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news
White cycle helmetCanadian doctors call for mandatory cycle helmets for all 'to reduce head injury'
Paediatricians in Canada are putting pressure on the government to legislate for mandatory cycle helmets, saying that forcing adults to wear them could protect children who copy their behaviour.
Currently only currently only four of thirteen Canadian provinces and territories have full helmet legislation, but the Canadian Paediatric Society is calling for them to be made mandatory for all ages.
In a paper entitled Bicycle helmet use in Canada: The need for legislation to reduce the risk of head injury, the CPS argues:
Bicycling is a popular activity and a healthy, environmentally friendly form of transportation. However, it is also a leading cause of sport and recreational injury in children and adolescents. Head injuries are among the most severe injuries sustained while bicycling, justifying the implementation of bicycle helmet legislation by many provinces. There is evidence that bicycle helmet legislation increases helmet use and reduces head injury risk. Evidence for unintended consequences of helmet legislation, such as reduced bicycling and greater risk-taking, is weak and conflicting. Both research evidence to date and recognition of the substantial impact of traumatic brain injuries support the recommendation for all-ages bicycle helmet legislation.
"Bicycle helmets reduce the risk of head and brain injuries significantly and studies show that legislation increases the use of helmets," said Dr. Brent Hagel, statement co-author and member of the CPS Injury Prevention Committee.
"Everyone is at risk for head injury, regardless of age group.
"Children see adults and often adopt similar behaviours, so if we can get helmets on adults then children and adolescents will be more likely to wear them too."
Six provinces and territories currently have no legislation at all on bike helmets:
- Saskatchewan
- Quebec
- Newfoundland and Labrador
- Yukon
- Northwest Territories
- Nunavut
-
Three provinces have bike helmet legislation that only applies to children:
- Alberta
- Ontario
- Manitoba
Four provinces meet CPS recommendations for all ages bike helmet legislation:
- British Columbia
- New Brunswick
- Nova Scotia
- Prince Edward Island
The report found that in those places that had legislated, helmet use had gone up.
“Systematic reviews have... demonstrated that legislation increases the use of helmets in children and youth.
“One review showed that bicycle helmet use increased postlegislation, with more than one-half of the included studies demonstrating an increase of at least 30%.
“One Ontario study noted a 20% increase in helmet use among children five to 14 years of age two years after passage of helmet legislation covering riders younger than 18 years of age, demonstrating larger increases in low- and middle-income areas.”
Despite evidence from countries including Australia, showing that helmet legislation reduces the number of people riding bikes, Dr Hagel insists that this is not necessarily proven.
“We definitely don’t want to stop people from cycling, we want to increase cycling,” he said.
“If there’s more education that needs to be done and perhaps more environmental changes to increase cycling, I think that’s where we need to look next rather than target legislation for mixed evidence.”
The report added: “While some individuals may avoid bicycling due to helmet legislation, it would need to be shown that they do not replace it with other physical activities for helmet legislation to be considered to have a negative effect on overall health.”
The report said: “There is... ample research indicating that legislation reduces risk of bicycle-related head injury. Evidence of the potential negative effects of bicycle helmet legislation, such as reduced bicycling, is mixed, and a direct cause-and-effect relationship has not been demonstrated.
“Head injuries rank among the most severe injuries in bicyclists, representing 20% to 40% of all bicycling injuries.
“Overall death rates in Canada are estimated to be 0.27 per 100,000 population.”
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74 comments
To your last point (YOU KNOW, THAT ONE), airbags achieve the same effect as helmets, by reducing deceleration and spreading the load.
You might like to be a bit more up to date when you shout (assuming there'll be a next time).
Or better yet, ride out in the middle of the lane as you approach side roads so you can see drivers pulling out earlier (and they may see you), cover the brake levers so you are ready to stop if the driver doesn't, and keep a look out as you ride along.
All of this could reduce the likelihood of being t-boned.
My concern is that a substantial number of cyclists tend to put too much faith in personal protective equipment such as helmets, and indeed hi-viz, rather than using their own skills as a cyclist. I used to be a cycle instructor and I recall a comment a more experienced instructor made on the subject. Minimise all other risks first of all by your actions and then if you still feel that some risks remain then resort to PPE.
So there we are:
Accident prevention is better than dressing up in preperation for an incident the chance of which happening is less than other risks we find acceptable.
In fact preparing for this risk may actually increase the likelyhood of it happening.
So if this is a "cycling" problem you really want to fix, campaign for reprioritising outside spaces for people over vehicles.
If its a "head injury" problem you feel strongly about perhaps start with car drivers, footballers and drunks who constitute the majority of injuries.
We disagree fundamentally so there's not much else to say.
Democracy is never perfect. We live in a society full of imbalances of political, social, and economic power. I don't regard "democracy" as a magic word that over-rides basic rights.
You are also going off on a complete tangent - what law are you talking about? Your hypothetical helmet one? You are now accusing me of flouting a non-existent law? Bizarre.
You believe in the tyranny of the majority (actually 'majority as weighted by economic power'). I don't. Not much more to say, really.
Btw that "apart from a matter of conscience" rather undermines the entirety of your point! That's the whole point - these things _are_ a matter of conscience!
There is no strong evidence to suggest helmet laws help child cyclist safety. However, there definitely is strong evidence that such laws *discourage* children from cycling. Young teenage girls being one particular demographic that it affects badly.
Given the lack of evidence (which you acknowledge for adults) for injury reduction, the clear evidence for the damage it would do to cycling rates, and given children *already have* adults who are meant to help make decisions for them, why, why on earth would you choose to impose on them with a helmet law?
_You_ say it's irrelevant. You provide no supporting argument, so you will have to forgive me if I don't take your attempt at 'proof by assertion' seriously.
Again - you are just stringing together assertions and then demanding I accept them. If you have no actual argument why are you bothering?
Still more imperious assertions with no supporting argument. Yawn. Plus a bit of might-is-right at the end there!
The problem with the bicycle helmet debate in a nutshell is that those that propose mandatory helmets don't seem to listen to or understand the arguments of those that are against the mandatory wearing of helmets.
There are no health benefits to driving a car, or riding a motorcycle (indeed, quite the reverse - there are considerable risks) to offset against any reduction in car or motorcycle use.
To compare seatbelt or helmet laws for motor vehicles with helmet laws for cycling is to compare apples with oranges, and to miss the big picture:
1. Cycling is, population wide, an overwhelmingly beneficial activity for public health, with or without helmets.
2. Helmet laws demonstrably *discourage* people from cycling.
3. The benefits of helmet laws on injury are somewhere between low and negligible.
Thus helmet laws *damage* public health. Thousands of hearts damaged, to save one or two heads.
The problem with comparisons to seatbelt and motorbike helmet laws, is that both of those items are designed and tested to protect you in higher speed motor vehicle collisions. Bicycle helmets are not. They're being proposed as a compulsory measure to protect you in an RTA, while there is not one helmet manufacturer who will claim that their product is designed to do that.
If cycle helmets are to made compulsory, they will almost certainly have to offer better protection to be considered fit for purpose. If cycle helmets become a compulsory safety measure for public road use, then both the manufacturers of the helmets, and the standards to which they have to conform will be subject to potential legal challenges, so they will need to make sure they measure up. This happened when motorbike helmets were made compulsory. New standards were set to define what constituted a legal safety level, and many of the helmets on sale at the time became illegal overnight. To pass the standards, motorcycle helmets had to become stronger, and heavier.
There's a good chance this will happen if bicycle helmets are made compulsory, because sooner or later there is going to be a court case. You legally compelled my father / son / daughter to wear a cycle helmet that did naff all to protect them from brain injuries when they were hit at 40mph. Who do I sue first? I'm a little surprised it hasn't happened already in one of the countries that has already adopted compulsion, and the fact that no one is addressing the issue of what level of protection that cycle helmets actually offer when mandating them just shows how little real thought is being put into the campaign to make them law. But as it spreads, and if it succeeds, I think it'll just be a matter of time. And at some point, cycle helmets will have to be stronger, heavier and less comfortable if they are to be considered suitable for road use, and that will deter people from getting on their bikes.
Then there's the political of effect of passing a mandatory helmet law. Forcing riders to wear helmets is easy. It's about the quickest, easiest, cheapest and most visible thing that any government can do to address cycle safety issues. Unfortunately, it's also way, way down the list of things that are going to make any real difference. Now, call me cynical if you like, but it seems that pretty much any government will take "quick, cheap, easy, visible and superficial" over "complicated, expensive but actually effective" (like providing better infrastructure, or changing driver attitudes and behaviour) every single time if they can get away with it. So what we have to look forward to if helmet use is made compulsory, is a day when we ask our politicians, "What are you going to do to make the roads safer for cyclists?", and their answer will be, "We've made it compulsory for them to wear helmets".
The helmet law is a distraction, it's a red herring. While it remains the focus of the cycle safety debate, it makes the chances of real effective change even more remote.
@GoingRoundInCycles
In general you seem to regard issues of right-or-wrong as 'irrelevant', and think that all that matters is power. So in your view its 'right' if someone of sufficient power tells you to do something? OK, I get where you are coming from. But we differ on that.
And you really don't argue in a coherent fashion. I realise you have gone off on a hypothetical tangent about the merits of obeying a helmet law should one be introduced. That's a different argument (I'd almost certainly just give up cycling, but I certainly would respect those who chose to openly defy such a bad law, just as I respected those who disobeyed racial segregation laws in the US civil rights era).
What we are actually arguing about is whether such a law is morally justifiable, not how to respond to it if it existed.
From now on I'm going to stick to one simple argument:
Pedestrians are in as much danger of head injuries per mile as cyclists, there are far more pedestrians so it makes sense to enforce mandatory helmets upon all pedestrians first.
So you don't seem to think that adults and children alike being killed and maimed by cars on a regular basis, or having their freedom of movement eroded and suffering from obesity-related health problems (including premature death), or the disastrous effects of CO2-driven global warming on the world's poor, or the propping up of morally-bankrupt regimes in the middle-east due in large part to our demand for fuel for cars, are 'serious issues' or related to basic human rights?
These are all just trivial things compared to the 'real issues'?
Again, we just differ on that, sorry.
Absolutely, in the last week alone, I've felt that riding further out caused a driver (on a side road) to see me and wait when they otherwise wouldn't of, because of parked vehicles obscuring the view.
A good cycle lane here:
http://goo.gl/maps/IFux9
And still many cyclists ride left of the cycle lane in the door zone... A lot of cyclists need educating.
Watch this video and count the helmets:
www.youtube.com/watch?v=cWf5fbSUNAg
The real cost of helmet legislation is an opportunity cost. Theres only a finite amount of time and money available. Goverment, police and law courts would save far more lives putting their time into reducing the liklihood of being run over people in the first place, rather than ensuring those who are hit have a helmet on.
The question isn't "Would a helmet law save lives?", its "Could we save more lives by doing something else with the time & money it would take to implement and enforce a helmet law?"
There was a study I saw [Im trying to re-find it] about head injuries among pedestrians, cyclists and car passengers and cyclists actually come out having the slightly lower number of head injuries per km of the three.
If medical practitioners wish to make calls for mandatory helmets then they should base their calls on evidence and expand it to all people, all the time, in every environment.
Have you considered that the statistics in the study you reference don't include a large number of cyclists who DIDN'T have head injuries, because they were wearing a helmet when they had their accident? It would seem that most data is based on information from A&E departments etc, so it only includes those cases where a head injury occured. Hence, arguments in favour of helmets tend to be more anecdotal, as in "I fell off my bike last week and cracked my helmet, but my head was fine".
Most developed countries (including GB) publish annual figures for the amount of car, lorry, bicycle etc. miles ridden in the year. These have various inaccuracies no doubt, but as long as the method of collecting remains the same the figures will certainly capture trends.
Figures for cyclist head injuries treated in hospital are generally collected too. When helmets are made mandatory in a country the proportion of cyclists wearing them goes up suddenly, often to above 90% from 30 or 40%.
If the number of cyclists treated goes down (or up) but the number of miles or kilometres ridden remains the same when the rate of helmet wearing doubles or trebles we can deduce that helmets may have saved injuries and lives (or cost them).
In Oz, NZ and other mandatory helmet states the figures show no reduction in rates of injuries or deaths to cyclists. The number of casualties declined in proportion to the decline in miles cycled. This failure of helmets to reduce casualty rates has happened in all states where foam hats are mandatory. In states where helmets are not obligatory the figures seem to show the same, though because the increase in wearing is not so sudden it is more difficult to detect any effect or lack of effect.
As a control we can look at say pedestrian casualty rates and see whether they have moved in the same way as cyclists', in order to allow for other changes in the road environment.
The anecdotal evidence you mention is not very useful, but is often used by those in favour of compulsory helmets.
There is a large amount of information and discussion at
http://www.cyclehelmets.org/
This video totally makes the point that many are trying to make: it's not about helmets, it's about making a road culture that promotes, expects, and above all respects people on bicycles. A helmet law would not help this cultural shift at all, and in my opinion would actually make it worse.
Like many others here I frequently choose to wear a helmet, but usually don't when I'm 'utility cycling' (normal clothes, short journeys of a few miles). As a society it is this kind of cycling that needs to increase. The lycra and strava fuelled obsessives of this site are not relevant, it's your neighbours, your parents and grandparents, and your colleagues at work who don't cycle in the UK because there is such a car-bias that would be helped by a Danish/Dutch cycling attitude and structure. I've cycled in both countries, and seen that rate of helmet use is almost non-existent in both, and the odd person in HiViz is looked upon as though they're an alien. Yet they seem happy and healthy and the streets aren't littered with bodies.
The solution, is to make it easier to bike to the shops, station, work, school etc, helmets are at best a distraction from this.
Excellent comment, 3cylinder.
There is a very strong association between helmet laws (and high rates of wearing and of pro helmet propaganda), low levels of cycling and high rates of casualties for cyclists.
USA, Canada, Australia, New Zealand, South Africa have dangerous roads, few cyclists and high helmet wearing rates (and/or laws).
Denmark and Netherlands have low casualty rates, low helmet rates and many cyclists.
We are somewhere between. Why on earth do we want to copy the foam hat wearers? They are more dangerous for cyclists even though they make us wear helmets.
I think helmets are an alibi or substitute for measures which might actually make the roads safer for cyclists.
Dr. Hagel suggests that cycling might be replaced as healthy exercise by other sports.
The beauty of transport cycling is that it keeps you fit as a byproduct of getting around.
I can't see anyone swimming to school, not many of us could row to work, working out in the gym does not get you to the shops.
Really? Is there evidence for this? We are not compelled to wear helmets yet the majority of cyclists I see during my rides around the Cheshire lanes wear them.
My theory is that it's because people like to emulate their heroes and as long as Cav, Wiggo etc wear helmets so will us lesser road cyclists.
I used to play cricket and retired about 30 years ago before batting helmets came in. When I watch my old club now every batter wears a helmet (and arm guards and chest protectors). Why? In village cricket there's very little chance of being hit on the head as the bowlers are not fast or strong enough to produce the quick steep bounce that professionals achieve, so it must be emulation of the star players they see on TV.
It's not just emulating our heroes. Cyclists both old hands and new comers are under huge peer pressure to adopt the wearing of helmets and hi viz because of the 'perceived risk' on the roads. It comes from chain stores with the you will need this to friends and family saying I really wish you would wear one.
I have lived in Nova Scotia, one of the Canadian provinces that has complusory helmet laws and it has (or had - I lived there 14 years ago) a very different cycle culture to here in the UK and I don't know if the results of reduced injuries would be replicated here.
I moved to Halifax (the provincial capital) and bought my bike from Cyclesmith on Quinpool and I was told firmly that I needed a helmet but I was surprised when I asked for some lights and they said - "oh you don't need those - it's not a legal requirement"
Cycling was very much a leisure pursuit. I and some of my colleagues (from the Netherlands) used bicycles as utility transport and we were seen as a bit odd, though treated with respect. I once asked at a sailing club I cycled too ( I crewed on a yacht) if there was somewhere I could leave my bike and was told "people don't normally cycle" and a couple of drivers drove beside me and asked how easy it was to cycle round Halifax, they seemed genuinely surprised somebody would cycle just to get from one place to another.
Gavin
There isn't a lack of evidence, the evidence is inconclusive. I would rather err on the side of caution where children are concerned because (in general) children being less experienced than adults are not as good at assessing risk and more likely to have accidents.
The law does take decisions out of parents hands in matters that could have a long term impact on a child's future. A child cannot have a permanent tattoo, even if his/her (highly irresponsible) parent consent, until he/she is 18 years old.
It strikes me that the consequences of getting a tattoo when you are immature are not so difficult to reverse compared to trying to reverse the kind of permanent brain injury that can occur when a still immature teenage skull meets a cold unforgiving kerb at high speed.
So yes, I would err on the side of caution where kids are concerned and take the matter out of the hands of parents on this issue.
+1
Now can we just move on? It gets boring reading the same old comments regarding cycle helmets.
Well don't read them then. But don't try to censor others.
The consequences of getting a tattoo are fairly clear.
Inconclusive evidence for the efficacy of helmets in the real world IS a lack of conclusive evidence. On the other hand, we have *clear* evidence, from several jurisdictions, that the laws you advocate significantly depress cycling rates. Further, decreasing the rates of cycling would go *against* stated government public health policy goals for active transport (not that they're really doing much otherwise to try achieve those goals).
Introducing laws because some people *feel* it is prudent, despite a lack of evidence for that view and in the face of clear evidence of harms, is not good for society.
I'm not trying to censor anyone. But the comments in this thread are going round and round and round in circles. And these are the same old circles we've seen in every other thread debating helmet use. There comes a point when you have to look back at all the comments in a thread and admit that the discussion has reached the point that it can't move on any further. Those in favour of wearing bits of plastic on their heads won't back down and those against won't back down either. It is pointless to continue.
You may not agree with some of the other news items or forum topics attracting comments right now, but at least they're taking discussions in a different direction for once. Vasectomies and cycling - well that hasn't been talked about here before that I remember. Is Jon Snow right or not? Also something that hasn't been looked into much, and the same is true as to whether or not a piece about an armed robber escaping by bike is or isn't a cycling story, or the discussion over the piece by Lucy Kellaway. But helmets? ZZZZZZZZZZZZ.
Carry on if you want. But it won't get you any further ahead. And in a few weeks, we'll have another news item kicking off another helmet debate and then pretty much the same string of comments. And then a few weeks after that...
You believe wrong, then.
In spite of any potential risks from head injury, cycling has a net health benefit for the individual concerned, in terms of longer life and general well-being, and also for the wider community. So the costs of treating head injuries resulting from cycling are more than compensated for by the overall health benefits that cycling brings.
As an aside, consider the injuries incurred by victims of motor collisions, or those who play contact sports - are you happy to underwrite those costs? They are just as unnecessary and just as avoidable. Head injuries from cycling are a drop in the ocean by comparison.
Also, in any debate on protecting people on bikes from head injury, it needs to be remembered that bike helmets are the least effective safety measure and should not be held up as the answer to all the questions about cycling safety.
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