The pros and cons of mandatory bicycle helmets are hotly contested, as regular Croakey readers will know.
In the article below, Daniel Vujcich offers a suggestion for how to move the debate forward.
***
Laying down a challenge to all sides of the bicycle helmet debate
Daniel Vujcich wries:
The debate about the appropriateness of mandatory helmet laws has resurfaced recently. Lower than anticipated levels of public interest in both the Brisbane and Melbourne city cycle schemes has been attributed by some to the inconvenience of having to wear a helmet or risk a penalty.
In this blog, comments on previous posts regarding the health benefits of helmets have closely resembled Newton’s Third Law – that is to say, almost every empirical claim has a tendency to be met with an equal and opposite counter-claim.
The babel of a statistical warfare can often be hushed by the clear voice of a Cochrane Review.
A 2008 review (up-to-date as of September 2009) accounted for the methodological quality of available studies and “found positive evidence that bicycle helmet legislation both increases bicycle helmet use and reduces bicycle related head injuries”, with the proviso that “enforcement is necessary to ensure compliance”.
However, the conclusion was accompanied by a number of caveats – namely, (1) it is difficult to obtain full and accurate information about actual helmet use; and (2) it is difficult to determine whether decreases in head injury rates are a product of helmet laws or other factors such as changes in hospital admission procedures, or lower levels of bicycling.
While the Review only included studies with a comparative control group so as to discount alternative explanations, five of the six studies compared child head injuries (following the introduction of a mandatory child-specific helmet law) with those of an adult control group. The Review authors noted that “comparing adults with children may be problematic”.
Three years on and the promise of a statistical cease-fire has proved ephemeral.
Yet, to employ a school yard analogy, there is only so much that one can achieve by countering every “is not” with an “is so” when it comes to political debates.
Until the day that the much coveted Study-to-End-All-Studies is delivered, I argue that pro-helmet proponents need to bolster their discursive arsenal if they are to effectively defend their position in the face of a recurring media appetite for reform.
Aside from statistics, one weapon that is currently invoked by pro-helmet advocates is the ‘precautionary policy principle’ – the idea that, in the absence of scientific consensus, policy makers are justified in adopting a course of action which allays a suspected risk.
However, the precautionary principle leaves us wanting. As Cass Sunstein (2003) has forcefully argued, the central weakness of the precautionary principle is not that “it leads in bad directions, but because … it leads in no direction at all. The principle threatens to be paralysing, forbidding regulation, inaction, and every step in between.”
Protecting society from the suspected risk of increased rates of head injuries in turn exposes it to the suspected risk of a potentially less active population, and all that that entails. Thus, through an application of the precautionary principle, the two warring camps once again find themselves at an impasse.
From my perspective, a better strategy for helmet law proponents is to rely on the economic/cognitive behavioural theory of loss aversion. In short, the theory states that most people favour avoiding losses to making gains.
Thus, in the present situation, when faced with a lack of scientific consensus, the general public should prefer to maintain the status quo. This is because if the current law is lifted there is a plausible risk that bicycle-related injuries and mortalities might increase, which would constitute a loss to society.
Since avoiding plausible losses is preferable to making plausible gains, the promise of a potentially more active (and perhaps more healthy) society than we currently have would be considered insufficient to justify the risk.
The onus therefore shifts to those in favour of reform to demonstrate that the potential societal health gains are big enough (and inevitable enough) to warrant a deviation from the default preference for loss aversion.
Should the pro-reformers manage to achieve this, those arguing for the status quo would rightly be left helmet in hand.
• Daniel Vujcich is a graduate of the University of Western Australia. He is currently on a Rhodes Scholarship to the University of Oxford where he has completed a Master’s degree in International Development, and now reads for a doctorate in Public Health. His research relates to the way in which Indigenous Australian health policies are formulated.
The Cochrane review is invalid.
A study published in the British Medical Journal showed that the health benefits of riding a bicycle outweigh the risks by a ratio of 77.
http://www.bmj.com/content/343/bmj.d4521
Australia, comparison of cyclist to pedestrian fatalities, 1986 to 2008
From 1986 to 2008 population increase and road safety has changed, e.g. Road safety has improved, Queensland fatality rate per 100,000 population, 1991 – 13.2 and in 2008 – 7.6, down about 42%.
The 4 years before helmet laws started in Australia, 1986 and 89, percentage cyclist to pedestrian deaths was 16.2% (342 cyclists /2082 pedestrians). Comparing with 2005 –08, 148/851 =17.4%. Census shows a substantial fall in cycling but the percentage of cyclist to pedestrians has increased. Additionally the number of children cycling reduced by 36% in Victoria and by 44% in NSW. The data suggests that cyclists have not benefited from wearing helmets and helmet legislation has caused a drop in cycling.
Queensland fatality aspects
The Monograph 5 review details for Queensland 1993 to 2008 there were 146 cyclist fatalities, 44 not wearing helmets, 82 worn, 20 unknown (Table 13, page 30). In fatal type accidents helmets can dislodge and on inspection it may not be known if the rider was wearing or carrying a helmet. The data suggest of known cases 65% were wearing helmets. Various reports have detailed some of the differences that can occur with helmet wearers and non-wearers, income type groups, wearing hi-viz safety vests, drinking habits, riding habits and age. The adults have a higher wearing rate than teenagers also tend to have more experience and this results in a lower risk per km of travel and they would have this lower risk regardless of helmet use.
Road traffic crashes Queensland data (1999 to 2004) also details the number of cyclists killed wearing and not wearing helmets. The reports show 51 deaths in the 6 years, 35 wearing, 10 not wearing and 6 unknown. Of known cases 77.7% were wearing helmets. The 2001 survey on helmet wearing reported 5117 cyclists were observed of which 77 percent were wearing a helmet, up from 71 percent in 1997 and 52 percent in 1991
Tin Tin S, Injuries to pedal cyclists on New Zealand roads, 1988-2007, Tin Tin et al. BMC Public Health 2010, 10:655 http://www.biomedcentral.com/1471-2458/10/655
It reports – Results
“The highest rate of cycling injuries was observed among the 5-14 year olds (Figure 1). In this age group, from 1996-99 to 2003-07, there was a substantial increase in injury risk from crashes not involving a motor vehicle. However, this trend was not observed when analyses were restricted to those with serious injuries. Males had a higher rate of collision and other injuries compared to females (Figure 2).”
Fig 1 shows a major increase in the accident rate for 5-14 age group, almost doubling the rate. Road safety improved in NZ from 1990 – 2009, roughly 50%+ reduction. Therefore a fall in serious cyclist injuires would be expected.
It reports- Discussion
“Of particular concern are children and adolescents who have experienced the greatest increase in the risk of cycling injuries despite a substantial decline in the amount of cycling over the past two decades.”
Table 1 in their report details the cyclist accident rate per million hours, 25.6 in 1988-91, 30.7 in 2003-07.
It appears that most of the increase in risk was to children. This outcome appears very similar to Victoria and New South Wales in both reducing safety for children and discouraging them from cycling.
A Parliamentary inquiry to investigate why Australia was misled is needed.
Applying Freedom Rider’s precautionery principal to other risky endeavours in life would surely mean that all new cars should be immediately fitted with full harness restraints and helmets be made compulsory for all vehicle occupants. Similarly given the exhorbitant rate of injury and death by motor cycle riders compared to all other transport modes means they should be immediately banned outright now.
These changes wont happen. We as a people have accepted that while there is risk, we are happy to accept that risk for the other perceived benefits. I suspect the bike helmets got through at a time when it was essentialy only children were riding bikes and of course we must think of the children.
In the end I see this type of law as sensible and sane as all the other prohibitions that have been tried “for our betterment” over the last 100 years.
Your argument is an excellent example of why people should do nothing about climate change – there is a plausible additional cost, offset by ‘prospects’ of new jobs installing home insulation, renewable energy systems and avoiding losses to coastal cities from potential sea level rises.
Despite the lack of complete scientific consensus, most people (myself included) who have read and understand the issues, believe that the cost of not addressing climate change could cost much more in the long run.
Bicycle helmet laws are the same. The Cochrane review is misleading, because its author relies mainly on her own study that found a downward trend in head injuries. She conveniently omitted to mention that there was no long-term increase in helmet wearing, and failed to mention a similar downward trend for pedestrian injuries – see graphs at http://www.bmj.com/content/332/7543/722.2.extract/reply#bmj_el_243531
The generally-accepted way to evaluate a road safety intervention is to look for a response when the measure in introduced. That’s how we know that speed cameras and random breath testing work – the response was immediate and sustained.
There was an immediate and sustained response to Victoria’s helmet law – see Fig C at: http://www.bmj.com/content/332/7543/722.2/suppl/DC1#fb The problem is that non-head injuries fell almost as much as head injuries. Helmets don’t prevent non-head injuries, but we’d expect fewer non-head injuries if there were fewer cyclists.
In other words, the biggest, most noticeable effect of the law was that is discouraged cycling. We know this not only from the reduction in non-head injuries, but also the comprehensive surveys at the same 64 sites and observation times and the same time of year – post law, 36% fewer cyclists were counted.
An evaluation in 1996 pointed out that head injuries per km cycled actually increased compared to what would have been expected without the law. At the time, this was not easy to explain. But subsequent studies have shown that reduced cycling leads to reduced safety in numbers. A clear effect of risk compensation in relation to bicycle helmets has also been demonstrated.
Drivers leave significantly less room when overtaking a helmeted cyclist. The researcher, Dr Ian Walker, was hit twice when conducting this research – by a truck and a bus – both times when he was wearing a helmet! http://www.eurekalert.org/pub_releases/2006-09/uob-wah091106.php
Another study found that that cyclists accustomed to wearing helmets ride significantly faster (implying greater risk tolerance) when wearing helmets than without – see http://www.cycle-helmets.com/P885.pdf. This is likely to increase the risk of crashing.
Having taken the time to read the Cochrane Review, I hope you will read the other evidence and decide which is more plausible. The Cochrane Review that found a downward trend in head injuries (in Canadian provinces that implemented helmet laws compared with those that did not), but failed to mention:
a) Pedestrian injuries in helmet law provinces showed a similar downward trend compared to non-law provinces
b) The helmet law wasn’t enforced. Surveys of helmet wearing showed that it soon returned to pre-law levels – there is no plausible reason why a non-enforced law that didn’t increase helmet wearing should have reduced head injuries.
In contrast, if helmet laws worked, the review in the British Medical Journal – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410838/?tool=pubmed should have found them.
Substantial health benefits were found for users of Barcelona’s the public bicycle sharing scheme. Compared with car users, the estimated annual change in mortality of the Barcelona residents using Bicing (n=181,982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77:1) see http://www.bmj.com/content/343/bmj.d4521.full
So with no clear evidence that helmet laws actually reduced head injuries, and indeed evidence that they increased because of risk compensation and reduced safety in numbers, isn’t it time to repeal the laws?
Daniel Vujcich’s principle of status quo in support of mandatory helmet-wearing assumes that removing compulsion would plausibly result in injuries that are only balanced by general health gains from cycling. However, it can plausibly be argued that compulsory helmets actually increase risk.
Bath University research showed drivers were twice as likely to get particularly close to cyclists wearing helmets. If, as many cyclists believe, road and driving culture are the biggest dangers to cyclists’ safety, then increasing drivers’ sense that cyclists are vulnerable and increasing the number of cyclists on the road by removing mandatory helmet laws would be the most plausible way to reduce cycling injuries.
http://www.bath.ac.uk/news/articles/archive/overtaking110906.html
Yes, people who believe helmets reduce injury should bolster our discursive arsenal. Just like people who think that seatbelts, lower car speeds, crumple zones, speed cameras, booze busses, better roads, air bags,……. reduce the road toll should boost theirs. That’s because despite all the evidence people tend to make emotional decisions like ‘I don’t like wearing a helmet therefore helmets are bad’ and then rationalise them. Simple facts like the ever increasing number of bikes sold and bike sales eclipsing car sales are ignored by people who either choose to misrepresent evidence or who simply don’t have the skills to accurately interpret data (a plural btw freedom rider)
Study after study after study finds helmets reduce injury but the fact is no amount of evidence will convince the anti-camp and it’s a waste of time trying. Far better to put effort into showing non-aligned stakeholders like parents, riders and law makers the proven benefit of augmenting your heads ability to reduce shock being transmited to the brain than trying to convince people who Moses and the prophets gave up on.
@ Freedom rider,
This is a completely invalid conclusion.
You need to consider one of the few valid arguments put forward by climate change deniers – correlation is not causation.
The number of children cycling has reduced since 1986 – 1989. This happens to coincide with the introduction of helmet laws. It is a logical fallacy to draw a causal link between the two without trial by the scientific method or evidence of causation.
One could draw a graph which “proves” by this flawed logic, that the reductions in children’s cycling were “caused” by the proliferation of mobile phones.
Or, we could look overseas to see how they cope without mandatory helmets. I am afraid I dont have time to indulge in dredging through reports that I am sure exist, but… Based on what I have seen when in Europe my gut instinct is we should ditch the laws that are inhibiting the bike hire schemes. I have seen these schemes in a number of French cities including Bordeaux and Paris, also German cities. In each case they seem to be a tremendous benefit for not only the locals who use them but also tourists. The cities where I have seen the schemes operating also have very congested traffic and often pebble roads. I have not seen anyone come a croppa on the bikes although I am sure it happens, I suspect not often though. The benefits are obvious.
Making helmets mandatory is an obvious show stopper for the scheme. People will not carry a helmet around, just in case they may hire a bike. They dont want to wear one someone else just had on their head and of course vanity & hair will come into it.
I ride a bike regularly at home and always wear a helmet when on the road and would recommend anyone wear one if riding at speeds say over 25 Km/h and on highways. I do think making this mandatory for every instance you get on a bike is an overkill and the downside from this law far outweighs the upside.
The author seems to have been running for a deadline and left the analysis incomplete. The plausible gain, to be drawn from his introduction, is that the quantity of cycling would increase from relaxing of helmet laws. Another plausible gain is that adults should have the freedom to choose – and the evidence for safety benefits is marginal at best – so why is Australia leading the pack in front of safety-oriented societies such as Sweden, on imposing decisions of marginal value?
Trevor wrote: “Or, we could look overseas to see how they cope without mandatory helmets.”
Israel enacted all-age mandatory bicycle helmet laws four years ago. Early this month the Israeli Knesset (parliament) repealed the helmet law for adult cyclists in cities and towns.
The Israeli politicians obviously didn’t ditch the adult helmet law on a whim … they studied the results in their own country, in Australia and in New Zealand. There were three countries with national all-age helmet laws – now there are two.
Submissions to the Knesset drew on various Australian studies and records of cycling participation, head injury, all-body injury and affiliated repercussions from the helmet legislation – including from http://www.cycle-helmets.com
I suspect the Israelis recognised that studies of what might happen don’t correlate with what actually has happened in the few legislatures that punish people who choose cycling exercise instead of driving a tonne or two of polluting and potentially lethal metal.
The bike share failures in Melbourne and Brisbane simply reflect what’s been happening for 20 years – a public health disaster that discourages regular recreational exercise in one of the world’s fattest countries, at the same time increasing the ratio of injuries per cyclist on the road.
Incidentally, Mexico City also repealed its mandatory helmet law in early 2010 so that its Ecobici bike share scheme had a chance of attracting users.
Thanks largely to soaring petrol prices, Australian cyclist numbers have been increasing since the late 1990s but remain below the numbers recorded by the ABS prior to hemet law enforcement starting in 1990.
It’s an absurdity that within a year Australia will have some of the world’s most punitive carbon dioxide legislation yet is one of just two countries with national laws that actively discourage the use of a safe, non-polluting mode of transport.
As Dr Paul Biegler stated in the linked SMH article, I think this debate needs to give consideration to the lack of quality and consistency of cycling infrastructure in Australian Cities. European cities have better infrastructure and consistent networks which can more safely accommodate tourist cyclists or other casual cyclists. I think if the helmet law was changed to promote tourism it should be considered in the context of a properly designed network of cycling infrastructure in the first instance.
Chris Gillham rather than quote a partisan web page with no academic credibility read the study entitled “The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia, by Scott R. Walter, Jake Oliviera, Tim Churches, and Raphael Grzebietaa
“Head injury rates decreased significantly more than limb injury rates at the time of legislation among cyclists but not among pedestrians. This additional benefit was attributed to compulsory helmet legislation. Despite numerous data limitations, we identified evidence of a positive effect of compulsory cycle helmet legislation on cyclist head injuries at a population level such that repealing the law cannot be justified.”
“We set out to perform the most comprehensive analysis possible on the subject while addressing any data limitations and possible confounding factors,” said study author Dr Jake Olivier.
“What we found provides compelling evidence that the legislation has served its purpose in reducing bike-related head injuries and any repeal of the laws would only put lives at risk,” he said.
But then you probably favour the monkton view of the world
Wearing a bicycle helmet is a good thing, and if it become optional for adults to wear a helmet I’m sure that many people would continue to wear them.
So the question becomes the health benefits of the small increase in head injuries from not making helmets compulsory for adults compared to the health benefits from getting more people to cycle. I would expect that the overall health benefits would outweigh the extra head injuries.
Of course the other question is at what stage it is appropriate for government to make things compulsory or illegal? As there is now only one other country that mandates helmets for adults, we are definitely at the nanny-state end on this issue.
And even if helmets are to remain compulsory, I still think it would make sense to have an exception for those riding the city hire bikes. Either that or those involved in the schemes planning should have had the common sense to know that the scheme would not work with compulsory helmets.
Captain Planet wrote
Posted August 24, 2011 at 10:54 am | Permalink
@ Freedom rider,
“Census shows a substantial fall in cycling but the percentage of cyclist to pedestrians has increased. Additionally the number of children cycling reduced by 36% in Victoria and by 44% in NSW. The data suggests that cyclists have not benefited from wearing helmets and helmet legislation has caused a drop in cycling.
This is a completely invalid conclusion.”
The Melbourne surveys, 64 sites at 10 hours per site, showed 30 more teenagers wearing helmets but 623 fewer cycling. The main effect of the law was to discourage cycling.
Robinson 1996 report, Table 2 shows data for children in NSW. The equivalent number of injuries for pre law level of number of cyclists increased from 1310 (384 head + 926 other injuries) in 1991 to 2083 (488 head + 1595 other injuries) in 1993. For NSW the helmet laws discouraged cycling and reduced children’s safety. The increased injury rate was 59%, from 1310 to 2083.
Robinson DL; Head injuries and bicycle helmet laws; Accid Anal Prev, 28, 4: p 463-475, 1996 http://www.cycle-helmets.com/robinson-head-injuries.pdf
In 2008 Curnow concluded, “Compulsion to wear a bicycle helmet is detrimental to public health in Australia but, to maintain the status quo, authorities have obfuscated evidence that shows this” and “Cycling declined after the helmet laws by an estimated 40% for children, with loss of the benefits of the exercise
for health. As serious casualties declined by less, the risks to cyclists, including death by head injury, increased.” A link to the paper is at http://www.ncbi.nlm.nih.gov/pubmed/18481926 ,
Erke and Elvik 2007 stated: “There is evidence of increased accident risk per cycling-km for cyclists wearing a helmet. In Australia and New Zealand, the increase is estimated to be around 14 per cent.”
Assessment of Australia’s Bicycle Helmet Laws, refer ‘Mandatory’ can have unanticipated consequences – Civil Liberties Australia web site, 25 Nov. 2008. Providing details of the effects of the legal requirement to wear cycle helmets.
http://www.cla.asn.au/Article/081125BikesHelmetPolicy.pdf
The UK’s National Children’s Bureau (NCB) provided a detailed review in 2005 stating “the case for helmets is far from sound”, “the benefits of helmets need further investigation before even a policy supporting promotion can be unequivocally supported” and “the case has not yet been convincingly made for compulsory use or promotion of cycle helmets.”
I believe a Parliamentary inquiry is needed to look at all of the evidence.
For NSW, Children 0-15 years of age
Survey data showed reduced children cycling following legislation in 1991 . Fig 1 shows the drop in children cycling from 1991 (pre law for children) to 1993.
Children counted
1991 – 6788
1992 – 4234
1993 – 3798
A reduction of 44% occurred.
Survey counts of school students riding to/from NSW schools:
1991 – 3107
1993 – 1648
A drop of 47% occurred
The information shows that 9% extra were wearing helmets after the law, however, 44% fewer were cycling.
The 1985/6 Day-to-Day travel report details distanced travel in NSW and Sydney. For cycling the figures were NSW 924000 km and Sydney 424000 km. Rural NSW by calculation did 54% of cycling, 500000 km per day.
Rural adult road cycling reduced by 37%. Overall adult road cycling reduced by near to 50% for outer rural locations (Albany, Bathhurst, Dubbo, Grafton, Lismore, Queqanbeyan, Tamworth and Wagga Wagga).
Agaiin a Parliamentary inquiry is neeeded.
Just to explain,
The information shows that 9% extra were wearing helmets after the law, however, 44% fewer were cycling. The legislation failed, as the main outcome was to discourage children from cycling. Helmet wearing rates based on pre law 1910 from 6072, post law 2479 from 3414. Extra wearing 569 out of 6072 cyclists.
SBH – I made my points about the NSW study a couple of months ago:
http://www.cycle-helmets.com/cycle-helmet-injuries-nsw.html
It’s not peer-reviewed so beware. And yes, I prefer facts over opinion.
It can only be a matter of time before the ACCC investigates the unsubstantiated, misleading and deceptive claims attached to bicycle helmets – & that day can’t come soon enough!
http://freedomcyclist.blogspot.com/
SBH, the paper by Scott R. Walter et al. is flawed, because does not relate injuries to the amount of cycling.
Similar data for children were analysed by Robinson (Accid Anal Prevent, 1996), copy available at: http://www.cycle-helmets.com/robinson-head-injuries.pdf Comparing the two years before vs after the helmet law, the ratio of head to non-head injuries fell from 30.7% to 24.2% – a 21% fall not dissimilar to the 25-29% estimated by Walter et al.
Unfortunately, this is not a good thing – the total number of head injuries fell by 37%, but the amount of cycling fell by 40%, so the risk of head injury was actually higher than before the law!
This was published before other peer-reviewed research showing that drivers left less room when overtaking a cyclist wearing a helmet, that cyclists accustomed to helmets ride faster when wearing them, and before research showing that reduced cycling leads to reduced safety in numbers – references in previous post.
Wasn’t the Walter et al. research was funded by the RTA, perhaps in the hope of justifying the helmet law? Isn’t that why they avoided comparing numbers of injuries with the amount of cycling – because they knew that if they did, it would show that the helmet law increased the risk of injury, compared to what would have been expected without the law?
The ‘study after study’ you claim showing helmets reduce (head) injury (relative to other injuries) are methodologically similar to the analyses of hormone replacement therapy (HRT) and heart disease, reviewed by Stampfer MJ, Colditz GA. Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prev Med 1991;20:47–63. (Reprinted Int J Epidemiol 2004;33:445–53)
From when this study was published (1991), to the publication of randomised control trials in 2004, the accepted wisdom was that HRT halved the risk of heart disease. Things changed completely when the randomized control trial results showed the opposite – if anything a slight increase in the risk of heart disease.
Like the effect of HRT on heart disease, I fear that the same flawed methodology has led to a substantial exaggeration of the benefits of helmet wearing. But if you don’t mind wearing one, and (unlike the average helmet wearer) don’t take any more risks, I wouldn’t argue against your choice.
My argument is entirely with helmet laws, because they reduce cycling, leading to lost health and environmental benefits and reduced safety in numbers. The lost health benefits increase healthcare costs which are paid for by my taxes, the lost environmental benefits lead to increased pollution (which I breathe) and increased global warming. The reduced safety in numbers increases the risk that I will be hit by a motor vehicle.
So to avoid all these undesirable consequences, I wish the Government would come clean and admit its mistake, instead of trying to save face by commissioning studies such as that of Walter et al. that “conveniently” ignore the only relevant statistic – the risk of head injury per cyclist or per km cycled.
http://www.bv.com.au/file/file/carrsq%20bike%20helmet%20report.pdf
http://injuryprevention.bmj.com/content/16/4/219.short?q=w_injuryprevention_current_tab
and so on and so on – yawn but you know Moses and the prophets. this info is for supporters of helmets to help them back up and frame arguments when lobbying law makers
Before we even get to the point of asking whether helmet legislation (or helmet use itself) is successful in reducing injuries, we should probably be asking the following:
Is riding a bike without a helmet even dangerous enough to justify any sort of government intervention in the first place?
The answer is no – as the rest of the world clearly shows us.
Of course it’s possible to get a head injury riding a bike, just like it’s possible to get a head injury driving a car, roller-blading, playing football or doing many other things for which helmets are not compulsory.
Just because injury is possible and that a safety device might reduce some of those injuries it does not follow that it should be a criminal offense not to use that safety device.
The risk and incidence of head injuries from cycling are very low – in a relative and absolute sense.
I cannot see any merit whatsoever in a “precautionary policy principle”. No-one with any sort of consideration for maintaining a free society could support the grotesque idea that suspicion or whim should be enough to justify laws which criminalise certain individual actions.
Chris Gillham, SBH, RidesToWork:
One of the interesting things about the recent study by Walter et al, is that the strongest result in the model was for the proposition that the helmet law reduced the rate of PEDESTRIAN head and arm injuries.
Now this is obviously an ridiculous conclusion – however the data presented in that study indicated a greater level of statistical significance for this absurd hypothesis than for the hypothesis that the helmet law reduced the rate of cyclist head-to-limb injuries.
Unsurprising the authors did not dwell on this strange result to much – they simply ignored it, and went on to claim that their very weak results were ample justification that the law should not be repealed.
@ Luke Turner,
Agreed. I could not have put it better myself.
This argument holds a heck of a lot more water than the spurious and disjointed attempts I am seeing here, by some individuals who clearly have nothing better to do than froth at the mouth over bicycling statistics, which mistake correlation for causation.
To draw the conclusion that helmet laws have discouraged children from cycling? I really doubt that. In the 1970’s almost all of my primary school classmates walked to school. As a parent myself I know that now very few metropolitan children walk to their primary school. Shall we blame the introduction of helmet laws for ….. errr… a reduction in WALKING? Of course not. But Freedom Rider is quite happy to (erroneously) manufacture a fictitious causal link between the reduction in children’s cycling rates. I think you will find there has been a similar reduction in the amount of time children spend outside playing street cricket….. and a corresponding increase in the amount of time spent playing Xbox. Shall we blame helmet laws for that too?
The entire premise that helmet laws increase injury rates amongst adult cyclists, on the other hand, is so mind bogglingly stupid as to defy belief.
Captain Planet
Wrote
“To draw the conclusion that helmet laws have discouraged children from cycling? I really doubt that.”
As detailed previously
“For New South Wales their survey data showed children’s cycling reduced by 44% following legislation in 1991.
Children counted
1991 – 6788
1993 – 3798
http://www.cyclehelmets.org/1108.html provides a state-by-state guide. The evidence clearly shows the helmet laws discouraged cycling. Prior to introducing legislation some people reported that they would cycle less or not at all.
http://www.cycle-helmets.com/australian-cyclist.html
Captain Planet
Wrote
“The entire premise that helmet laws increase injury rates amongst adult cyclists, on the other hand, is so mind bogglingly stupid as to defy belief.”
Jacobsen, P. L. 2003. Safety in numbers: more walkers and bicyclists, safer walking and bicycling. Inj Prevent 9: 205-209.
It is generally recognized that safety depends on driver’s expectations of encountering cyclists. Where cycling numbers are high, drivers take more care. Helmet laws discourage cycling and therefore increase the risk per km cycled.
Walker, I. 2007. Drivers overtaking bicyclists: Objective data on the effects of riding position, helmet use, vehicle type and apparent gender. Accident Analysis and Prevention 39: 417-425. Walker reported the average clearance distance when overtaking cyclists and this reduced when wearing a helmet.
Phillips, R. O., A. Fyhri, and F. Sagberg. 2011. Risk Compensation and Bicycle Helmets. Risk Analysis (epub published ahead of print). Reported on helmet use and risk and concluded cyclists wearing helmets took more risks.
Morrongiello, B. A., B. Walpole, and J. Lasenby. 2007. Understanding children’s injury-risk behavior: Wearing safety gear can lead to increased risk taking. Accid Anal Prev 39: 618-623.
For adults there are examples of higher risks by wearing helmets, American football, where wearing a helmet became part of their play of charging head first, leading to brain damage by repeated impacts. Mountain biking is an example of higher risk taking when wearing a helmet.
Erke and Elvik 2007, stated: “There is evidence of increased accident risk per cycling-km for cyclists wearing a helmet. In Australia and New Zealand, the increase is estimated to be around 14 per cent.” Erke A, Elvik R, Making Vision Zero real: Preventing Pedestrian Accidents And Making Them Less Severe, Oslo June 2007.
In Victoria a helmet petition was presented,
http://tex.parliament.vic.gov.au/bin/texhtmlt?form=jVicHansard.dumpall&db=hansard91&dodraft=0&house=ASSEMBLY&speech=5089&activity=Petitions&title=Safety+helmets+for+bicyclists&date1=28&date2=May&date3=1991&query=true%09and+%28+activity+contains+'Petitions'+%29%09and+%28+hdate.hdate_3+=+1991+%29%09and+%28+hdate.hdate_2+contains+'May'+%29%09and+%28+hdate.hdate_1+=+28+%29%09and+%28+house+contains+'ASSEMBLY'+%29
28 May 1991 ASSEMBLY
Safety helmets for bicyclists
To the Honourable the Speaker and members of the Legislative Assembly in Parliament assembled:
The humble petition of the undersigned citizens of Australia respectfully showeth:
That your petitioners are gravely concerned that the introduction of the bicycle helmet wearing mandatory regulation has the effect of increasing the risk of having an accident by the combined reasons of 1 to 7 as listed:
1. Increased fatigue due to the extra weight on the head.
2. Increase in head temperature.
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3. Giving the rider a higher centre of gravity, making turning less stable.
4. Peripheral vision reduction in some cases.
5. Noise effects: many cyclists experience noise increase which reduces their awareness of approaching traffic.
6. Reduction in the head’s ability to move quickly in observing traffic, due to increased weight and chin strapping.
7. Having a feeling or sense of being safe, reducing caution and taking increased risks.
The combined risks of 1 to 7 being reflected in the Victorian accident statistics for years 1984-89 as cyclists aged 17-50 years old had a 119 per cent increase in accidents.
Your petitioners most humbly pray that the Parliament will change the law to ensure that for bicyclists over eighteen years old there is no legal requirement to wear a helmet.
And your petitioners, as in duty bound, will ever pray.
It mentions 119% increase in accidents for the 17-50 age group. A full investigation should have been conducted into helmet use and the accident rate but Parliament failed to safeguard public health and safety.
Clarke CF, The Case against bicycle helmets and legislation, VeloCity Munich, 2007. http://www.ta.org.br/site/Banco/7manuais/colin_clarke_cycle_helmet.pdf
The report lists a number of reports showing a higher accident rate associated with helmet use and provides various details. In conclusion there is reasonable evidence showing helmet use may increase the accident rate.
Across Australia fines are issued for not wearing helmets, e.g. 19000+ in Victoria first 12 months, possibly 50k fines per year – 20 years – 1 million fines perhaps. All of these fines are unjust.
If you view helmet laws and wrongly assume they may be OK. This misses the important safeguards that are required when imposing a legal requirement for their use. In brief helmet laws discourage cycling, increase the accident rate per km cycled, result in thousands of fines, remove the human right of making a personal choice etc etc.
7 REASONS TO OPPOSE A CHILD HELMET LAW, (caution, ‘Facts’ should be considered as ‘Opinion’) http://zakka.dk/cykelhjelm/CTC_Helmet_Law_Brochure.pdf may be helpful reading.
Is there a third way here, perhaps when riding on bike paths, designated cycling lanes and roads with a 50km/hr speed limit or below, helmets could be optional. This covers “slow” riding in less traffic, such as riding to school/work on side streets, puddling around a CBD at low speeds. When riding IN the traffic, without the benefit of bikelanes, and the speedlimit is 60 or above, helmets would the be mandatory.
Personally though, my kids and I would always wear them, having hit the edge of a brick fence with my head at 16, I was very happy for the bright yellow Stackhat.
Captain Planet,
The “mind-bogglingly stupid” idea is to confuse long-term trends with immediate responses coinciding with a change in legislation. If the number of children walking to school decreases gradually, say by 5-10% per year, we can safely say it had nothing to do with the helmet law.
If, on the other hand, all the surveys show increases in cycling until the helmet law was introduced, then a 36% drop coinciding *exactly* with the helmet law, it looks kind of suspicious, doesn’t it?
If there are also surveys aiming to promote cycling, which ask kids who didn’t cycle in the past week, why not and 51% of them say because of helmet restrictions, compared to safety concerns (18%) and parents (20%), the argument about a “fictitious causal link” sound rather like clutching at straws.
Can you also explain why you think the other issues – risk compensation, reduced safety in numbers – are all “mind bogglingly stupid”? The fact that scientists conducted experiments and found significant differences in riding speed when cyclists accustomed to helmets wore them, and significant differences in the amount of room drivers left according to whether the cyclists was wearing a helmet – is ???
What are you trying to say – that you believe in helmets – and consequently don’t need to actually read the research showing that helmet laws don’t work, simply dismiss it without even looking at it, as “mind bogglingly stupid”?
“Just because injury is possible and that a safety device might reduce some of those injuries it does not follow that it should be a criminal offense not to use that safety device.”
I guess my compromise position might be like states in the US with no compulsory motorcycle helmet laws. You can ride without a helmet if you choose but if you crash (through your fault or not) you’re f*cked. Fair? Not the kind of society I’d like to live in but might work.
You know the other correlation with the introduction of helmet laws Ridetowork? A dramatic drop in public transport use in favour of cars. Causailty?
As for driver driving closer to helmeted riders well a) arguable at the very best but b) the same argument that women who dress provocatively are ‘asking for it.’
what’s the phrase? Oh yeah – ‘mind bogglingly stupid’
Of course wearing helmets is safe, but no-one should have the right to impose measures on me when I’m doing something that doesn’t affect anyone else! It’s infantilising the population to first socialise health care and then say, we are paying for your health care, so we can now control your behaviour. I think the only bridge we haven’t crossed is to say, it is 77 times safer to ride a bicycle so it should be illegal not to ride one each day.
Personally I would outlaw television…
SBH,
I’ve just looked at the census data for travel to work by public transport vs cars in capital cities, and simply can’t see anything remotely resembling the effect you describe.
Did it apply in all states at the same time as the helmet law (different times for different states)? Did large numbers respond to surveys asking why they no longer used public transport saying that it was because of the bicycle helmet law?
Co-incidences do happen – one bus or train company might have raised fares at the same time as the helmet law was introduced in one state. But when you find the same result from several different studies – systematic pre-and post law counts at more than a hundred sites, stratified into road intersections, routes to schools, recreational areas, as well as data from automatic bike counters on cycle routes, telephone surveys asking people if they would cycle more if they didn’t have to wear a helmet, street surveys asking if helmet laws have affected the amount they cycle, and school surveys conducted by teachers …. every single one indicating that enforced helmet laws discourage cycling … I suspect that your comments cannot be considered as an objective review of the evidence.
As for “dressing provocatively” and “asking for it”, the law is very clear that such actions are to be utterly condemned. I don’t know what studies have been done, but it wouldn’t surprise me if, nonetheless, it affected the risk. It’s your right to wear a helmet (or a woman to dress provocatively), even if it does increase the risk.
This discussion is about is the whether the government should force me to wear one, given the statistics showing increased injuries per cyclist in the first few years after Australian helmet laws were introduced, compared to what would have been expected without the laws.
Solid, well researched arguments here that unfortunately miss the forest for the trees.
Q. What should the role of our Government be?
Is it the role of our government to take over our personal responsibility of looking after ourselves? If so, then we should not get upset when drunks dive into sandbars, break their necks and then sue the council. Nore should we be upset when individuals who lack self control, and conveniently have an obesitity gene run amok, sue McDonalds for serving fatty foods. Or those who cannot control a gambling habit sueing the casino. Or those who suicide slowly with cigarettes sueing tobacco companies. The end result is a highly litigious society, full of irresponsible children that has little hope in hell of advancing itself.
The more responsibility we hand the government the less we keep for ourselves to the point where we are not only a nanny state but actually need a nanny state to make sure we will not trip over the cracks in the concrete (another true example).
Darwin’s Theory has worked pretty well over the last few million years to get us to where we are. Not sure if the Nanny Theory is working as well. Makes for good reality TV however like Biggest Loser. Think I will go and sit on the couch with a 6 pack and watch a few rereuns.
SBH
[I guess my compromise position might be like states in the US with no compulsory motorcycle helmet laws. You can ride without a helmet if you choose but if you crash (through your fault or not) you’re f*cked. Fair? Not the kind of society I’d like to live in but might work.]
I’m not quite sure what you’re trying to say here. Do you think it’s impossible to have a socialised or partly socialised health system without having bike helmet laws? No European countries have all-ages bike helmet laws and most have a more socialised health care system than we do in Australia.
Head injuries resulting from bicycle accidents are a negligible cost to our health system, when compared to the costs of other traffic accidents (cars, pedestrians, motorcycles). Then when you compare it to the incidence and costs of other health problems in Australia, you can see bike injuries are basically a rounding error.
For example, the Cycling Promotion Fund reports that:
“Physical inactivity costs the health budget an estimated $1.5bn a year and causes 16,000 premature deaths per year.”
Annual deaths from bicycle accidents is usually around 30-40 (the majority of these are usually wearing helmets, by the way).
So at absolute best, bike helmet legislation might be saving 10-20 or so lives per year. This is being very generous – some studies of this have found that there is actually no evidence that helmet legislation has reduced injuries (on a population-wide basis).
If only a tiny proportion of those who are suffering ill health from a lack of activity are being dissuaded from riding a bike due to helmet laws, then it’s likely that the law is doing more harm than good.
This is not to say that wearing a helmet is bad, or that anyone should be stopped or discouraged from doing so. Simply that the benefits of wearing a helmet are not so great that it should be illegal to ride without one in all situations.
wrong again RTW, this discussion is about moving the debate on from the tit for tat my study trumps yours approach that charactises this ‘debate’.
Rechoboam you’ve used a false dichotomy. When you say ‘doesn’t affect anyone else’ you’re not taking into account what would happen if you decide to do something dumb and end up being a burden on your family friends and society. If you get seriously hurt then it does affect someone else as well.
You know what Luke Turner, what I’d like is for us all to stop wasting time on a non-issue and do something useful. I don’t really care whether you wear a helmet or not. The ignorant stupidity of railing against any public health measure as soon as its suggested annoys me and sometimes can have far reaching affects but you’re right, this is a small issue. And the arguments run out by some are just assinine. For instance the idea that inactive people will suddenly leap on a bike because we’ve freed them from the tyrany of helmets is silly.
I’d venture that a far greater deterent is car driver behaviour and the safety of our roads. Far better to spend our time lobbying for coerced and/or encouraged changes to driver behaviour than this issue. I’ll leave this paddling pool to the infants.
SBH, no-one is forcing you to waste your time on this. As for your desire that everyone else also stop wasting time on it, well I can decide for myself what is a good use of my time and effort, thanks.
I actually agree with you that road safety is a greater deterrent to bike use than helmets, but that doesn’t mean it’s a waste of time to lobby for repeal of a bad law. I think you will find that many people who are pushing for law reform in this area are also active in lobbying for better infrastructure and other law changes (strict liability for eg).
The arguments against compulsion are not “assinine” (pun intended, given our current subject matter?). No-one is suggesting that every overweight person would jump on a bike if the law was changed. But some certainly would – the evidence that compulsory helmet reduces cycling is extremely strong.
As RidesToWork and Freedom rider have pointed out above, we observed a significant decline in cycling when the laws came in, and people are still telling us that helmet laws are a disincentive. I am myself one of those people who rides less as a result of the requirement to wear a helmet at all times. It’s basic logic also – making helmets optional accommodates all preferences, so it’s likely to lead to higher participation.
Regardless of this, there are still perfectly valid arguments against compulsion that have nothing to do with injury reduction or participation. For me it’s quite simple. I would prefer not to wear a helmet in some circumstances. Much of my riding is in very low-risk environments like quiet streets and bike paths. Given that it’s not dangerous to ride bare-headed in such circumstances, I don’t think it’s a reasonable law to make it illegal to do so.
I agree with the majority of arguments put forward by those against mandatory helmet laws. There is a trade off between safety and practicability for every activity and in the case of bicycling we have not set it at the right point.
There is an assumption underlying this debate that bicycling is a dangerous activity worthy of special scrutiny. We should all work to bring the perception of risk back into line with reality.
I’d like to congratulate the posters on here for having a mostly civil and intelligent debate. Usually this topic reduces down to foul language and impolite tactics so it’s quite refreshing to see it happening in this way.
It’s important that we don’t stoop to the level of people who make hyperbolic statements or clumsily compare anyone who disagrees with them to climate change deniers.
Helmets have only really become a problem when a law is imposed. I ride with a group sometimes, 20 riders +, most actually wear helmets, some wear them most of the time and some carry them occasionally. They like to decide when to wear one or not being told to wear one. Others do not wear them and some wear caps. One cyclist who used to ride practically every day before the law, has is bike in storage and no longer rides.
It keeps most people happy when choice is allowed. It probably all to do with helmet sales, 15 million per year in the USA. The safety case is questionable and the health case negative. Moderate cycling has many physical and mental health benefits (BMA 1992 ) by reducing the risk of developing heart disease, diabetes, high blood pressure, colon cancer and depression, and helping to control weight and increase fitness. Dr Mayer Hillman from the UK’s Policy Studies Institute calculated the life years gained by cycling outweigh life years lost in accidents by a factor of 20 to 1. One report from Australia stated that “Despite the perceived risks of cycling, the absolute magnitude of the risks is low, and the benefit-to-risk ratio is overwhelmingly positive; for chronic disease prevention, obesity reduction and mental health, the benefits are substantial”.
The best approach is allowing choice but helmet sales and profits compromise the situation.
http://www.bikeforums.net/showthread.php/644296-Driving-Without-Dying-Campaigns-to-Get-Motorists-to-Wear-Helmets
I do not support making drivers wear helmet, it should be their choice.
In the end, SBH, we need to put evidence above personal prejudice. Your claim of a significant drop in public transport coinciding exactly with the start of helmet law seems very dubious, but I’d hate to think you would think it OK to mislead people by just making it up. Please do provide details.
The devil is, after all, in the detail. Assuming you agree that safety should be expressed in terms of injuries per km cycled, we need to discuss the source of the injury statistics and the survey data used to calculate the amount of cycling. Arguing that ‘my study trumps yours’ without discussing details (e.g. how cycle use was measured) is stupid, as well as childish.
If we want to make cycling safer, we need to collect accurate statistics. Cycling in Holland is much safer than here, partly because, when they design new facilities, they evaluate them using injury statistics before and after the intervention, and also by asking if cyclists like them and find them convenient.
Here, we have a battle with the local councils and the traffic authorities, asking them *not* to build cycle lanes that force cyclists into the parked-car-door-opening-zone, but instead to try alternatives like consulting local cyclists on where they encounter safety problems, installing advisory markings to encourage cyclists to ride further away from parked cars (when it’s safe to do so) and advisory markings to encourage motorists to look out for cyclists.
Our city’s draft BikePlan contains all the above, together with a formal commitment to evaluate new facilities. I really hope it starts to address the decline in cycling that began when helmets became mandatory.
http://www.cyclehelmets.org/1207.html?NKey=67
makes interesting reading.
I should clarify a comment I made,
“Helmets have only really become a problem when a law is imposed.”
This may be true in general.
To safeguard the public, a number of warnings should be included with helmet sales. They would have to be carefully considered, as a guide.
1 Helmets are designed for low speed impacts and they may not provide sufficient protection in many accident situations.
2 Children should not wear helmets in playgrounds or when climbing trees. The helmet can snag and the strap can asphyxiate them. Several deaths have been recorded. (14 worldwide is about the figure)
3 Research evidence suggests that helmets may increase the accident rate and extra care may be advised.
4 Helmets in general are not tested for rotational acceleration effects, which are associated with serious brain injury. They may double the impact rate compared with a bare head and also increase the torque for rotation by approximately 30% or more.
http://www.cycle-helmets.com/head-helmet.doc
5 The UK consumer magazine Which? independently tested 24 helmets and reported that only 9 passed all tests and therefore even new helmets may not be reliable.
6 The health benefits of cycling generally exceed the injury risk and children or adults should not be forced or coerced into wearing them if it discourages them from cycling.
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