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Canadian doctors call for mandatory cycle helmets for all 'to reduce head injury'

Paper claims those discouraged from cycling by helmet laws may move to alternative sports to keep fit

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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GoingRoundInCycles replied to FluffyKittenofTindalos | 10 years ago
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@FluffyKitten

Good grief! One last attempt and that is it!

We live in a democratic society that is governed by the rule of law. Apart from a matter of conscience, it doesn’t matter why the law exists, whether the reasons for its existence are sound or not, the duty of a good citizen is to obey the law. If you believe the law to be wrong, the correct thing to do is to do your research and then lobby parliament to change the law. Until that time, if you cannot or will not obey the law then you have to accept the consequences of your lawlessness.

There are laws governing what you are compelled to do to operate a contraption on the road. For a driver of a car, he must have a valid licence, insurance, the car must be roadworthy and all passengers have to wear seatbelts. Why they have to wear seatbelts is totally irrelevant! Who they protect is totally irrelevant! If you want to drive a car, you either obey the rules or suffer the consequences.

For a motorcyclist, similar legal requirements exist in terms of licensing, insurance and roadworthiness but instead of seatbelts, motorcyclists are compelled to wear a crash helmet. Why they have to wear crash helmets is totally irrelevant! Who they protect is totally irrelevant! If you want to drive a motorcycle, you either obey the rules or suffer the consequences.

For a cyclist, there are already some legal requirements. You must have working lights front and rear after dark and also reflectors at the rear and on your pedals. You must not cycle on the pavement or on the road under the influence of alcohol or drugs. Why these rules exist, who they protect is totally irrelevant. If you want to ride a bicycle you must obey the rules or suffer the consequences.

Let us imagine that the UK government has just passed a law making it mandatory to wear a cycle helmet at all times when operating a bicycle. Why this new law exists, who it is designed to protect is totally irrelevant. You simply have the choice to obey the law or suffer the consequences.

Now to what I described as ridiculous which is your utterly hysterical claim that such a law would be “an assault on the basic human right of freedom of movement”. How?

Being obliged to wear a hat by a law passed by a democratically elected government is no infringement or encroachment of your human rights. It would just be another rule added to the already long list of rules that govern the operation of road vehicles.

Obey it or don’t, that would be your choice but please, hat wearing is neither a matter of conscience nor a matter of human rights. If you don’t mind, I will save my sympathy for those millions of people around the world for whom a human right to a political life without the threat or murder of torture is still a pipe dream rather than a first world fashion victim who someday might be required by law to wear an ungainly hat on his/her head when cycling.

Quote:

And yet here you are doing everything you can to defend the motorist's right do do as he/she pleases and insisting its everyone else's responsibility to try and minimise the consequences of his/her choices!

I am not sure whether you need Specsavers or reading comprehension lessons but I cannot see any comments in this article published by me or anyone else for that matter that even vaguely corresponds with this claim.

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FluffyKittenofT... replied to GoingRoundInCycles | 10 years ago
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GoingRoundInCycles wrote:

@FluffyKitten

Good grief! One last attempt and that is it!

We live in a democratic society that is governed by the rule of law. Apart from a matter of conscience, it doesn’t matter why the law exists, whether the reasons for its existence are sound or not, the duty of a good citizen is to obey the law. If you believe the law to be wrong, the correct thing to do is to do your research and then lobby parliament to change the law. Until that time, if you cannot or will not obey the law then you have to accept the consequences of your lawlessness.

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!

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FluffyKittenofT... replied to GoingRoundInCycles | 10 years ago
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GoingRoundInCycles wrote:

@FluffyKitten
Why they have to wear seatbelts is totally irrelevant! Who they protect is totally irrelevant! If you want to drive a car, you either obey the rules or suffer the consequences.

_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.

GoingRoundInCycles wrote:

For a motorcyclist, similar legal requirements exist in terms of licensing, insurance and roadworthiness but instead of seatbelts, motorcyclists are compelled to wear a crash helmet. Why they have to wear crash helmets is totally irrelevant! Who they protect is totally irrelevant! If you want to drive a motorcycle, you either obey the rules or suffer the consequences.#

Again - you are just stringing together assertions and then demanding I accept them. If you have no actual argument why are you bothering?

GoingRoundInCycles wrote:

For a cyclist, there are already some legal requirements. You must have working lights front and rear after dark and also reflectors at the rear and on your pedals. You must not cycle on the pavement or on the road under the influence of alcohol or drugs. Why these rules exist, who they protect is totally irrelevant. If you want to ride a bicycle you must obey the rules or suffer the consequences.

Still more imperious assertions with no supporting argument. Yawn. Plus a bit of might-is-right at the end there!

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FluffyKittenofT... replied to GoingRoundInCycles | 10 years ago
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GoingRoundInCycles wrote:

Obey it or don’t, that would be your choice but please, hat wearing is neither a matter of conscience nor a matter of human rights. If you don’t mind, I will save my sympathy for those millions of people around the world for whom a human right to a political life without the threat or murder of torture is still a pipe dream rather than a first world fashion victim who someday might be required by law to wear an ungainly hat on his/her head when cycling.

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.

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FluffyKittenofT... replied to GoingRoundInCycles | 10 years ago
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GoingRoundInCycles wrote:
FluffyKittenofTindalos wrote:

Mandatory helmet laws are an assault on the basic human right of freedom of movement.

Don't be ridiculous. No one is trying to ban you from running or walking, which let us not forget, are the only natural method of transportation that have zero impact on the environment.

Actually the constant pandering to cars does indeed make it harder and harder to walk anywhere. Which is why children are now ferried to school in 4x4s.

Restrictions on cyclists are just the start - we already have restrictions on pedestrians, in the form of roadside fences and parking bays painted on pavements. Anything rather than actually tackle the problem at source.

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Paul J replied to GoingRoundInCycles | 10 years ago
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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?

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GoingRoundInCycles replied to Paul J | 10 years ago
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Paul J wrote:

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?

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.

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Paul J replied to GoingRoundInCycles | 10 years ago
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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.

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congokid replied to GoingRoundInCycles | 10 years ago
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GoingRoundInCycles wrote:

I believe that a substantial impact to the NHS of accidents involving cyclists not wearing helmets needs to be conclusively demonstrated before compulsion can be contemplated.

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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FluffyKittenofT... | 10 years ago
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First instal mandatory speed-limiters in all cars, then get back to me.

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Paul J | 10 years ago
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Mandatory helmet laws, be they for children and/or adults, achieve nothing in terms of preventing population wide head injuries. While at the same time they do *terrible* damage to cycling as an ordinary, everyday, normal activity - cycling rates decrease. E.g., see this overview of the data and studies on the Alberta helmet law:

http://cyclehelmets.org/1250.html

And there are similar trends in Australia.

If your solution to cycling safety is mandatory helmets laws (for any age group), then you're doing it wrong. You're either quite badly informed, or killing cycling is actually your *goal*.

Helmet laws: Bad for cycling safety, bad for cycling.

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sm | 10 years ago
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Ah, tiresome. Man finds one side of a two-sided argument and has an opinion.

Paediatrician wants adults to wear helmets. Just send the kids out in bubblewrap and leave the adults be.

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Ush | 10 years ago
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When you say that six provinces have no legislation at all on bike helmets (including Québec) this excludes municipal by-laws.

To the shame of Québec , and despite the good educational lobbying carried out by Vélo-Québec, the town of Sherbrooke has a mandatory under-18 helmet law, complete with fear-mongering posters around the town showing the helmeted top of a head sliced off and the contents (cartoons of memories, e,g. the Eiffel tower, sports) leaking out. This retrograde initiative seems to largely have been the work of a local pediatrician.

What's interesting about the Canadian Pediatric Society paper above is that they acknowledge that they intend to compel adults to wear helmets as a way to persuade children that a huge lump of beer cooler on your head is normal.

What's also interesting is that they've retreated slightly from their citing of Thompson, Rivara & Thompson's 85% claim and now are speaking of "head injuries" while leaving the impression that they're talking about serious brain injuries. Sneaky.

And all this time they drive around in cars.

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IanW1968 | 10 years ago
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It's the weekly helmet / hi viz nonsense.. woop woop!

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