Don’t be fooled, keeping bike helmets is best for health

If helmets protect against brain injury, why not wear them?

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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