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Do bike helmets save lives?

A study published in the British Medical Journal has revealed that wearing bike helmets, or not wearing them, is Not “associated with reduced hospitalisation,” so do bike helmets save lives?

SOUNDS LIKE A NO-BRAINER, but a new study by Canadian health experts suggests bike helmet legislation has little effect on cyclist safety. But before we rush to discard our styrofoam and plastic headwear, as usual it’s worth questioning the data.

The Canadian study was published in The British Medical Journal, one of the most respected medical journals in the world. It analysed data on bike-related hospital admissions across 11 jurisdictions with differing bike helmet laws and concluded that helmet laws were “not associated with reduced hospitalisation rates for brain, head, scalp, skull or face injuries”.

One of the ongoing arguments is that by removing “impediments to cycling” (such as the need to wear a helmet or ride on busy public roads) more people would be encouraged to take up cycling and, statistically at least, make cycling safer.

A 2012 study into bike sharing schemes in Melbourne and Brisbane discovered that they were getting only five to 10 percent of the anticipated usage and one of the main disincentives was the mandatory wearing of bike helmets.

Experts will quickly leap in here and point to the decline in injuries sustained by cyclists since mandatory helmets were legislated, but bicycle injuries across Australia were already declining and had been since the 1980s. By the end of the 80s, about one third of cyclists were wearing helmets of their own volition. In WA, the number of regular cyclists almost doubled between 1982 and 1989 and during the same period, hospital admissions and reported deaths fell (deaths by 48 percent and serious injuries by 33 percent). After the helmet legislation was enacted in 1992, hospital admissions of injured cyclists have risen by 20 to 30 percent in proportion to the number of cyclists on the road, reaching new records in 1997, 1998, 1999 and 2000. Total cyclist head injury figures were higher in 1995 and 1996 than during any year before the law was introduced (except for 1988) and the proportion of cyclist upper body injuries almost doubled between 1988 and 2000.

A survey of Sydney residents found that 23 percent said they’d ride more if they didn’t have to wear a helmet (although this is deceptive since saying you’ll ride more and actually riding more are quite different things). However, if even some of these people did ride more, it would potentially double or triple cycling participation.

It certainly appears that bike helmet legislation was rushed through without thoroughly investigating the implications or looking at alternatives. Doctors in particular developed the belief that helmets would be essential in reducing cycling injuries and lobbied for compulsory helmets without conducting trials to assess their effectiveness. Australia is one of only two countries in the world with national, all-age mandatory helmet laws (the other is New Zealand). Israel experimented with national legislation but repealed the law in 2011 following a four year trial.

Real safety, it has been claimed, will come about by reducing the number of collisions and making roads safer, rather than demanding riders wear more personal protective gear. Adding to the problem, government research warned that so-called soft-shell helmets can cause brain injury and recommended a stronger helmet standard, a recommendation that was ignored.

The Australian Cyclists Party is calling for a national enquiry into the legislation with the ultimate aim of new laws that “would allow adult cyclists the choice of wearing a helmet or not”. Of course, they are also calling for an increase in bike infrastructure mainly through the addition of dedicated bike lanes. The ACP, like many opponents of compulsory wearing of helmets, claims that they don’t improve injury rates, they discourage regular recreational exercise and are an unnecessary and unjust intrusion into individual freedom.

In the most extensive study of the real-world effects of mandatory helmet laws, Australian researcher Dr Dorothy Robinson of the University of New England found enforced helmet laws discourage cycling but produce no obvious response in the percentage of head injuries, despite 20 years and masses of research. In fact, the cycling serious injury rate in Australia is 22 times higher than in the Netherlands.

And as always, the squeaky wheel is getting the grease. The City of Melbourne is spending $5 million on a bicycle action plan to turn Melbourne into a “cycling city”, and other Australian cities are following suit.

So why does the argument about bicycle helmets continue?

While there is evidence that wearing a helmet will provide some protection from a knock to the head, the benefit is small. Severe head injuries amongst cyclists are not particularly common, and helmets do not prevent all or even a high proportion of those that might occur, but rather provide some marginal decrease in the likelihood of injury.

It would seem that protective benefits of wearing a helmet would be evident across the whole population and experts are still debating why this isn’t so. Perhaps one reason is that helmet laws bring about some unwanted side effects.

It’s well known that making somebody safer alters their behaviour and perception of risk (I call it the “Volvo syndrome”, but the official term is “risk compensation”). Some cyclists will take more risks when wearing a helmet than they would if not. A Norwegian study found that cyclists who wear helmets routinely perceive reduced risk and compensate by cycling faster – chances of a head injury increase threefold above 20km/h and fivefold at speeds greater than 30km/h. Other studies show that some motorists drive closer to helmeted cyclists than those not wearing helmets.

Compulsory helmets have discouraged cycling. The reduced number of cyclists on the road statistically increases the risk to those who continue to ride. And according to the Heart Foundation, lack of physical activity is responsible for 16,000 premature deaths each year in Australia, compared to 40-odd cycling fatalities.

Compulsory helmet wearing has led to the failure of Australia’s two public bike hire schemes. Let’s face it, the convenience of jumping on a bike and then leaving it at a designated drop-off point is considerably reduced if you have to carry your helmet with you (or, worse, wear someone else’s). Similar schemes in cities where helmet wearing is not compulsory (Paris, London, Montreal, Dublin and Washington DC) have been hugely successful.

A 1987 study by the Federal Office of Road Safety highlighted some serious deficiencies with bicycle helmets. “The substantial elastic deformation of the child head than can occur during impact can result in quite extensive diffuse brain damage. It is quite apparent that the liner material in children’s bicycle helmets is far too stiff” (because the liner material is designed to protect adult heads). Bicycle helmets were also found to increase rotational acceleration by 30 percent more than was found in similar tests using full face polymer motorcycle helmets, apparently as a result of insufficient shell stiffness. A New Zealand doctor reported “cycle helmets were turning what would have been focal head injuries, perhaps with an associated skull fracture, into much more debilitating global head injuries”. The study also found “a high proportion of impacts were to the lower facial and side of face areas and it is imperative that the temporal area be more fully protected than it is by current bicycle helmet designs”.

So it is obvious that not all the problems are necessarily a result of compulsory helmets, but because the design and construction of current helmets is insufficient. Even 28 years later, these deficiencies in bicycle helmet design have not been adequately addressed.

Soft shell helmets tend to disintegrate on impact, absorbing little energy. People see the crumbling and think this is what has saved their life, but if what’s left of the Styrofoam isn’t compressed, it has done little to protect the wearer. In one notable court case, three neurosurgeons refused to state that a rider would be safer wearing a helmet than not when the accident involved simply falling from a bicycle onto a flat surface with minimal forward momentum.

Let’s discuss cycle helmets rationally and with factual data. Then a decision can be made as to whether compulsory helmet laws should be repealed.


Paul Murrell

Paul Murrell

Paul’s mother knew he was a car nut when, aged three, he could identify oncoming cars from their engine note alone. By 10, he had decided what his first car would be and begun negotiations with a bank to arrange finance, the first of many expensive automotive mistakes. These days, he is happy to drive other people’s cars (on the road, off the road or on the track) and write up what’s good about them and what isn’t.