Gigantic SUVs are a public health threat. Why don’t we treat them like one?

With an annual toll of 40,000 American lives, the deadliness of secondhand smoke is now common knowledge. But it was only a few decades ago that puffing on a cigarette was defended as an act that affected only the smoker.

In the 1980s, researchers for the first time demonstrated that smoking can kill people who never themselves lit a cigarette. Those findings undercut tobacco industry claims that smoking need not be restricted, because smokers had accepted any health risk arising from their habit. Even if that was true, it certainly wasn’t for others forced to breathe polluted air.

Secondhand smoke galvanized the anti-smoking movement. “You’re suddenly not talking about suicide,” said Robert Proctor, a history professor at Stanford University. “You’re talking about homicide.”

By the end of the 1990s, smoking was banned on domestic flights as well as across an expanding number of bars, restaurants, and workplaces. Tobacco use tumbled: In 2000, 25 percent of Americans said they smoked a cigarette during the prior week, down from 38 percent in 1983.

Secondhand smoke is a textbook example of a negative externality: a product’s costs that are paid by society instead of its users. It’s a framework that helped turn the public against tobacco, and it carries lessons for another product that is as ubiquitous today as cigarettes were 50 years ago. And like tobacco, its use can — and often does — kill innocent bystanders. I’m talking about oversized cars.

Over the last half-century, American sedans and station wagons have been replaced by increasingly enormous SUVs and pickup trucks that now comprise 80 percent of new car sales, a phenomenon known as car bloat. Much like secondhand smoke, driving a gigantic vehicle endangers those who never consented to the danger they face walking, biking, or sitting inside smaller cars. Although not widely known, car bloat’s harms are well-documented. Heavier vehicles can pulverize modest-sized ones, and tall front ends obscure a driver’s vision, putting pedestrians and cyclists at particular risk. Deaths among both groups recently hit 40-year highs in the US. The threat of hulking vehicles could even deter people from riding a bike or taking a stroll, a loss of public space akin to avoiding places shrouded in tobacco smoke.

Despite ample research demonstrating car bloat’s harms, American policymakers have done virtually nothing to counteract them. The political headwinds are powerful: Encouraged by carmaker ads depicting SUVs traversing rugged terrain, millions of Americans use oversized vehicles daily simply to get to an office, store, or school.

Convincing policymakers to regulate the size of automobiles would require a broad base of public support. The story of secondhand smoke shows how reformers could build it.

How the anti-smoking movement won over the public

Tobacco use was ubiquitous during the mid-20th century, even though scientists had started to link smoking and cancer before World War II. During the 1940s and 1950s, over 40 percent of Americans smoked cigarettes regularly, with most of them going through at least a pack a day. The cigarette industry was a political powerhouse, with many of its closest allies hailing from North Carolina, then home to more than a fourth of American tobacco farms.

In the postwar years, medical researchers produced a growing pile of studies concluding that tobacco damages smokers’ health. In 1964, the Office of the Surgeon General spurred a national conversation with a historic report linking smoking to lung cancer and heart disease. In 1967, the lawyer John Banzhaf, dubbed “the Ralph Nader of the tobacco industry,” cited that report when he convinced the Federal Communications Commission to require that TV networks broadcast anti-smoking ads that would counterbalance tobacco commercials. 

During the 1970s, a grassroots “nonsmoker’s rights” movement began to emerge by appealing to Americans who found smoking unpleasant. “They were mostly women who fastened on to the idea that somebody else’s use of space shouldn’t preclude my enjoyment of that space,” said Sarah Milov, a historian at the University of Virginia who wrote The Cigarette: A Political History. Clara Gouin was a Maryland housewife who founded Group Against Smoking Pollution, published its newsletter, and mailed policymakers signs with a catchy phrase: “Thank you for not smoking.”

At the time, smoking was seen as annoying to nonsmokers but not necessarily hazardous to them. Still, there were ominous signs. In 1975, researchers found that carbon monoxide levels within the Detroit Lions’ football stadium surged during games by a factor of 10 — exceeding federal air pollution guidelines — when thousands of fans congregated and lit up at the same time.

Tobacco companies defended their products by invoking ideals of liberty and independence. “For decades, the industry had trumpeted the cause of free choice for smokers,” wrote former Food and Drug Administration head David Kessler in his memoir, A Question of Intent. “The concept had struck a chord with the public by tapping into a libertarian instinct in American society.”

Finally, in the 1980s, scientists demonstrated that secondhand smoke was more than a nuisance; it could kill you. In 1981, Takeshi Hirayama, a Japanese epidemiologist, published a landmark study whose title neatly summarized its conclusion: “Non-Smoking Wives of Heavy Smokers Have a Higher Risk of Lung Cancer.” Hirayama had pored over 14 years of health and smoking data collected from tens of thousands of Japanese citizens, finding that non-smoking women were more likely to get lung cancer if their husbands smoked.

Hirayama’s study was a sensation, getting front-page treatment in the New York Times. People without scientific training still grasped its warning. If secondhand smoking harmed spouses, it likely harmed anyone else who shared a room with a smoker — be they a coworker, friend, or stranger.

Secondhand smoke captured more attention in 1986, when the Surgeon General released another blockbuster report, this one detailing the dangers of “involuntary smoking.“ Its Reagan-appointed author, C. Everett Koop, pleaded for policymakers to act: “As both a physician and a public health official, it is my judgment that the time for delay is past; measures to protect the public health are required now.” Koop was looking beyond Congress when he wrote that, Milov said, targeting lower-level officials.

Koop got his wish when local communities nationwide soon restricted public smoking. In 1987, Aspen, Colorado, became the first city in the United States to end smoking in restaurants, and in 1990 San Luis Obispo, California, did the same for all public buildings. Employers, too, began to restrict smoking within their facilities. “Banning smoking in public places doesn’t stop anyone from smoking,” Banzhaf told me in an interview, “but it does make it far more inconvenient to smoke.” 

After barely budging for years, in the 1980s adult smoking rates began a prolonged decline: Eleven percent of Americans now use cigarettes, an all-time low.

America is now ignoring its car bloat crisis

In a 2020 article, The Onion described a “conscientious SUV shopper” who “just wanted something that would kill the family in the other car if she got into an accident.” That story was satirical, but it exposed the underlying ethical tension of products that can be deadly for non-users.

In a recent exploration of car bloat, The Economist found that the extra heft of the very heaviest US cars do make their occupants marginally safer, but every life saved corresponds with more than a dozen lost among those inside smaller vehicles that collide with the larger ones. People on foot are at even greater risk. Large vehicles’ height can conceal pedestrians at intersections, as well as children sitting in front of them. Tall, flat front ends are also more likely to strike a pedestrian’s head or torso instead of their legs: One study found that limiting vehicles’ hood height to 1.25 meters — 15 cm shorter than the Ford F-250 — would save over 500 lives annually. 

Americans are catching on. A YouGov poll published in February found that 41 percent of respondents believe that cars are too big, and around half think they endanger pedestrians and occupants of smaller cars. Their awareness is particularly striking because federal officials have done little to bring it about. In 2023, Department of Transportation Secretary Pete Buttigieg dodged a direct question about the role that SUVs play in pedestrian deaths, and in 2021 President Joe Biden sat for a photo op behind the wheel of a GMC Hummer EV that weighs as much as three Toyota Corollas.

In the fall, the National Highway Traffic Safety Administration did suggest an overdue if narrowly designed rule to mitigate the risk of a pedestrian’s head striking a vehicle’s hood. But even that proposal — which did not address other car bloat dangers like blind zones and torso strikes — is likely to be cast aside by incoming Trump appointees who are disinclined toward new business regulations. Congress, for its part, has shown no desire to address vehicle size itself.

As neglectful as it is, the bipartisan federal foot-dragging reflects a certain political logic. Constraining vehicle size would threaten car companies that collect disproportionate profits from large vehicles, and any perceived criticism of large SUVs and pickups risks launching a culture war that could make the tobacco battles of the 1980s seem like schoolyard tiffs.

For the people who love big cars, owning one can be integral to their identity, reflecting very specific ideas about American individualism.

“Cigarette smokers didn’t really have an identity built up around being smokers,” Milov, the historian, said. “But it’s very easy to see how having a big SUV or truck is a marker of a whole host of other ideological associations.” A majority of truck owners go off-roading at most once per year; they didn’t buy their pickup for practical reasons. Image is intrinsic to its appeal.

Despite growing unease about oversized vehicles, grassroots opposition has been muted, largely confined to road safety and urbanist advocates scattered across the country. It does not appear anyone is lobbying members of Congress to restrain vehicle size.

Public officials hoping to remain in their job can only move so far ahead of popular sentiment. Beyond the logic and justice of the cause, curtailing car size requires an energized public demanding it — much like tobacco reforms 40 years ago.

The anti-smoking playbook could turn the public against oversized cars

As with tobacco use in the 1970s, the most common defense of oversized cars invokes the need to give consumers freedom to make their own choices. Researchers like Hirayama demolished that argument for smoking when they showed that it affects the health of those who never took a puff or consented to inhale smoke. Restricting public smoking became a logical way to protect nonsmokers from being harmed in ways that they could not control.

An abundance of research now shows that oversized cars increase the risk of injury or death among other road users, a negative externality akin to secondhand smoke. The problem is that most Americans don’t yet see oversized cars as the hazards that they are.

“We tend to treat the car as a closed thing, ignoring its impact on the environment, the climate, and the pedestrian,” said Proctor, the Stanford professor. “We need to think about big cars in the same way that we think about cigarettes: Affecting not just the user, but everyone around the user.”

The history of tobacco, in which Surgeon General reports brought attention to cigarettes’ harms and provided ammunition for reformers, shows the power of a federal megaphone. National Transportation Safety Board chair Jennifer Homendy has warned about the threat of oversized cars, but others with broad reach, such as US Surgeons General as well as transportation secretaries, have remained silent. 

Still, public pronouncements alone only go so far.

“Enlightenment alone cannot effect a widespread change in behavior,” Milov wrote in the Cigarette. “Laws and institutions must change as well. People must be compelled.” The question is how.

The history of tobacco regulations warns against counting on Congress to penalize big cars. A powerful industry like cigarettes or auto manufacturing can rely on support from “home state” lawmakers — North Carolina for tobacco and Michigan for automobiles — as well as an army of lobbyists to defend itself in the insular confines of Capitol Hill. 

For reformers, a wiser approach is to demand change at the state and local level, overwhelming industry lobbyists with proposals mushrooming across the country.

That strategy was hugely successful during tobacco battles two generations ago, Proctor said, and its lessons are universal. “If the mouse hole is small, one cat can control 1,000 mice,” he told me. “But if 1,000 mice attack a cat, they might well win.” 

To fight car bloat, local activists must first expand the ranks of people who see big vehicles as a danger to themselves and their loved ones. “Part of the genius of the nonsmokers rights movement was to point out that what we have taken for granted as the social default shouldn’t be the social default,” Milov said. Perhaps a new generation of community groups could devise a slogan akin to “Thank you for not smoking.” (“SUV is not for me”?)

Although car safety rules are a federal responsibility, state and local officials have numerous mechanisms to counteract vehicle size. Cities could follow Montreal’s lead and increase parking fees for owners of the biggest cars. Local and state governments can replace the SUVs and pickups in their vehicle fleets with sedans. States, which register cars, could emulate the District of Columbia and scale fees to vehicle weight. They can also ban aftermarket lifts, which expand the blind spots of already towering trucks. Local leaders in Paris have even discussed prohibiting SUVs entirely from downtown areas.

The private sector, a frequent target of anti-smoking activism, could also encourage reasonably sized automobiles. Real estate developers, for instance, can install “compact car” parking spots proximate to entrances, providing a convenience to their owners while also expanding total parking capacity. 

When local activists secure a win against car bloat, Milov suggests they throw themselves a party. “The nonsmokers rights movement gave people a sense of efficacy — a sense that they participated in something and saw the change pretty quickly,” she said. “City council did X or Y, and you experience it and see that the sky is not falling. Then more people become mobilized around the issue.”

Still, even a wildly successful movement against gigantic trucks and SUVs will require patience. While many smokers were willing, even eager, to quit their addiction several decades ago, the same cannot be said about people who now own oversized cars and trucks. They and automakers will almost certainly rally around the status quo — much like the tobacco industry did decades ago. But their defenses are not impregnable. 

The movement against car bloat is nascent, but it has righteousness on its side. Like cigarettes, enormous vehicles can kill those who never used the product, which calls for regulation. Forty years ago, the intuitive outrage of secondhand smoke was an eye-opener for many Americans. A similar narrative could help people recognize the havoc that four-wheeled behemoths now wreak on the nation’s streets.