Convincing more Australians to get on a bike would undoubtedly deliver health improvements that come with reduced waistlines. But ditching bike helmets isn’t the answer.
The health benefits of more cycling would need to be multiplied countless times before they could offset the loss of life and health harms caused by serious head injury.
Benefits of helmets
Bicycle helmets have long been recognised as the best protection against head injury. As far back as 1977, Standards Australia approved a helmet design for cyclists to reduce their risk of head injury.
Throughout the 1980s the Victorian Government promoted cycling and encouraged the use of helmets with a bulk-purchase subsidy scheme, compulsory helmets for the schools Bike Ed program, a television and radio campaign, and a $10 per helmet rebate on purchases each December from 1984 to 1988.
Observational surveys show that the campaigns worked and helmet use grew each year in the 1980s, mostly among primary school children and also in teen and adult commuting cyclist groups.
As helmet use grew, the risk of head injuries reduced. The number of cyclists killed or hospitalised with head injuries reduced by about a third in the 1980s.
The number of other injuries actually increased, though it’s not surprising given there were greater numbers of cyclists on the road.
When the Victorian compulsory helmet laws passed on 1 July 1990, helmet wearing rates more than doubled — from around a third to three quarters — by March 1991. The increase was smaller for primary school children, who were already avid helmet-wearers.
Rates of cyclist head injury fell by 48% and 70% during the first and second years of the law.
It’s been suggested that helmet laws contributed little to the reduced injury rate, and that Victorian cyclists benefited most from road safety improvements, such as random breath testing, speed camera enforcement and supporting mass-media campaigns.
These initiatives may explain some of the reduction in the total number of cyclists killed and hospitalised during the early 1990s.
But the additional reduction in head injuries in the first two years of the law was consistent with the rise of helmet-wearing in those years.
Cyclist rates
So, there’s no doubt that mandatory helmet laws reduced head injury and improved cyclist safety. The problem is that it also reduced rates of cycling in some groups.
Teenage cycling decreased by 43% and 46% in the first and second years of the law. Rates of primary school student cyclists also dropped slightly.
But it wasn’t all bad news.
More adults began cycling after the introduction of mandatory helmet laws. Adult bicycle use increased by 88% from 1987/1988 to 1991, and doubled by 1992.
Overall bicycle use had increased by 9% in 1991 and by a further 3% in 1992.
So focusing on reduced bicycle use by teenagers, and to a lesser extent by younger children, gives a misleading impression of the overall impact of the helmet law on bicycle use.
New generations of cyclists
It’s interesting to speculate on what would happen if helmet laws were repealed.
Because the bicycle-use surveys weren’t repeated throughout the 1990s, we won’t ever know if helmet laws continued to discourage cycling.
If they did, we would have to ask whether repealing the law would increase cycling and bring about sufficient health improvements to offset the increased risk of head injury.
Valuing the benefits of exercise through cycling is outside my area of expertise. And I am yet to see a full analysis of these benefits comparable to an objective analysis of the costs of increased cyclist trauma, especially head injuries.
But failing to prevent serious trauma on our roads isn’t just a transport problem or even a public health issue — it’s both an ethical and economic dilemma.
Investment in preventing a road death is now valued at about $6 million in the National Road Safety Strategy. A serious head injury resulting in permanent brain damage, which a bicycle helmet can often prevent, could cost our health system a lot more.
More than two decades after they came into effect, it is likely that cyclists — and parents of child cyclists — have accepted that helmet wearing is a normal part of cycling.
Only those who are ideologically opposed to their legal obligation to protect themselves would choose not to wear a helmet.
What’s clear is that our community values preventing road deaths and serious injuries much higher than it did in the past.
Ultimately, the health benefits of increased bicycle exercise have a long way to go before they can offset the increased costs of cyclist death and serious head injury.
Chris Rissel from the University of Sydney kicked off The Conversation’s debate about mandatory bike helmet laws in March, when he said ditching helmets would encourage more people to get on a bike and get to fit. Read his article here
Continue the conversation in the comments field below: Should mandatory helmet laws be maintained to protect cyclists against serious head injury?
References:
Cameron, MH, Vulcan, AP, Finch, CF, and Newstead, SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia – An evaluation. Accident Analysis and Prevention, 1994, 26(3), 325-337.
Wood, T, and Milne, P. Head injuries to pedal cyclists and the promotion of helmet use in Victoria, Australia. Accident Analysis and Prevention, 1988, 20(3), 177-185.
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Comments (27)
Paul Martin
(logged in via email @me.com)
"If helmets protect against brain injury, why not wear them?"
If this is something which you firmly believe then you must insist, given the greater benefit, that helmets should be mandatory for all car occupants too. If not, why insist that ALL bicycle riders, under ALL conditions, must wear them? The reason is that it is a minority and utility cycling (ie. not cycle sport) a minority yet again.
You might want to update your old references too... 1994 & 1988? Good grief.
Will Ross
(Medical Officer at Victorian Infectious Diseases Reference Laboratory)
Excellent point. Helmet wearing is ultimately a security measure; it protects against a harm. All security measures involve tradeoffs, which is why we don't adopt even very effective ones.
For example, bullet-proof vests reduce the risk of being shot and killed. I choose not to wear one, however, because of the low risk, it is expensive, heavy, and makes me look stupid.
Why can't A/Prof Cameron write a piece that honestly addresses the issue of the security tradeoffs rather than thinking the argument is proved when he can establish that a countermeasure reduces a harm?
Sue Abbott
(logged in via email @virtualgypsies.com.au)
Your references are archaic, and have been well & truly refuted.
Standards Australia is an agent for SAI-Global, a company in the business of manufacturing and trading in standards. The amended standard, AS/NZ2063 still has not incorporated a test for an oblique impact for various reasons; ethics, lack of equipment, lack of biomechanical knowledge, funding constraints, time constraints.
Given that Australian academics are still squabbling on this issue, it ought to be a matter that is left to the realm of personal choice. The rest of the world (New Zealand being an unfortunate exception) manages very safely without mandatory helmet laws to the point where they have more cyclists sharing the roads with considerably more motorised vehicles than we have here in Australia.
It's time for us to grow up and acknowledge what the world already knows - bicycle helmet laws are dangerous for our health!
Dan
(logged in via Twitter)
What an extraordinary article! I note the this website promises 'academic rigour'; it is a shame that Mr Cameron seems entirely unable to provide it.
His second sentence, for example, can be refuted with a simple literature search. There are a number of studies that have been done that conclude that the negative health benefits of helmet laws (because people stop riding) outweigh the positive benefits form head injury reduction. One of the most pertinent was conducted by Professor Piet de Jong at…
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Harvey C
Cyclist (logged in via email @gmail.com)
"A serious head injury resulting in permanent brain damage, which a bicycle helmet can often prevent"
That is not true. The cause of serious head injury resulting in permanent brain damage is diffuse axonal injury (DAI). The main cause of DAI is rotational acceleration. Not only helmets cannot protect against rotational acceleration but they can increase it. In other words, helmets can CAUSE permanent brain damage, or make it worse.
Here is a well-researched article that covers helmets effectiveness…
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Harvey C
Cyclist (logged in via email @gmail.com)
It would also be worth checking out the AS/NZ 2063 standard for bicycle helmets, especially what they are tested for. The tests are low speed (19.5km/h), and only straight on. Not all sizes are tested (notably absent are small children’s helmets). There are no oblique test or test for rotational acceleration. Essentially, the most common helmet today (the soft-shell helmet) is a thin layer of polystyrene that crumbles very quickly on impact, and cannot absorb much energy at all. This crumbling…
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Peter Robinson
Agricultural Engineer (logged in via email @nex.net.au)
Back in the late '60s the Danish had a high cyclist road toll. Like anywhere in Australia, Copenhagen was car-clogged.
They were loosing 300 cyclists a year.
What they then did brought the toll down to 19 by last year.
It was not helmet law.
They did it with advanced infrustructure and laws that favour cyclists.
A few years ago the issue of helmets came up.
But, citing the "Australian Effect", they voted 90 to 20 not to have a helmet law.
They could see that it had not worked in Australia.
What happened…
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Gary MacDonald
(logged in via Facebook)
You state that "Valuing the benefits of exercise through cycling is outside my area of expertise". I would argue that writing articles promoting helmet use is also outside your area of expertise. With all of your "statistics" above you seen to have forgotten to substantiate these claims with actual research data. There are numerus study which suggest that the health benefits from cycling (with or without a helmet) outweigh the risks by 20:1 (see Hillman M, Cycling and the promotion of health., PTRC…
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BicycleTim Stredwick
(logged in via Facebook)
If there is a positive health case for compulsory helmet wearing, then there is a greater case for compulsory wearing of helmets in cars. There are far more people killed and injured due to head injuries in car crashes than cycling accidents.
Colin Clarke
(logged in via email @vood.freeserve.co.uk)
It says
"helmet wearing rates more than doubled — from around a third to three quarters — by March 1991"
In 1990 Melbourne surveys had 3121 cyclists with 1006 wearing helmets, by 1991, 2011 cyclists with 1303 wearing them. About 10% extra wore helmets, 297 in number, compared with 1110 fewer cyclists. Injury data suggest a larger reduction in cycling in regional areas of Victoria.
Robinson DL; Head injuries and bicycle helmet laws; Accid Anal Prev, 28, 4: p 463-475, 1996 http://www.cycle-helmets…
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timgummer
(logged in via Twitter)
Helmets are a sign of a failed cycle culture. Like flouro hi-viz [nice idea.. give riders road worker status.. that’ll be a big sell…) they send a very clear and unambiguous message that cycling is unsafe that turns off potential new cycle riders, thereby ensuring less cycle riders on the roads, and a more dangerous environment. As has been pointed out, successful cycle cultures are lidless, and their accident rates are far lower. UK research (bath university.. check it out) has shown that car drivers…
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Etienne de Briquenel
(logged in via Twitter)
You are quite correct in claiming that "cyclists have accepted that helmet wearing is a normal part of cycling". The problem, however, is that we are talking about most established cyclists here; you know, the ones that make up around 1-2% of the population. The huge number of potential cyclists who have been turned off by the enormously exagerrated "dangers" of cycling certainly do not share this view, nor do a considerable number of established cyclists who either do not comply with the law or…
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Alan Todd
(logged in via Facebook)
The debate about bike helmets has been dogged by belief based on little or no evidence. It is disappointing to find that Max Cameron's latest contribution is in this category. Take just the opening sentences:
"The health benefits of more cycling would need to be multiplied countless times before they could offset the loss of life and health harms caused by serious head injury."
"Bicycle helmets have long been recognised as the best protection against head injury."
In 2010 Piet De Jong published…
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Dorothy L Robinson
(logged in via email @gmail.com)
In the first and second years of Victoria’s bicycle helmet law, the numbers of *pedestrians* with concussion fell by 29% and 75%.
Pedestrians weren’t forced to wear helmets. So other factors, e.g. safer roads, probably had a much greater effect than helmet laws. 93 pedestrians were killed in Victoria the year helmet laws were introduced (1990), compared to 159 the previous year. Comparing the 24 months before and after Victoria’s helmet law, pedestrians and cyclists had identical changes in…
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Will Ross
(Medical Officer at Victorian Infectious Diseases Reference Laboratory)
I'm not sure how statements like "Only those who are ideologically opposed to their legal obligation to protect themselves would choose not to wear a helmet." fit in a respectable piece about public health.
Not only is it a logical non sequitur, it is also empirically false. Large numbers of Australians ride bikes in Europe, and when they do, they will tend to conform with the prevailing norm and law. When I ride a bike in Copenhagen, I'm not choosing to ride without a helmet due to some ideological disagreement with you! I suspect, however, that if you *did* wear a helmet, that in itself may be a more ideological act.
Dave Kinkead
(logged in via Facebook)
Wow Max - is this really the standard of logic and analysis we can expect from C-MARC?
It seems from your article that you are confusing two issues: the efficacy of helmet usage with the effectiveness of mandatory helmet laws. I would expect most people, especially those with experience in accident research, would be able to tell the difference between the two but you have proven me wrong.
On the issue of helmet effectiveness, the jury is out. Clearly, there are a number of situations where wearing…
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Peter Teow
(logged in via email @yahoo.com)
Firstly, removal of the Mandatory Helmet law is very, very different from 'ditching bike helmets' - if people who ride bikes, skateboards or even drive their cars, can still choose to wear helmets, just like in the many countries of the world with better cycling safety without MHL.
Secondly, Standards Australia AS/NZ 2063 legislation is another classic enforcement shoved down the throat of the Australian public. A purported $20,000 to test a helmet so that you get a silver sticker for the helmet…
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Bob Bobsson
Mr (logged in via email @hotmail.com)
You make a compelling argument, and are obviously significantly more aware of the studies around this than I. But what about the fact that more people on bikes results in greater awareness of them by motorists? This should result in motorists being more careful around those cyclists than they are now.
If you compare the rates of cycling deaths by the Dutch (who have no mandatory helmet laws and who cycle *much* more frequently) with those of Australians, you'll see that the Dutch cyclists are…
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Frank Krygowski
At this point, joining the chorus of well-stated disagreement with this pro-helmet article may seem redundant. Yet there is one point I'd like to emphasize.
Almost all analyses of the effects of bicycle helmets are founded on an unspoken assumption: that bicycling is an unusually important source of serious head injury, and that therefore some form of protection is obviously necessary.
My study of available data shows this to be a myth.
As an example: John Pucher of Rutgers University has…
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Karl Stade
(logged in via Facebook)
Great comment Frank. I honestly am surprised that there is even such a debate about helmets for cyclists considering that such a debate does not seem to exist for other, higher risk actives such as walking or driving a car. It seems that helmets are an easy target, effectively placing further responsibility on cyclists for their own safety - rather than on motorists to drive slowly, safely and be aware of other road users. We need to stop blaming the victims - instead we should focus on making cycling a common activity like it is in places like Holland and Denmark. More cyclists on the streets/paths travelling at normal speeds, better quality and designed infrastructure, vulnerable road user laws, lower road speeds and reduced travel distances will do far for for the safety of cyclists and pedestrians than a helmet law ever will.
Werner Hammerstingl
(logged in via LinkedIn)
I find the use of percentages without a baseline number a significant hindrance to a full evaluation of the arguments. After all a 50% decrease can describe a change from 2 to 1 or 150 to 75....
Troy Barry
Mechanical Engineer (logged in via email @gmail.com)
Helmet laws could be relaxed without being entirely rescinded. For example, helmet use could be optional on bike paths and on streets where the traffic speed limit does not exceed the suburban speed limit. Selecting the cut-off point would require a closer look at the statistics and an ideological compromise from both sides of the discussion.
Dave Kinkead
(logged in via Facebook)
Troy - in the NT, it is legal to ride on a foot/bike path without a helmet. Interestingly, despite having a per capita road toll 3 times higher than the rest of the country, their cycling fatality rates are identical to southern states. The NT has not suffered for relaxing the laws.
All states have some, rather strange exemptions. Often, unicycles aren't defined as bikes and therefore not covered by the laws. Pedicabs are normally exempted (for paying passengers only - it seems that when money changes hands, people become safer. But not the riders, they always have to wear one).
Finally in QLD, you can get an exemption from your GP. As the skin cancer capital of the world, we have around 2000 deaths annually from skin cancer, but less than 40 from cycling. Given that you can't wear a wide brim hat with a helmet, most GPs are willing to write an exemption on these grounds if you ask.
Peter Robinson
Agricultural Engineer (logged in via email @nex.net.au)
Troy, this is a good approach and I have written many emails and letters to polititians over this very question. Why are there no common-sense exemptions when there are for every other safety intervention? There is an infuriating vacuum where there should be an answer to this question. They WILL NOT ANSWER this question. Instead we have a situation where one is actually breaking the law if one straddles a bike in any public space without a helmet. This is puerile beyond belief in a purported free country.
Justin Wood
(logged in via Facebook)
I have nothing to add other than to endorse the range of comments here pointing out the seriously questionable claims that bicycle helmets actually even represent a safety benefit.
I would challenge Max to respond directly to those points. It is telling that he in no way addressed the specific statements on the lack of protection from serious head injury raised by Chris Rissel in his original article.
Paul Richards
The UCI - Union Cycliste Internationale have adopted helmets for protection.
Their model carries the weight of superior experience, knowledge, and wisdom regarding cycling.
No amount of logical argument, statistics, supposition and dare I say cognitive bias will ever compete with their insurers actuarial data.
Yes, insurers carry a bias, toward reducing risking their profit. Insured riders are killed, injured permanently disabled in and out of competition, but they are insurable. The underwriter…
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Harvey C
Cyclist (logged in via email @gmail.com)
The UCI adoption of helmets wouldn’t have anything to do with the sponsorship income earned from helmet manufacturers?
This authoritative and uncompromising argument is ridiculous, dismissing any form of rational discussion. You could use the same argument to claim that, since racing car drivers wear helmets, every car driver must wear an helmet.