It’s a common scene at intersections across the country. Anxious drivers in hulking vehicles are lined up at a red light, impatiently revving their engines, as a person given inadequate time to reach the other side of the street on foot sprints across the crosswalk in fear.

“What do you get?” asks the disembodied voice of actor Jon Hamm, after listing features for a new vehicle from Mercedes-Benz. “You get out of the way.”

That ad, which aired during the 2018 Super Bowl, was shot on a street in Los Angeles, a city that has seen pedestrian deaths skyrocket over the last five years. City leaders have a goal to eliminate traffic deaths by 2025 by cracking down on dangerous driving behaviors like speeding. But city leaders also routinely give car companies permission to stage re-creations of dangerous driving on the very streets where people have been killed by reckless drivers.

Automakers spend about $35 billion annually on advertising, easily outspending any other industry. This is evident at a spectacle like the Super Bowl, where many of the biggest ad buys come from car companies. Advertising for cars has never been celebrated for its authenticity. But over the last few years there’s been a marked shift in the way vehicles are designed and marketed, and its impact on U.S. streets is impossible to ignore.

“Today, the nation is in a pedestrian safety crisis, with more and more killed by super-horsepowered, high-clearance SUVs and small trucks,” says Jessie Singer, senior editor of Transportation Alternatives, who has designed a bingo card to track the worst car-ad tropes during Sunday’s Super Bowl. “The ads that sell those vehicles do more than glance over their danger—danger is a selling point.”

As pedestrian deaths have increased in the U.S. to numbers not seen since the 1990s—over 6,000 pedestrians were killed last year, out of over 40,000 traffic deaths nationwide—safety experts have made a clear connection to the larger, more powerful cars that now make up a majority of the U.S. fleet. A person hit by an SUV or truck is two to three times more likely to be killed than someone hit by a smaller vehicle. The increase in SUV sales over the last decade almost perfectly tracks the increase in pedestrian deaths across the country.

The SUV boom is also contributing to other public health concerns as well. Larger vehicles are categorized as “light trucks” and aren’t subject to the same fuel-efficiency standards as regular cars. This is worsening air pollution, where vehicular emissions are responsible for tens of thousands of premature deaths per year in the U.S. and have been directly linked to a wide range of cognitive impairments and an increase in childhood asthma cases. SUVs and trucks are also responsible for a dramatic increase in vehicular greenhouse gas emissions. In fact, the increase in carbon emissions from SUV sales alone is now large enough to wipe out any reductions made by recent increased sales of electric vehicles.

Automakers might manufacture some smaller, zero-emission models, but they still need to sell more cars that are larger, more powerful, and less fuel-efficient in order to increase their profit margins and, in some cases, fund investments in electric vehicle production (or so they claim).

“It’s an arms race situation,” says Greg Shill, a law professor at the University of Iowa who studies how the country’s legal system codifies automobile dependence. “You have manufacturers with an incentive to produce heavier vehicles for themselves and for their customers. And they’ve shifted their ad money to these vehicle purchases and put billions behind it.”

When you see that glossy black SUV hood roll into frame during the Super Bowl break, here’s a better way to envision what you’re looking at—three global crises glamorized in a single product shot.

When car advertising was invented, cars weren’t the fastest, cheapest, or most efficient ways of getting around. Taller buildings, changing economies, and new rail systems were allowing people to live closer together, making cars of marginal use to the growing number of urban-dwelling Americans. Many early cars like the Model T were marketed to farmers, says Brendan Cormier, senior design curator of the Cars: Accelerating the Modern World exhibition currently on view at the Victoria and Albert Museum in London. “The car, for the first 30 to 40 years, was never about cities at all.”

Since car companies had to work much harder to sell automobiles to urban dwellers, they invented benefits for their vehicles that may not have been immediately obvious to potential buyers. Many of these sales pitches are still in use today: speed and freedom, the ability to escape from the city, and the idea that a car is a head-turning extension of your personality.

Right away, people started getting killed by cars, and the car companies had a marketing campaign to take care of that, too. “It is the only invention that is so popularly accepted where the death statistics are so easily put aside, making it one of the most contradictory objects in human history,” says Cormier.

“It’s hard to think about any other product we allow to advertise that has these severe societal effects that cars do,” says Tara Goddard, an urban planning professor at Texas A&M University who studies the impact of car commercials on road safety.

Not only do car commercials play up the worst gender stereotypes—the soccer mom who can take the whole team to practice, the beefy man who hauls a load of lumber to a construction site—realistically, many people aren’t using these vehicles for those tasks at all, and are mostly driving alone in them to work, says Goddard. What’s more, the aggressive masculinity that pervades the marketing of these cars—more torque! more horsepower!—is directly reflected in driver behavior, she says. “For example, we know men are more likely to speed, and more likely to be killed in traffic crashes because of that speeding.”

Aggression has become so key to selling cars that even “responsible” vehicles are now being marketed that way. “The idea of the Prius was for people to say, ‘I give a shit about the state of the world,’” says Jason Torchinsky, a columnist at Jalopnik and author of Robot, Take the Wheel: The Road to Autonomous Cars and the Lost Art of Driving. “Tesla has a different angle that’s more combative: ‘I’m saving the world—and you’re ruining it.’”

In many ways, he says, Tesla is to thank for the country’s incremental adoption of electric cars, in part because the company has positioned its plug-in vehicles as more confrontational and status-driven, to compete with sales of SUVs. (Tesla also makes an electric SUV and an electric truck.) Sales of electric cars dipped slightly last year. Tesla’s sales, however, went up.

Tesla, infamously, does not advertise, although it does have flashy launch events, Elon Musk’s 30-million follower Twitter account, and a rabid fanbase. But Torchinsky points to how the coming-soon electric Hummer—a gargantuan vehicle which debuted an ad during the Super Bowl—is being marketed much the same way. “We’re now in the era where EVs get promoted and advertised and understood with the same delirious irrationality as any other car out there.”

And it’s not just the EV Hummers; across the board, cars are becoming so freakishly imposing that people are now taking photos of themselves and their children standing in front of SUVs and trucks to show how how deadly the high profiles of these vehicles can be. A particularly gut-wrenching segment on an Indiana television station lined up small children in front of popular SUVs to demonstrate the dangerousness of their blind spots. The driver of a Cadillac Escalade seems shocked when she discovers she can’t see a dozen children sitting in front of her car. She could only see the top of the head of the 13th kid.

Commercials do a masterful job of obscuring the danger these larger vehicles pose to people who are not in cars by hyping their so-called safety features. A father waving goodbye to his coworkers as he steps into a street is saved by an automatic braking system. Can’t see the curb? It’s ok, cars can park themselves now! One particularly awful example shows a woman driving an SUV through a city where everyone else on the road, even the bus driver, is looking at their phones, but her family is safe because of their detection tools. Perpetuating the myth of the distracted pedestrian is yet another way for automakers to sell cars, when distracted driving is what’s causing traffic deaths, regardless of how much on-board technology cars have.

Some car advertising appears harmless. Take this Super Bowl spot for Hyundai’s new high-end SUV brand Genesis where Chrissy Teigen and John Legend playfully jab at luxury car ads. It’s funny. There’s no dangerous driving. But the SUV this ad convinces Americans to buy in 2020 will be on the road for an average of 12 years. That’s 12 years of endangering the lives of pedestrians, choking neighborhoods with particulate matter, and spewing out carbon pollution long past the deadline when scientists believe that we should have slashed emissions by at least half. Teigen and Legend have two young kids. Is this really the legacy they want to leave for their children?

Shill thinks U.S. cities need to start thinking about marketing for cars the same way the country addressed the marketing of another public health crisis: the tobacco industry.

“We used to allow smoking everywhere—even in hospitals,” says Shill. “It was totally normal, but gradually that’s changed. We should think more rigorously about where we want vehicles and where we do not. We should start to protect people from secondhand driving.”

A landmark 1998 settlement with 46 states started to change cultural norms around where tobacco use was allowed, and imposed major restrictions on how it was marketed. The industry was charged with slashing underage tobacco use by 67 percent within 10 years, funding $1.5 billion in anti-smoking campaigns, and ending most types of advertising. Cigarette packaging now comes plastered with scientific warnings about the true dangers of tobacco use.

The campaign was so successful that deaths from tobacco use plummeted. Now more people die from air pollution primarily caused by the burning of fossil fuels than smoking.

In the last few decades, many countries including Canada, Australia, and the UK have regulated car advertising. Commercials are banned for showing dangerous, reckless, and unsafe driving—including driving off-road in places where it’s not actually legal to drive—and the UK has even banned car ads that portrayed particularly egregious gender stereotypes.

While it’s unlikely that the U.S. will deploy the same types of federal regulations for car ads, there might be an opportunity for safety agencies to require certain types of legal disclaimers. Goddard recommends labels like cigarette warnings on car ads. “Maybe it’s government intervention that would require advertising companies to say ‘We cause 40,000 traffic deaths a year,’” she says.

Cormier also sees an opportunity for advertising to change cultural norms, perhaps the same way anti-smoking ads reduced the number of American smokers. “If an incredibly irrational object was popularized by an alluring marketing and sales campaign, can we popularize the alternative with an equally alluring campaign?”

Advertising agencies and production companies could opt not to take on automakers as clients in the same way many eschewed tobacco money. As far as an “anti-smoking” campaign for cars, there is some ad money being spent to turn consumers on to electric vehicles (some of which is being funded by the Dieselgate settlement that penalized Volkswagen for cheating on emissions claims). But electric vehicles don’t necessarily solve all the public health issues associated with cars. Do we need electric bike ads?Amazing bus ads?

Cities like Los Angeles could also ban the filming of car commercials on their streets, which would limit the places those ads could be made. Dozens of U.S. cities have set Vision Zero goals to eliminate traffic deaths, and over 400 mayors have pledged to dramatically reduce carbon emissions. It would not be much of a policy stretch to ban the filming of car commercials on their streets as part of those commitments.

What might make the biggest impact, however, is if the places that run car ads, like streaming services, social media platforms, and major sporting event broadcasts, would refuse advertising from automakers. The Guardian recently announced it would stop taking advertising from fossil fuel companies. “Oil and gas firms now find themselves alongside tobacco companies as businesses that threaten the health and well-being of everyone on this planet,” reads a statement from Greenpeace condoning the decision. The same could definitely be said about the cars that burn those fossil fuels.