working to speed along such work over the last few decades, but the results have so far been somewhat underwhelming. The United Nations had aimed to halve global road deaths from the baseline of roughly 1.2 million by 2020, a goal we didn’t come anywhere close to reaching. On the other hand, world population has greatly increased in the last few decades, so holding the absolute number of traffic deaths constant is still a meaningful achievement: From 2010 to 2021, the global per capita road fatality rate decreased by about 16 percent. And in that period, Tran said, road safety has at least gained a lot more visibility among political leaders and civil society as a badly neglected public health crisis. 

Having missed the 2020 target, the UN now aims to halve road deaths by 2030. But we will “definitely not” meet that goal either, Bhalla told me. 

A core reason the global road fatality crisis has been so maddeningly obstinate is that the root of the problem is complicated, contested, and depends on one’s perspective. “It’s not the same as when you’re talking about Covid or HIV, where there is a virus” that we want to eradicate, said Tran. “When you talk about road safety, what is the virus?” Is it dangerous individual behaviors — speeding, drunk driving, refusing to wear a seatbelt? Is it deteriorating roads or a lack of sidewalks? Is it humanity’s growing dependence on cars themselves? 

Tran, like many road safety advocates today, calls for an approach that focuses on the most upstream cause of car fatalities — the proliferation of cars — and champions good urban planning designed to prioritize transit, walking, and cycling over the movement of cars. That would make safety an inherent feature of the transportation network and obviate the need for what Tran calls “quick fixes” to poorly designed systems.

WHO director-general Tedros Adhanom Ghebreyesus echoed that message in the agency’s 2023 road safety report: “As motor vehicles proliferate, countries are doubling down on transport systems built for cars, not people, and not with safety at their core,” he wrote. 

There’s a lot of wisdom to this, as the American experience over the last century well shows. The US experiment in car dependence has burdened us with a road fatality rate that rivals nations much poorer than us. Urban planners now widely agree that that car-dependent paradigm was a mistake, but now that it’s built out, it’s hard to claw our way out of.

But that lesson also requires some humility: Even a car hater like me can acknowledge that for many people in poorer nations, automobility offers a measure of freedom that rich countries have taken for granted for many years. And it would be a mistake to see simple interventions that can save tens of thousands of lives, and that were instrumental in bringing down car fatalities in rich countries, as mere Band-Aids. We need both approaches. Just as humans did with once-devastating infectious diseases, we will have to learn to see a person killed for simply trying to get somewhere not as a tragic act of God, but as the result of forces within our control. 

On its surface, the national revolt against data centers seems simple: They are a nuisance, and people do not want them in their proverbial backyards. But I haven’t been able to let go of the idea that there must be something much deeper driving the backlash against them, and few other subjects have confounded me more than trying to figure out what to think about it.

These facilities — the massive suburban and exurban warehouses that power AI, along with much of what we do on the modern internet — spew noise, have been accused of guzzling electricity and water, and have a halo of general ugliness around them. And over the past year-and-a-half or so, many Americans have gone from barely knowing what a data center is to having fiercely held opinions about them. Seventy percent of Americans, according to a recent Gallup poll, now say they would oppose one being built in their area. The environment tops their list of concerns. They’re also disquieted by the idea of high-tech facilities buying up land from America’s farmers and ranchers. Anti-data center campaigns have swept communities across the country, producing dozens of local moratoria on their construction.

These objections sound public-spirited enough. But as Vox’s Eric Levitz and many others have written, many of the rationales for stopping the buildout of data centers, particularly the environmental case against them, have been overstated (more on that in a moment).   

Yet grassroots anti-data center activists are hardly wrong to be worried about artificial intelligence — it is one of the most formidable policy problems we face today. AI’s ultra-wealthy makers promise a world of unprecedented progress and prosperity, but also say they might also eliminate everyone’s job and possibly annihilate humanity in the process. 

If you are terrified that AI is ushering in a future that will be miserable to live in, I fully share in that feeling (and would personally prefer to go back to a world before ChatGPT). And I think this sentiment, rather than any ecological anxiety, explains much of why Americans are suddenly fighting to ban the physical infrastructure on which AI and tech more generally depends, why they’re so pessimistic about AI in general, and why college seniors graduating this spring have been booing the mere mention of AI off the commencement stage. 

But it’s a problem that stopping a data center locally feels like the only policy lever that an ordinary person can pull right now to try to slow down AI, because it’s a blunt instrument that can’t give us the outcomes we really want. Canceling data center projects town by town is unlikely to meaningfully slow AI adoption, and it certainly doesn’t regulate AI use or protect us from its worst possible outcomes. 

Instead, this approach traps us in a debate about relative trivialities rather than about one of our society’s most important questions: how we will manage a technological and economic transformation that’s already happening. And that dysfunction in turn prevents us from seeing any upside to AI and thinking about how we might broadly share it. It is, at bottom, a symptom of the same obstructionism that blocks us from addressing many of the biggest problems of our time, from green energy to housing and so much else, under similarly confused pretexts. 

Could that ever change? 

Where the data center revolt is coming from

The great US data center buildout is colliding with a national economic mood that appears to be historically, singularly bad. Americans are angry about the cost of living, afraid for their futures, increasingly mistrustful of each other, and don’t trust our institutions to solve the problems we face. They despise (it probably goes without saying) Big Tech. Majorities of the public say that AI will do more harm than good in daily life, that it will take away their economic opportunities, that government is not doing enough to regulate it. Young people are particularly fixated on the impacts of AI, and they seem positively miserable about it.  

It’s little surprise Americans feel such a dread of AI; Congress has introduced dozens of bills to govern the technology but has failed to pass any comprehensive legislation. With no federal regulation apparently forthcoming that would, say, provide a measure of economic security to the tens of millions of workers who could be replaced by AI in the coming years, it’s perhaps no wonder that there’s been such vigorous backlash against the physical manifestations of the tech. 

Surely, then, at least some of the reasons that data centers are being pigeonholed as an ecological issue is that people are searching for legitimate-feeling reasons to try to stop this runaway train. The tendency to fall back on reasons that can be metabolized by the policymaking processes that ordinary Americans can actually influence, like environmental review, has been inherited from the environmental protection laws embraced across the country beginning in the 1970s, when pollution had become a visible public crisis. But just as when environmentalism is weaponized to block new housing or high-speed rail or in support of whatever other garden-variety NIMBY cause, the ecological argument for shutting down AI mostly withers under scrutiny.  

Like all economically important industries, data centers and AI certainly have real environmental impacts. These facilities use a lot of electricity, and much of it comes from fossil fuels because most US electricity is still derived from fossil fuels. Their electricity use will grow quickly as demand for AI tools increases.  

But years of covering one of the world’s most underrated environmental menaces — agriculture, especially animal agriculture — have taught me to be skeptical of contextless claims about how much water or energy any particular industry uses. The planetary harms of data centers aren’t radically out of proportion to what we would expect from an industry that is increasingly important to daily life and the economy; computing is far less intensive in energy and physical resources than many other things we do and many of the activities it stands to replace, AI researcher Andy Masley has pointed out repeatedly. Data centers’ water use, meanwhile, amounts to a tiny fraction of all US water use, and there is not much evidence that they’re going to cause water scarcity issues even in arid parts of the country. In cases where a data center replaces, say, farmland growing water-intensive cattle feed crops in dry regions of the US, it might even benefit the environment. 

I never want to sound glib about the future of our planet, nor do I want to take too far a detour into the political philosophy of how we decide whether an industry’s resource use is “worth it.” But I think it’s fair to say that campaigning against data centers on ecological objections is a dead end, if we are serious about finding a policy response to this technology that addresses the true concerns around it. An environmental frame may even be a gift to the AI industry, because the industry can defend itself on that ground pretty straightforwardly. Even data centers’ dependence on fossil fuels, one could argue not entirely unreasonably, is a problem for policymakers to solve by accelerating the buildout of renewable energy. 

The AI debate we’re not having

So what, then, are we to with AI concerns if not taking them, converted into gigawatts and gallons, to the local planning commission meeting?  

I wrestled with that question as I read Techno-Negative: A Long History of Refusing the Machine, Thomas Dekeyser’s recent book on the long human lineage of attempting to destroy the technologies that reshape the way we live, from the ancient Greeks, who, much like contemporary dread of AI, worried that machines could eclipse human agency, to computer arsonists in the 1980s. Dekeyser, who is a lecturer on human geography at the University of Southampton, writes that technological progress has always been a “political battlefield” where the purpose of human life is contested.

The fight to choke off data centers represents the latest expression of that struggle to define what it means to be human in the face of technological change, of what Dekeyser calls the “tenacious, fierce urge to negate life’s technologization.” What is AI, the technology that promises to replace the human mind itself, if not the apotheosis of our fears of being made obsolete? To the median American, data centers might feel like a manifestation of the forces that want to take all their power and relevance away from them.

Yet widespread cynicism about AI, I think, doesn’t stem from any inherent property of the technology itself, but rather from our politics. The public has not been offered any credible political vision of a future where AI could be deployed to support human flourishing, nothing that can offer a satisfying answer to the most important questions about our relationship with technology. As Dekeyser writes: “Do they constitute and expand, or undermine, human subjectivity?”  

In this way, political possibilities shape the way we feel about technology: Imagine if, for example, instead of the prospect of widespread economic disenfranchisement, the productivity gains from AI could be harnessed to pass a four-day (or, hell, even three-day) work week, or to finance a generous universal paid leave policy. The US, as the richest country in the world and an undisputed leader in AI, certainly has the leverage to enact such policies. We could also give workers power over how AI is deployed in their workplaces, or incentivize AI development in a direction that expands, rather than replaces, human creativity. Or, as Sen. Bernie Sanders proposed this week, give the public a direct ownership stake in the technology itself, created by a tax on AI companies.

Whatever you think of these ideas, we’d be better off debating their merits and thinking through the particulars of how they might be implemented than fixating on individual data centers. But because an ambitious national AI policy feels unimaginable right now, and so of course people see AI as all downside and no upside. But simply channeling popular sentiment into local bans on physical infrastructure forecloses debate over the most important aspects of AI before we can even have them, as Holly Buck, an associate professor of environment and sustainability at the University of Buffalo, recently argued.   

The politics of local veto has produced many of America’s other major governing failures, too: We can’t decarbonize the economy, solve a structural housing shortage, or absorb a technology as big as AI when local zoning hearings are the only places where the fight is happening and actionable decisions are being made. The essential difference with AI, though, is that on housing or climate change, we already mostly know the policy solutions we need. On AI, that terrain is still much less certain. We don’t yet know what we want from a potentially existentially transformative technology. That calls for real national confrontations with the most important questions: How can technology be used to make our society freer and more equal, and to augment human agency rather than diminish it? 

Maybe that future still requires more data centers, many more of them (or maybe we should build fewer of them). Whichever outcome we choose, it should be downstream of a rational and deliberative policy process, rather than a poor simulacrum of the debate we all deserve.  

The housing abundance movement has won more of the intellectual argument than anyone might have predicted a decade ago. Across much of American politics, even in Zohran Mamdani’s New York (listen, I love the guy), it is now at least possible to say out loud that we have too many pointless rules making it impossible to build enough housing. But that doesn’t settle the politically harder questions of…where exactly should the housing go, and what should it look like?  

There has often been disagreement among housing reformers on that point — or at least a difference in emphasis. Should advocates try to add homes in already vibrant urban and suburban areas, which would add density but run into a buzzsaw of zoning codes and angry neighbors? Or should the focus be building at the urban fringe, in the form of sprawl, where land is cheap and plentiful and obstacles to building are fewer? 

These approaches, known respectively as infill and greenfield development, aren’t necessarily opposed; with America millions of homes short, most housing experts would say that we need both. But there are many reasons to prefer building in over building out. Building on top of or in between existing development reduces the toll on the environment and wildlife, minimizes commute times, and better supports compact, walkable, livable communities. And a recent report from the Pew Charitable Trusts’ housing policy initiative, the World Resources Institute, and the research firm ECOnorthwest advances another, less appreciated reason to favor infill: It could help keep your city solvent and maybe even keep your property taxes down. 

How? The researchers simulated different future housing construction scenarios across 10 diverse states, including fast-growing ones like Arizona and Texas and slower-growing states like Pennsylvania. They then compared the public costs of essential services like roads and sewer lines for homes built within existing communities versus those built at the edge of cities. 

Each home developed near jobs, shops, and transit, according to the report, would require upfront infrastructure expenses about $21,000 less on average than those added at the urban fringe, amounting to a one-third reduction in the cost of that infrastructure. (The categories used in the report are more complex than just an infill-versus-greenfield split, but for simplicity, I’ll use these terms as shorthand.)

The ongoing maintenance for all that infrastructure, meanwhile, added up to about 50 percent less on average for homes built within established communities, while communities developed this way would raise about 13 percent more in property taxes per acre on average because they have more households concentrated in the same land area. 

Urban analysts have made variations of this observation many times before, and the logic is mostly basic geometry: Compact housing development allows cities to spend less per person on physical infrastructure like roads, and to spread the costs of that infrastructure across more households. Yet American land-use policy is set up to discourage precisely that kind of growth. As a result, we build many more single-family homes than apartments or condos, and increasingly in low-density areas outside of major population centers. 

Meanwhile, the US is fast hitting fiscal limits — higher interest rates, an aging population, and amid it all, a nationwide revolt over property taxes. Fiscally efficient growth matters more than it has in a long time, and that might be the invitation we need to rethink America’s abiding instinct to grow ever outward.

Sprawl costs cities more, but it’s not everything

To understand how this works, it helps to picture it through real-world examples: Take the largely middle-class suburb of University Park, Illinois, which is home to about 681 people per square mile, and compare it to nearby Chicago, which is nearly 18 times as dense. That means University Park serves many fewer people per mile of road or foot of piping, providing a thinner tax base to pay for the infrastructure on which the community depends. 

As Pew’s report notes: “Home construction in established areas relies primarily on existing infrastructure and often includes apartment buildings, duplexes, townhomes, and accessory dwelling units (ADUs), all of which require less infrastructure per unit than detached single-family homes.” While the report relies on modeling, its findings comport with more empirically grounded research on the question.

Cheaper infrastructure, however, does not mean lower costs across the board. Arpit Gupta, an associate professor of finance at New York University Stern School of Business, has pointed out that physical infrastructure like roads, bridges, sewers, and water services makes up only a small share of local governments’ costs in the US. Social spending, on things like healthcare and education, are much more fiscally important. That’s one reason why even though the governments of blue cities like Chicago benefit from the economics of density, they are often costlier to build and live in, thanks to factors like higher public sector wages and more onerous environmental review and permitting processes. 

Nevertheless, while a sprawling community may be able to shoulder the burdens of more extended infrastructure so long as it continues growing, should growth begin to stagnate, the costs of years of greenfield development can really start to hit. And in the US, one need not even venture outside the suburbs to see it. Earlier this year, I spoke with John Zeanah, the chief of development and infrastructure for Memphis, Tennessee, about what this pattern has meant for the city. “Memphis lived it firsthand,” he said. “There are significant costs associated with sprawl that ultimately are unsustainable.” 

Many sprawling American cities — Houston, Dallas, Phoenix — are growing quickly in population, but there are also many others whose populations have stagnated or declined in recent decades and that are now burdened with figuring out what to do with an overly large geographic footprint. In the late 20th century, Memphis grew by literally annexing nearby unincorporated developments, but in recent years its population has been declining.

By 2015, compared to about 50 years prior, “the city’s land area grew by over 50 percent with virtually no population growth. This meant 50 percent more infrastructure to service and maintain,” Zeanah told me in an email. The costs of this go well beyond just hard physical infrastructure, Zeanah explained, extending to services like police, fire, and transit, all of which must serve a larger area than they would otherwise and need to be supported by a stagnant tax base.

Memphis is now trying to undo these mistakes. Its latest comprehensive plan, Zeanah wrote to me, recognizes that “the city’s most viable path was to concentrate investment in existing neighborhoods and corridors where land and infrastructure capacity was available, relative costs are lowest, and the return on public investment is highest.” In other words, exactly what Pew’s research points to.     

Can we overcome the barriers to density?

The challenge is that American cities and suburbs hoping to make that philosophical change in how they grow — adding infill to already thriving neighborhoods rather than sprawling outward — face a gauntlet of regulatory and cultural barriers. 

There are, of course, local zoning codes and parking minimums that bar dense home construction and have become a political albatross for cities trying to reform their approach to housing. There are NIMBYs who don’t want sudden changes to their proverbial neighborhood character and wish to push any development further afield. And municipalities also have structural incentives to grow outward, because it can be easier to find money for new infrastructure than for maintaining existing infrastructure. “Local jurisdictions can access funding for upfront infrastructure costs (from federal, state, and private sources) relatively easily but face limited options for paying for long-term maintenance, making greenfield development appear fiscally attractive in the short term,” Tushar Kansal, a senior officer for Pew’s housing policy initiative, said in an email. 

Ultimately, fiscal sustainability may be a relatively minor argument in favor of building homes as infill in established neighborhoods, albeit one with particular salience at the moment, given the American cost of living crisis and anger about taxes. But the US remains a very rich country that can afford the material costs of sprawl and exclusionary zoning if we really want it. 

The stronger case for infill is based not on fiscal thrift, but rather on human freedom, quality of life, and the bigger benefits to our economy of allowing population growth in our most prosperous cities. We should legalize more housing in places where people already live, because more people want to live there — and that alone should be enough.