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Bicycle helmet laws are “failed public policy” says public health expert

A previous Croakey post put a strong case that mandatory bicycle helmet laws are having a detrimental effect on public health.

Now a leading public health and cycling advocate, Clinical Associate Professor Chris Rissel from the University of Sydney, has weighed in to the debate – suggesting that the laws are “failed public policy”.

He writes:

“I agree with Sue Abbott that the legislation for mandatory bike helmets is failed public policy.

There is little evidence to support the view that there was a drop in head injuries as a result of the helmet legislation. Any observation of the head injury rate since 1950 shows that this declining in New South Wales BEFORE the introduction of mandatory helmet legislation, and certainly before the self-reported level of helmet use increased. This is consistent with the general decline in motor vehicle related fatalities and morbidity in NSW from 1950 to the present, but in particular between 1980 and 1990.

It is most likely that a series of changes in road safety and conditions before 1991 contributed to a generally safer road environment, which benefited people cycling as well as other road users. For example, on December 17, 1982, New South Wales, introduced random breath testing, with an immediate 90-percent decline in road deaths, which soon stabilized at a rate approximately 22 percent lower than the average for the previous 6 years. The introduction of intensive road safety advertising in 1989, and the introduction of speed camera programs in 1990, plus the implementation of national road safety strategies (eg STAYSAFE Committee) all contributed to marked reductions in traffic related mortality and morbidity through the 1980s and early 1990s.

Two previous papers looking at the impact of helmet legislation reported on pedestrian deaths and head injuries as a comparison with cyclists before and after 1991. Robinson found a decline in deaths and serious head injuries among pedestrians paralleled the decline in these injuries among cyclists between 1988 and 1992.[1] Between 1988 and 1994 the decline in deaths from head injuries among pedestrians was 8% greater than the decline in deaths from head injuries among cyclists.[2] Clearly pedestrians are not affected by helmet legislation, yet the reduction in head injuries among pedestrians supports the idea that factors other helmets may be responsible for generally safer road conditions.

From a practical and policy perspective, the introduction of mandatory helmet legislation is not temporally associated with a substantial drop in head injuries among cyclists. The problem with a focus on helmets is that it seeks to attribute injury responsibility with the vulnerable road user rather than the cause of the injury, which is essentially road and traffic conditions such as, for example, poor road surface, allocation of road space for cyclists, speed of vehicles, and attitudes of drivers.

The discussion should not be about whether helmets protect the head or not, but whether the helmet legislation caused less head injuries. There is no evidence that it did, and lots of argument that helmets are a barrier to cycling and the health benefits that come from cycling.”

1. Robinson D.L., Safety in numbers in Australia: more walkers and bicyclists, safer walking and bicycling, Health Promotion Journal of Australia, Vol.16, No.1, 2005, pp47-51.

2. Curnow W.J., Helmets not helpful- and example of poor public policy, Health Promotion Journal of Australia, Vol.16, No.2, 2005, p160.

Comments 21

  1. noelbike says:

    Good to see this subject presented (it seems) obectively. Having been on a bike in Sydney throughout the period it rings true.

    My concern is that we could have mounting pressure for anti-MHL (mandatory helmet law) but not see the changes needed for bikes to be safer. Indeed, as each year passes I see more and more cars. Whether they are in use, in traffic jams or parked, their aggregate number in itself is a challenge to cycling.

    The stage we are at in Australia with debate about private motoring is a worry. For government, the auto industry ranks as an economic stimulus opportunity. Governments are rarely pushing back against private motoring.

    The point in the article stands on its own. But can we see 50% of the ‘energy’ that it gives rise to aimed at the need for our society to get out of private cars? Sure, lets fix the roads for bikes too. But most people still won’t ride bikes in a sea of cars.

  2. SBH says:

    This apiece which goes badly astray at the first line “A previous Croakey post put a strong case” (no, it put a weak and poorly argued case) looses all credibility at the point where it says:

    “For example, on December 17, 1982, New South Wales, introduced random breath testing, with an immediate 90-percent decline in road deaths”

    This is demonstrably untrue and should be retracted.

    Demonstration?
    In 1982 the road toll in NSW was 1253. In 1983 it was 966, a reduction of 23%. Todays road toll is about 390 so an overall reduction in 27 years of about 70%. Nothing like an ‘immediate” reduction of 90%

    page seven of this report http://www.aph.gov.au/house/committee/trs/roadsafety/report/chap2.pdf
    QED

  3. axy74fg says:

    Hasn’t the argument about mandatory helmet laws been done to death? It keeps recurring every few months or so, with little twists in vocabulary, tone, viewpoints, like high school papers or a venereal disease.

    After all the links have been linked to, after all the (same) arguments have been made, nothing ever gets beyond the online squabbling.

    Here’s my equally useful article:
    Repeal MHL. Kthxbai

  4. Dr Paul Martin says:

    Firstly, to the ‘ICU Nurse of 22 years’: Tell me you’re joking…

    I would be extremely surprised if any cyclist who has had their head ‘run over by a truck’ would end up in ICU. In my broad experience they end up in the morgue. A bicycle helmet will do nothing for this type of impact. Are you aware of what they ACTUALLY test for in the AS/NZS2063 Standard for Bicycle Helmets? I’m sure you are not.

    They are tested for very limited impacts, at speeds no greater than 19.5km/h (the speed the helmet reaches if dropped 1.5 metres). Not all sizes are tested (notably absent in testing are small children’s helmets…). Go to your local State Library and read up on them – I did and I was shocked at how inadequate they are.

    Bicycle helmets do afford some protection but only in certain circumstances:
    – it will reduce lacerations and minor head (scalp, not facial) injuries in low speed falls (assuming you actually hit your head and not injure your arms, legs, neck – which is far more likely).

    They DO NOT reduce the risk of serious head (ie. brain) injuries in significant impacts. They should have never been marketed as being effective at preventing serious head injury. Now we have a generation of ‘believers’.

    Nobody is saying that this argument is about mandatory NON-wearing of helmets. It is suggesting that it should be OPTIONAL, no more. If you want to wear one, fine – go for it – I’m all for that – that’s your choice, if we had a choice. The problem with people that are happy with helmets is that they just don’t care about MHLs – but they should. If helmets were so important then why is there an exemption for passengers of three- or four-wheeled ‘bicycles’ BUT only if they are PAYING passengers! So it is OK to not wear a helmet if it affects a business?

    It is not mandatory to wear sunscreen at the beach yet skin cancer in Australia costs the country a fortune (and many lives) – I’m assuming you were going to use the ‘cyclist head injuries cost the tax payer millions!’ argument… that is tired one.

    With bicycle helmets, I am pro-choice (I’m pro-choice in other areas too…). I am in full support of laws for the common good – this is not one of those laws.

    Dr Paul Martin
    Consultant Anaesthetist
    MBBS, FANZCA
    Brisbane, Australia

  5. Dr Paul Martin says:

    Apologies. My post (above) was meant for the other article!

    Dr Paul Martin
    Consultant Anaesthetist
    MBBS, FANZCA
    Brisbane, Australia

  6. Liz says:

    Never thought I’d say this but I’ve read the posts and am starting to question my assumptions about helmets. Thanks Chris for weighing into this debate.

  7. Freedom rider says:

    NSW Parliament should evaluate the health and safety issues and consider all reports in full. Civil liberties should also be given a value.

  8. Bellistner says:

    I’m going to keep wearing my helmet. if nothing else, it keeps my ears attatched to my head when I get knocked off my bike by an inattentive driver.

    Bicycles seem to still be considered by most drivers as an inconvienience (“I pay for the roads”, “you need a licence”, etc), but I have noticed, however, a decline in the number of people who deliberately drive as close to bicyclists as possible. Maybe, despite all the (often formented) rhetoric in the paper and online, there’s more give-n-take out there than we’re led to believe. Maybe the MSN has a vested interest in keeping the Happy Motoring Utopia kicking on.

  9. Jon Hunt says:

    Can anyone tell me what happened to my post, which essentially said much the same as Doc Martin’s, but with perhaps less authority?

  10. Jon Hunt says:

    I suspect it is probably located at the other article.

  11. jima says:

    Since the law was imposed, who hasn’t heard of/from a cyclist whose ‘life was saved’ by their helmet?
    If all these were added to the tally of actual fatal-&-serious head injuries – which have increased pro-rata – it suggests the opposite, that the very wearing has hugely increased the risk.

  12. Jenny Haines says:

    It may be fashionable to knock doctors and nurses as just conservative medical opinion, but we are the ones who have to care for the foolish. By the way, nursing is not medicine. We are an autonomous profession. We think and practice for ourselves and certainly don’t take direction from the AMA.
    True that someone whose head was run over would not get to ICU, they would more likely go to the morgue. I guess it depends on how you want to go.
    Funnily enough the day after I posted the previous post I cared for a 59 year old man who fell off a pushbike. He was not wearing a helmet. He was not found for some time after the fall. He was in ICU following a C4 C5 spinal operation. He was also a quadraplegic. He was waiting for the period of spinal shock to pass to find out how much function he had left below the neck.

  13. Chris Gillham says:

    Jenny Haines … you cite a 59 year old man you have recently nursed with spinal injuries resulting in quadraplegia caused by a cycling accident without a helmet. His operation was for a C4 C5 spinal operation. It’s worth looking at the researched impact of helmets on neck injury …

    Research by McDermott et al. (Trauma, 1993, p834-841) found a significant increase in neck injuries for helmet wearers. 3.3% of unhelmeted riders sustained neck injuries while 5.7% of helmeted riders sustained neck injuries – a 75% greater risk among helmet wearers. The study compared 366 helmeted riders and 1344 non helmeted riders admitted to hospital in Victoria before helmets were mandatory.

    The Australian Transport Safety Bureau (ATSB) issued a report in June 2000 titled Bicycle Helmets and Injury Prevention: A formal review CR 195. The ATSB report “meta-analysed” 16 research papers. The ATSB meta-analysis found in favour of helmets but confirmed that they increase the risk of neck injury.

    Here in Western Australia, a comparison of Health Department data re cyclist injuries in the three years before law enforcement vs three years after shows a 39% increase in upper limb fractures (51 more admitted to hospital per year).

    As an aside, it might be worth noting the wording of American Heritage invention and technology magazine in providing a detailed history of all types of helmets. On the invention and introduction of football helmets, the magazine notes: “However, it had a paradoxically catastrophic effect on injuries. It reduced some head damage but was held responsible for a tripling of neck injuries and a doubling of deaths from cervical spine injuries.” On bicycle helmets, the magazine notes: “By 2001, the CPSC reported, 69 percent of child cyclists and 43 percent of adults in the United States wore helmets. Yet this apparent success has turned up a paradox. In the decade from 1991 to 2001 the surge in helmets was accompanied by a decline in ridership and an increase in cyclist accidents, resulting in 51 percent more head injuries per bicyclist.”

    More info on the increase in accident risk / neck injury due to helmets can be found at http://www.bikersrights.com/statistics/trauma.html

    The increase in risk is because the helmet effectively doubles the diameter of the head and provides grip in the event of an accident (which might have been a narrow miss had the helmet not been there). Grip doesn’t help if your head stops moving but your body keeps tumbling… i.e. neck and spine injuries. This is one of various reasons why the accident/injury rate per cyclist increased by about 50% (300 extra cyclists in hospital per year) in Western Australia after helmet law enforcement … see http://www.cycle-helmets.com

    I advise against citing neck and spinal injuries as evidence re the worth of mandatory helmets.

  14. Jenny Haines says:

    Chris Gillham, I wouldn’t get too excited about the % differences in the McDermott study given the small percentages, and allowing for a margin of error.
    Don’t get me wrong – I am not against bike riding, just an advocate for safe bike riding. I have ridden a bike myself, more in my younger days, than now in my 50s, but I am alarmed that bike riders think it is more safe not to wear a helmet, than to wear a helmet. Having ridden bikes with and without a helmet myself, I would be reluctant to even try riding a bike now on Sydney roads without a helmet. Maybe in a park on a leisurely Sunday afternoon ride with the wind in my hair, but not in Sydney’s mad and unpredictable traffic, in all sorts of weather conditions. I also advocate the old fashioned attachments that I used have when riding bikes in my younger days, like mirrors, so that bike riders can see who is coming from behind them, and reflectors, and comfortable clothes and shoes. Just me being old fashioned I guess!!

  15. IkaInk says:

    Jenny Haines,

    I do not doubt that helmets do help save lives of people that hit their heads in bike accidents, however I think that is simplifying the issue too much.

    Helmets make bikes far less convenient. Not always of course but there are many situations where this is true:

    I visit a friend, he has 2 bikes and two helmets, one is his the other far too small for my head, we choose to drive instead

    I get off the train I see the fancy new public bike system that has opened in Melbourne I think I’ll ride, alas no helmet

    My friend is going away, she offers to lend me her bike for two weeks. I don’t own a bike and her helmet doesn’t fit so I decline the offer.

    Now these are just a few examples, but times that to a population on a whole (especially in the situation of a public bike system) and you have a whole lot less people riding bikes and a by de facto, a lot more people driving.

    The effects of having more people participating in regular and incidental exercise, having less cars on the road whilst conversely having drivers that are more bike aware will do more for bike safety than mandatory helmet laws ever will.

    All done and said, you can still wear a helmet if you wish, as I will continue to do so.

  16. pjrob1957 says:

    I have a theory about the impossibly high number of helmet-saved-my-life stories.
    I often have to work with earmuffs (little ear helmets) to protect from noise. When wearing them I seem to bump hard objects constantly, and as the sound is amplified, there is an exaggerated sense of the proximity of danger. I do not have any scars around my ears from not having them.

  17. pjrob1957 says:

    As far as saving your skull is concerned I have doubts about the helmets we wear. I have had many falls from horses and have been knocked out once. Recently a story aired of a woman who suffered serious head injury falling from a horse wearing a $900 helmet that uses the same foam as our cycling helmets and has a titanium shell. No cars involved, just a straight fall to the ground. I believe if I had been wearing such a helmet the greater area contacting the earth as I hit ,and subsequently quicker deceleration, would not have been compensated for by the softness of the foam let alone the increased likelyhood of neck injury.
    Before any thoughts occur about the hardness of our roads, the TAC requires helmets to be worn by kids and adults in parkland, thats on grass, in Victoria.

  18. wheelo says:

    I personally just don’t like wearing something on my head. I find it off putting, which is in turn dangerous.

    I’ve been cycling in London for 2 years without one and haven’t had an accident to date. I also cycled from Canada to San Fran without any problems. Not saying i’m right, just that surely it should be my choice…after all it’s my body and therefore my risk (if you see it that way) to take. I think people should do whatever they feel makes them safe and comfortable to be able to enjoy a cycle.

    Anyway time to enjoy Sunday

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