09 Sep Bicycle Helmet
Recent research on bicycle helmets and concerns about how public bicycle hire schemes will function in the context of compulsory helmet wearing laws have drawn media attention. This monograph presents the results of research commissioned by the Queensland Department of Transport and Main Roads to review the national and international literature regarding the health outcomes of cycling and bicycle helmets and examine crash and hospital data. It also includes critical examinations of the methodology used by Voukelatos and Rissel (2010), and estimates the likely effects of possible segmented approaches to bicycle helmet wearing legislation.
The research concludes that current bicycle helmet wearing rates are halving the number of head injuries experienced by Queensland cyclists. Helmet wearing legislation discouraged people from cycling when it was first introduced but there is little evidence that it continues to do so. Cycling has significant health benefits and should be encouraged in ways that reduce the risk of the most serious injuries. Infrastructure and speed management approaches to improving the safety of cycling should be undertaken as part of a Safe System approach, but protection of the individual by simple and cost- effective methods such as bicycle helmets should also be part of an overall package of measures.
Cycling and health outcomes
The effects of bicycle riding on health can be positive or negative and can be divided into those which are direct to the individual and indirect effects on society as a whole. Elvik (2000) notes that the net effect on health of walking and cycling to the individual is the outcome of three impacts: (i) exposure to the risk of road crashes, (ii) exposure to air pollution from walking or cycling close to motor vehicles, and (iii) walking and cycling as a form of physical exercise. Indirect benefits may accrue to society if increased cycling results in less car use and therefore reductions in air pollution.
Approximately 70% of Australians undertake insufficient weekly levels of physical activity which is associated with a number of chronic health conditions. A 10km bicycle commute to work twice a day has been shown to improve fitness and HDL cholesterol levels. The annual health benefit of active travel by bicycle has been estimated at approximately $3,500 for each new person, and half that value for continuing commuters (Genter et al 2008).
A large number of studies have sought to examine the relationship between physical inactivity and increased mortality and morbidity. Some studies have focussed on cycling, while others have included a range of different types of physical activities. The research has generally found that cycling (and other forms of physical activity) are associated with lower premature mortality, cardiovascular disease, cancer (all, colon, breast and lung), Type 2 diabetes, and depression. However, there are many factors that affect both health and the likelihood of cycling, making unambiguous links between cycling and better health outcomes difficult.
A review of the most scientifically rigorous research concluded that bicycle helmets that meet national standards protect against head, brain, and facial injuries. Helmet wearing was associated with a 69% reduction in the likelihood of head or brain injury and a 74% reduction in the likelihood of severe brain injury. The benefit was the same whether a motor vehicle was involved in the crash or not. Helmet wearing reduced the likelihood of injury to the upper and mid-face by 65%.
In Australia, bicycle helmet wearing laws are universal in approach, applying to bicycle riders and pillions of all ages who are riding on roads and road-related areas (except in Northern Territory where they apply only on roads). Road-related areas include most riding locations. Bicycle helmet wearing laws have been introduced in many other jurisdictions in North America and Europe but most commonly apply only to children (or apply to certain riding areas only in a small number of countries).
Compulsory helmet laws have been criticised by various organisations (e.g. the British Medical Association) and individuals. Many of these critics acknowledge the injury reductions associated with helmet wearing but consider that these are outweighed by detrimental health and safety impacts associated with reductions in cycling participation. Others have argued that helmets encourage risky riding or that they distract attention from other safety measures such as improvements to infrastructure and reductions in motor vehicle speeds.
The introduction of bicycle helmet wearing legislation has led to increases in wearing rates in jurisdictions where the legislation is universal (with lower rates but still increased for teenagers) and where it applies to children only.
Australian and international research has demonstrated that introduction of bicycle helmet legislation was followed by a reduction in the number and severity of head injuries to cyclists. New Zealand research shows that the legislation has good cost-effectiveness. In support of this conclusion, changes to US motorcycle helmet laws have shown that head injury (and overall fatality and injury) rates have increased when universal laws were repealed and returned to earlier levels when laws were reinstated.
The ability to assess the effects of bicycle helmet laws on cycling participation rates is constrained by the lack of long-term participation data that covers all types of riding. It is also difficult to predict what current cycling participation levels might have been under different scenarios.
Limited work has been conducted in Australia specifically to evaluate the effect of helmet legislation on cycling participation. In Melbourne adult cyclist numbers doubled after the helmet legislation was introduced but there were fewer child cyclists, particularly teenagers. Data from South East Queensland suggests that the number of journeys to work by bicycle fell after the introduction of helmet legislation but now exceeds pre-legislation trip numbers. However, this excludes the number of trips taken by for purposes other than commuting (recreation, social, health and fitness, training etc.) which are likely to outnumber commuting trips.
Research studies, bicycle counts, sales data and anecdotal evidence suggest that cycling is increasing in popularity. There is evidence that the number of commuter cyclists has increased in Melbourne since 2006, and that the total number of cyclists travelling on bicycle paths in Perth increased between 2008 and 2010.
The WAVE surveys undertaken in Queensland provide little reliable information on the extent to which compulsory helmet wearing is a disincentive to cycling because of the very small number asked this question and the variations in how the question has been asked over time. Even among the small sample of respondents, compulsory helmet wearing was never provided as an unprompted
response and it was the sixth or tenth most common response when prompted. Other Australian surveys have also reported that compulsory helmet wearing ranks very low among a long list of reasons for not riding a bicycle.
There is mixed evidence regarding the effect of mandatory helmet use for children on cycling participation in international studies. Research from locations where helmet wearing is not compulsory has identified many other factors as barriers to cycling including weather, distance, perceived levels of safety and other psychological factors.