The case against bicycle helmet advocacy: a quick guide

October 28, 2011 at 08:34 · Filed under Cycling ·Tagged advocacy, cycling, harmful, helmet, injury, risk compensation, safety

Bicycle helmets are tested with vertical drops from a maximum height of about 3m onto flat surfaces (BS/EN 1078:1997). In such testing, helmets definitely help. However, the scientific evidence on helmets & population wide injury rates is far from clear that helmets actually are beneficial.

While amongst cyclists who suffer injury, helmets of themselves do reduce head injuries significantly, they also increase neck and facial injuries, so that there appears to be negligible benefit overall (Accident Analysis & Prevention: … meta-analysis of bicycle helmet efficacy). Study of bicycle injury rates in Australia around the time of introduction of mandatory helmet laws suggests that, though there is a noticeable dip in injury rates around the introduction of the law itself (not necessarily attributable to the helmet itself in my opinion) that injury rates then started increasing again, to the point rates were nearly the same at the end of the study period as before the helmet law, and trending to surpass it! (My Blog: study-shows-australian-cyclist-helmet-law-leads-to-increasing-head-injury-rates). Helmet use also appears to induce risk-compensation behaviour in motor vehicle drivers – they make closer passes (Accident Analysis & Prevention: Drivers overtaking bicyclists…). No doubt the cyclists themselves also are subject to risk compensation. Thus, by wearing a helmet there may be an increased risk of getting into an accident.

There may be further population wide psychological effects caused by a culture of “Must be wearing a helmet to be safe!”. It is sending the message that cycling needs safety equipment, and hence must be dangerous, which surely will put off many – certainly where mandatory helmet use laws are introduced rates of cycling then significantly decrease. The reverse is of course true: the overall health benefits of cycling greatly outweigh the quite tiny risks – risks which are not greatly changed by helmet wearing, the studies appear to say. In other words, by advocating helmet use, one may be harming the rates of cycling by sending the wrong message on safety, and hence harming public health overall. Further, as cyclist safety on the roads correlates strongly with rates of cycling – more cyclists leads to more awareness & safer roads, and similarly fewer cyclists means less safe roads – this means a culture of helmet use may well lead to increased injury rates amongst cyclists (in addition to the general adverse public health effects of fewer people cycling). This would be very hard to categorically prove or disprove in causal terms, however the Australian experience certainly suggests a correlation, as I think would a comparison of the UK and Netherlands.

Finally, in the Netherlands, one of the safest places for cycling in the world, cyclists almost universally do not wear helmets, including very young cyclists. Thus, we can be quite certain that helmet usage is not a pre-requisite for safe cycling. Indeed, it is in places like the UK and USA, with some of the worst cycling safety in the developed world, where the focus on safety equipment for the cyclist seems to be greatest.

In short, the focus needs to be on those things around the cyclist (e.g. default legal liability to influence motorists’ behaviour, safer road infrastructure, etc) – not what is on cyclists. Focusing on cyclist safety equipment to me seems futile at best, and perhaps even detrimental to the cause of mass, safe cycling, if that’s a cause you believe worthwhile.

NB: Helmet use should always be a personal choice. The issue is complex, the trade-offs may differ greatly in different scenarios – helmets may be very beneficial in some settings, e.g. some kinds of racing. The choice should be your own. However, general advocacy of cycling helmets seems inappropriate and probably harmful, to me.

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