Pedestrian deaths in the United States are at a five-year high, and if you’re among the few people who walks around Orlando, you’re more likely to be killed by a car than anyone else in the nation. You can thank 60 years of auto-centric planning and transportation policies for that.

Things aren’t much better elsewhere in the southeast or southwest, two regions that account for the majority of the 20 most dangerous metropolitan areas for pedestrians. All of them boomed after World War II, an era when urban design and transit planning favored the almighty automobile above walking, cycling and mass transit.

That’s the key takeaway from “Dangerous By Design,” a sobering report by the National Complete Streets Coalition, an arm of Smart Growth America. The report outlines the riskiest cities for pedestrians and argues–at a time when Congress is debating a transportation funding bill–that state and federal legislators and regulators must do more to make our streets safer for all who use them.

“Congress should require all federally funded road projects to consider the safety of all travelers, including those who are walking, taking public transportation, bicycling and driving, regardless of age or ability,” the report says.

The report notes that 45,284 pedestrians were killed between 2003 and 2012 (the latest year for which data were available). The numbers have spiked in the past few years, from just over 4,200 deaths in 2007 to nearly 5,000 in 2012, and the researchers behind it are at a loss to explain why. But they make no bones about arguing pedestrians and cyclists would be safer on “complete streets”—those that include crosswalks and dedicated bike and bus lanes to slow traffic and increase safety.

This is happening, albeit slowly. The Obama administration, along with hundreds of American cities, is slowly shifting the focus away from cars to create more inclusive urban and transportation planning. Four years ago, then-Transportation Secretary Ray LaHood declared the “end of favorizing motorized transportation at the expense of non-motorized.” He decreed that, henceforth, the needs of pedestrians, cyclists and transit riders must be considered alongside those of motorists when allocating federal transportation dollars.

But lots of work remains, as the report, released Tuesday, makes clear.

The report rates 51 metro areas by something called the Pedestrian Danger Index, which indicates the likelihood of being killed. It’s based on the number of pedestrian fatalities per 100,000 residents and the percent of people who commute on foot.

It isn’t a perfect measurement—it counts only pedestrian fatalities, not injuries, for example—but that shortcoming reflects a lack of relevant data. Much more research on this issue needs to be done, Michelle Ernst, one author, said.

Here are the 20 most deadly cities for pedestrians in the country, based on data for 2008 to 2012. For 2003-2012, the national PDI was 52.2. A full list of 51 metro areas is in the report. Here are the 20 most deadly cities for pedestrians in the country, based on data for 2008 to 2012. For 2003-2012, the national PDI was 52.2. A full list of 51 metro areas is in the report.

The common link is among cities in the Sunbelt, which grew rapidly after World War II, when transit design abetted suburban sprawl and focused primarily on drivers.

There, low-density neighborhoods “rely on wider streets with higher speeds to connect homes, shops, and schools—roads that tend to be more dangerous for people walking,” the report says. More than half of all pedestrian deaths recorded from 2003-2012 occurred on wide arterial roads designed to move cars quickly.

The safest cities, according to the study, tend to be older ones, particularly in the northeast, that developed long before the car became the dominant form of transport. Streets are narrower and cars can’t drive as fast as they can in newer cities, said Roger Millar, director of the National Complete Streets Coalition.

“One of the best ways to save lives is to slow traffic down.”

The key to reducing fatalities, Smart Growth America argues, is designing “complete streets” that everyone can use safely. That means providing more crosswalks, ample bike lanes and dedicated bus lanes. It also means narrower lanes for cars, and streets with median islands and roundabouts, all of which limit vehicle speed and keep pedestrians, cyclists and transit riders out of harm’s way.

Congress has a lot of clout to change how roads are built. Between 2003 to 2012, nearly 70 percent of pedestrian deaths nationwide occurred on roads built with at least some federal money, which was allocated according to federal guidelines that dictate things how like road markings, highway signs, and traffic signals are used. Such guidelines, advocates argue, should address the needs of pedestrians, cyclists and others.

And as it happens, Congress has a chance to do just that. The Moving Ahead for Progress in the 21st Century (MAP-21) Act, which allocated $105 billion for surface transportation programs for 2013 and 2014, is up for reauthorization.

Cycling advocates criticized the current law for lumping biking and pedestrian programs into one “Transportation Alternatives” program. That significantly cut funding for those projects, according to America Bikes, which lobbies for better cycling, pedestrian, and transit networks. MAP-21 allocates a total of $105 billion. $808 million of that will be for “Transportation Alternatives.”

The new bill, approved unanimously by the Senate Environment and Public Works Committee last week, would provide funding through 2020, but maintain the current formulas for sharing that money. So pedestrians would still lose out.

The key to making safer streets isn’t necessarily spending more money, Millar said, but rather tying existing funding to a national complete streets policy. In other words, distribute what we have more equitably.

And so advocates like the AARP (the elderly, with children and people of color, are overrepresented in pedestrian deaths) are making the rounds on Capitol Hill this week. They want to do “some very basic education” about the issue, executive vice president Nancy LeaMond said.

Then they will push for planning and transportation policies that reflects the needs of all, who use public streets, not just drivers.