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Should Helmets be compulsory for Cyclists?

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Public Support

June 2004: two thirds (635) of the public support a law making it compulsory to wear cycle helmets. (source) The Private Member’s Bill was tabled by Labour MP, Eric Martlew and received its second reading on 23 April. The survey of 9256 members of the public was conducted by the website, Myvoice.co.uk, according to the road safety charity Brake.

Research by the Royal College of Nursing and Royal College of Paediatrics and Child Health shows that 50 children’s lives could be saved each year if the law was changed to make wearing cycle helmets compulsory. In addition, the number of upper head injuries could be reduced by 85 per cent, brain injuries reduced by 88 per cent and facial injuries reduced by 65 per cent. National health bodies supporting the bill include the Royal College of Surgeons, the Royal College of Paediatrics and Child Health, the Royal College of Nursing and the Society of British Neurological Surgeons.

"Head or face injury is one of the most common reasons for a child to be brought to A&E, and injury is the biggest cause of death in children," says Tim Coats, professor of emergency medicine at Leicester Royal Infirmary. "Compulsory use of cycle helmets would significantly reduce the number of children killed or severely injured each year."

The British Dental Association and Faculty of Dental Practices also support the bill as a result of the serious facial injuries caused by cycling crashes.

However, The National Cycling Strategy and the national cycling organisation, CTC, oppose making helmets compulsory
as they argue that requiring people to wear cycle helmets will deter them from cycling. They claim that the health benefits of cycling are greater than the casualty risk.

The road safety charity Brake is disappointed that some cycling lobby groups are against this measure. "We must challenge the idea that cycle helmets are a deterrent to bicycle use," says Mary Williams, Brake’s chief executive. "They are a responsible, practical and easily implementable way of protecting children’s lives.

"If children are taught from an early age that wearing a helmet is the law and recognise it protects them against death or serious injury, then arguments against helmet use will disappear. As these children grow up they will become adults who have no problem wearing a helmet."

 

A Private Members Bill

In 2004, a private members bill (Eric Martlew, Labour MP for Carlisle) failed to get through parliament, the aim of which was to make it an offence to ride a bike without donning a helmet if you were aged below 16. It also stood to criminalise any adult who knowingly allowed a child to ride without one.

The bill never really gained sufficient momentum to be imposed by law, partly because the British Medical Association was not in all out favour of compulsion. Subsequently the BMA issued a statement which alters their stance stating that 'the BMA believe helmets should be compulsory for all cyclists'.

What research has been carried out? Has research proved or disproved the impact that compulsory helmet wearing will have upon injury and fatality rates in the UK?

BikeBiz.com has set out a petition which it aims to deliver to the BMA in an attempt to get them to reassess their position. http://www.bikebiz.co.uk/bma-petition.php

Discuss this issue in the BeSeenOnABike forum.

  • All child and adult cyclists should be forced to don lids, argues BMA
  • 30+ articles on Eric Martlew MP attempt to enforce cycle helmet compulsion

 

Hansard

Hansard 26th May 2004 - Edited by BSOAB

Child Cyclists - Mr. Eric Martlew (Carlisle) (Lab)

The sad truth is that a disproportionate number of accidents involve children on cycles. The Transport Research Laboratory has found that child cyclists comprise only 6.6 per cent. of road cyclists, yet the Department for Transport's analysis of average road-cyclist deaths in a two-year period leads it to conclude that there are 133 deaths, 28 of whom, or 21 per cent., were children. Using that calculation, children are four times more likely to die in a cycle accident on the road than adults. Once a fortnight, a child dies in a cycling accident on our roads. Children are seriously injured and often disabled in our constituencies every day of the year. Each year we kill the equivalent of a primary class of children and severely injure the equivalent of a small secondary school.

I do not claim that introducing cycle helmets will necessarily reduce the number of accidents, but I am convinced that the measure will reduce the severity of the injuries involved. Many accidents involve serious head injuries. Scientific research, both at home and abroad, has proved the case for cycle helmets in protecting the head and brain against the worst effects of injury.

The report "Bicycle helmets: review of effectiveness" was produced by the Department for Transport in November 2002. It is good and I recommend it to hon. Members. It states:

"There is now a considerable amount of scientific evidence that bicycle helmets have been found to be effective at reducing head, brain and upper facial injury in bicyclists. Such health gains are apparent for all ages, though particularly for child populations".

If my Bill were successful—it is still tabled for discussion, although I suspect that it will not become law—it would provide a legal framework that was practical and proportionate. It would make it an offence for children under the age of 16 to ride a cycle on the road, in a public park or in a recreation area unless they are wearing protective headgear. This is not new ground. A similar Bill was put on the statute book in 1990. The Horses (Protective Headgear for Young Riders) Act 1990, which was introduced by Harry Greenway, the then hon. Member for Ealing, North, made it an offence for children to ride a horse on the public highway unless they were wearing protective headgear.

My Bill would not make every child cyclist or their parents into potential criminals, as some of my more excitable opponents claim. Provision for an offence is an important enforcement mechanism when there is persistent flouting of the law, but in reality I envisage that a friendly word of caution or verbal instruction to wear a helmet would be enough to ensure that people complied with the law. Recent statistics show that in 2002 there were only 92 prosecutions of people riding on the pavement and 134 of people riding without lights. Some might say that there should be more prosecutions, but in many cases the law can be enforced without taking people to court.

The Government have argued about compliancy rates, and I accept that the Department for Transport has been trying to do something about them by actively targeting young people. Last year it devoted £137,000 to an advertising campaign on the importance of wearing a helmet as part of the safe cycling message. Perhaps the Minister will tell us whether there are plans for another campaign this year or next year.

The Department is concerned about compliance and it wants the rate of helmet wearing to increase to a critical mass before it is made compulsory. I understand the Department's motivation for holding that view, but does the Minister think that the goal will ever be reached? Surely, it should be the other way round. Rather than waiting for the practice of wearing helmets to change and then introducing an enforcement measure, could not the Government act now and introduce enforcement measures, so ensuring that the practice changes? If they do not, the Minister will continue to fall into the trap set by the opponents of helmets, such as the Touring Cycle Club, which will do everything it can to avoid helmets being made mandatory. The CTC discourages people from wearing them because it realises that if the practice reaches a critical mass, the Government might legislate.

In 2002, when 18 per cent. of cyclists were wearing helmets, the Government said that they would monitor the wearing rate and review the option for compulsory wearing from time to time. In October 2003, they used the same words, although the rate had by then increased to 25 per cent. The Minister must tell us what rate the Government would find acceptable before deciding to legislate to make it compulsory.

 

If the Government are concerned that making cycle helmets for children mandatory would be unpopular, they should take note of the poll of 9,000 adults carried out by the My Voice polling organisation in April. Some 80 per cent. of the those polled wanted helmets to be mandatory for children, and 70 per cent. of children agreed. Experience in other countries has led not only to recognition of the effectiveness of helmets, but to action—they have made it law.

In many countries, putting on a helmet is as common as using a safety belt in a car. Accidents and injuries have declined dramatically in countries in which helmets are mandatory, including Australia, New Zealand, Spain, the Czech Republic, and parts of the United States and Canada. Since the Second Reading of my Bill, two European Union countries—Sweden and Finland—have introduced laws making it compulsory for children aged 15 and younger to wear helmets.

Another important area is child cycle training. Perhaps hon. Members can remember the old cycling proficiency test at school—it was the first examination I ever passed and I took pride in that. It also had the advantage of bringing policemen into schools, so children's first contact with the police was favourable. Throughout the '90s, the police decided that they were too busy and that cycle training was not their responsibility. Sometimes that responsibility was passed to the county council, which decided that it was not mandatory. Therefore, the number of children being trained properly declined. We would not have dreamt of letting a child out on the streets without having taken a test. It should not necessarily be compulsory, but this and previous Governments have not given the issue the priority it deserves.

Mr. McNulty said:

The Secretary of State for Education and Skills is keen to encourage young people to cycle to school. Having seen the way some youngsters cycle, I think that they have never been made aware of the potential dangers. What provisions will there be to increase cycle training for children? I want more youngsters to go to school on bicycles. A report will be published tomorrow—although it is in the media today—on obesity and, in particular, child obesity. I want more youngsters to ride bicycles, because it is good for them, and to be taught what to do. I also want them to wear helmets so that we do not have the tragedies that we see at present.

The Government take the safety of children on the roads very seriously. Our road safety strategy, "Tomorrow's roads: safer for everyone", published in 2000, emphasised our aim to improve our performance on child road safety. The general target is for us to reduce deaths and serious injuries on the roads by 40 per cent. by 2010 compared with the average for the period from 1994 to 1998, but the target for children is 50 per cent. The reduction in child casualties has been outstanding. Compared to the baseline, child pedal cycle deaths and serious injuries have fallen by 47 per cent. That reduction significantly outstrips the decline in child cycling levels over the same period—something that concerns my hon. Friend—and represents a significant trend towards the target. However, we are not complacent and are taking action on a range of fronts.

The data show that, although the number of casualties is falling for child cyclists of all ages, we still have a problem with the number of young adolescent boys in particular getting hurt while cycling. We know from regular monitoring that boys are the most reluctant to wear helmets. Set against the general, rising trend, the wearing rate for boys went down from 16 per cent. in 1994 to 12 per cent. in 2002. A large proportion of those who choose not to wear helmets are young adolescents.

In the broader sense, we are doing much to improve child cyclists' safety. There are measures designed to make drivers far more aware of vulnerable road users, such as child cyclists. The highway code includes a section on road users, including cyclists, which requires drivers to take extra care. The practical driving test has been lengthened, so that drivers experience more road types and have a greater opportunity to encounter vulnerable road users. The theory test question bank contains many questions about vulnerable road users, including cyclists. Hazard perception skills are important to safe driving, and we want new drivers to develop those skills quickly. The screen-based element of the theory test includes video clips to help to test hazard perception with moving images.

We have also produced publicity for drivers. Our drink drive advert shows a motorist taking care to avoid a young cyclist. The underlying message is to give cyclists space. We have published the "Drive Safe, Cycle Safe" leaflet, in alliance with the AA and the Cyclists Touring Club. It is designed to make motorists and cyclists aware of one another. Of course, it is important that cyclists take responsibility for their safety, and cycle training is an important part of that, although awareness among drivers is equally part of the overall safety package. About one third of children aged between nine and 10 are trained each year at school. Research shows that trained children are significantly safer than untrained children, as my hon. Friend suggested, when knowledge and skills are tested two years after training. We strongly advise parents to encourage their children to have cycle training and not to let them out on the roads until they are competent to handle their cycles safely.

We have raised the standards of child cycle training. We assisted the Royal Society for the Prevention of Accidents financially with its "Guidelines for the management and operation of Practical Cyclist Training Schemes". My Department and the Department of Health gave a £76,000 grant to the CTC to develop a cycle training scheme for adults and teenagers, which was launched in May 2003. Driver awareness is certainly important but, as my hon. Friend suggested, the training of cyclists is very important, too.

Mr. Martlew : I am conscious that the Minister said that one third of youngsters are trained. That means that two thirds are not. How will we get to those two thirds? In addition, the CTC campaigns against wearing cycle helmets. How can the Government be involved with that organisation when it works against one of their objectives?

Mr. McNulty : I shall return to the CTC in a moment. On my hon. Friend's first question, he is right: a significant number of children are still not trained, and the job to ensure that more and more are trained remains ongoing. These are not one-off initiatives aimed at simply sorting the task out and moving on. The job on driver awareness and cyclist training is ongoing.

On publicity for child cyclists, we have published "Arrive Alive", a highway code for young road users that encourages children to act sensibly when using roads, and it includes a section on cycling. It is given to every child taking cycle training and more than 500,000 copies are issued annually. We are working with private sector organisations on a cycle smart campaign, which promotes safer cycling among children. It consists of a comic and a "Be safe and be seen" sticker. We promote the wearing of cycle helmets. Some say that helmets do not work. To try to get an independent, objective view on which could all agree, we commissioned research to assess the effectiveness of helmets. It concluded that they have been found to be effective in reducing injury for cyclists of all ages, especially children. As ever, some question that research, but as children are more likely to have low-speed accidents just falling off their bikes, I do not believe that much research is required to conclude that they will be better off wearing a helmet.

The Government helped to launch the Bicycle Helmet Initiative Trust's "Guidelines for Setting up Community Based Bicycle Helmet Programmes" in May 2002. That was the result of three years' work, with £100,000 of joint funding from the Department of Health and the Department for Transport. We also funded the Bicycle Helmet Initiative Trust to produce similar guidelines for schools, which it issued in July 2003.

We believe that helmets can work, so last year we launched publicity aimed specifically at boys in the vulnerable age group—the young adolescents. Before the launch, we tested different material with them to establish how they would receive it. The publicity that we ran was the material to which they were most receptive. It is called "Cycle Sense", and the campaign also covers issues such as technique, cycle maintenance and visibility. It consists of a poster, postcards and a website. We are also developing a TV filler film that we hope to launch later this year.

I agree with my hon. Friend; I, too, was very disappointed with the reaction of the CTC to that initiative. It mounted a campaign to undermine it and complained to the Advertising Standards Authority, which has since found in our favour. To an extent, I appreciate the CTC's concern to increase cycle levels, but that is an issue for the Government too, and we tailor publicity accordingly. If the reaction had been that young adolescents would be put off cycling, we would not have used the campaign. The CTC is a major cycling stakeholder and I hope that it will work with us more positively on safety in future, as it does on other cycling issues. Given the CTC's role as stakeholder, we could not simply refuse to work with it. However, I share my hon. Friend's concerns and acknowledge his complaints about its activities in the past.

Our position on compulsion has been that we will—to quote yet again the words quoted by my hon. Friend—review the option from time to time. However, due to the current rates of helmet wearing among children, which are relatively low, we have a concern that compulsion would affect cycling levels and cause enforcement difficulties. That has been the Government's position. The Bill has caused us to reflect; we need to think about how compulsory helmet wearing might affect the wider initiatives to increase cycling and improve health.

The supporters of helmet wearing say that provided that helmets are introduced with care, compulsion need not affect cycling levels. As my hon. Friend will know, some of the international experiences are that, with a long lead-in of promoting awareness, education and other elements, compulsion has subsequently been introduced. Opponents point to evidence from overseas where compulsion has clearly affected cycle levels. As ever in this life, the reality is mixed and the overseas experience can be read either way. We worry, however, that with helmet wearing by youngsters so low at the moment, compulsion would put many of them off cycling. If that happened it would affect cycling levels. Increasing cycling has the positive benefit of improving health. It is key to our anti-obesity strategy, especially for children, and to the further development of sustainable transport.

Our success in this area does not begin to compare with how well we are doing in moving towards the road safety targets, but I agree with my hon. Friend's intention: we must increase helmet wearing. We are continuing our campaigns to promote cycle helmets, ensuring that we do not do so in such a way that it presents cycling as dangerous or risky. The emphasis is on cyclists being sensible and other road-users taking care around them.

It is not simply about training, driver awareness and helmets, with or without compulsion. The whole package is designed to heighten cyclists' awareness and drivers' awareness of cyclists and the notion that cycling is good and should be encouraged, especially among young people. We want to promote cycling and the wearing of helmets. We will continue to reflect on the issue of compulsion and the level at which it should kick in.

Mr. Martlew : The Minister said that when we reach a critical mass the Government will consider implementing compulsion. What does he think the critical mass will be? Is there not a difference between children and adults with regard to compulsion?

Mr. McNulty : As I said, it is not as simple as just reaching a cut-off point for children or adults. It is about all those aspects: driver awareness, cyclist training more generally, and the promotion of cycling, especially among young children. There will be more focus on young adolescents through education. Depending on the effectiveness of all those policy initiatives, we will see whether compulsion should kick in. We will reflect on all those issues, because of the wider campaign and the points raised by my hon. Friend, and will review the position from time to time.

If not all those elements are successful, we may need to steer in other directions. Increased cycle helmet wearing may go alongside all those policy initiatives. We may need to reflect at every stage. One conclusion may be that things are going so slowly that we should move to compulsion. It may be at a far lower figure than we expected. If all those elements are successful, compulsion should be at the tail end, rather like the experience in New South Wales.

I wish my hon. Friend well in his campaign to increase helmet wearing by young cyclists. I know that it will not stop on 18 June. I fear that, for better or worse, the debate on compulsion will continue. I suspect that that is right and proper. We agree absolutely with his fundamental position: wearing helmets makes cycling safer. We should all, CTC included, endeavour to increase cycling wearing by young cyclists in the context of promoting cycling generally. It is an outcome that we all want to see.


 

Safety & Security .. Cycling Helmets
Wearing a helmet could save your life. Fact or Fiction?

source: whycycle.co.uk - edited by BeSeenOnABike

The truth is that there is no simple answer. In some accidents a helmet can reduce the risk of severe head injury but every accident is different and therefore the outcome can never be judged before the incident.

The majority of head injuries which result in death are caused by collision with other vehicles, travelling at comparative high speed, something which a bicycle helmet is not designed to cope with. The number of these serious head injuries is low.

Do the overall health benefits offered by regular cycling far outweigh the small amount of risk involved?

Should it be compulsory to wear a bicycle helmet?

Currently in the UK there is no legislation which places any requirement on you to actually wear a helmet. Whether to wear a helmet or not is currently a matter of personal choice (the majority of the cycle industry wishes it to remain that way).

What can a helmet do?

As with most safety orientated products, bicycle helmets have to pass certain standards prior to being allowed to be sold. What may be surprising is the exact nature of those standards.
Cycle helmets are only designed and tested to withstand an impact equivalent to an average weight rider travelling at a speed of 12 mph falling onto a stationary kerb shaped object from a height of 1 metre. This is the equivalent of falling from your bike onto the road or the kerb edge.

Helmets are not tested nor expected to be able to offer full protection if you come into contact with a vehicle which is moving.

The importance of size.

If you decide that you should wear a helmet then for that helmet to be able to offer you any worthwhile protection it must be the correct size AND fit.

To understand why size and fit is so important, you need to understand how a helmet works.

Bicycle helmets are manufactured from expanded foam polystyrene, similar to the type of stuff polystyrene coffee cups are made from. Polystyrene is structurally rigid and can be moulded into virtually any shape. However whilst being structurally rigid, it is a material which is easy to damage by crushing because it contains a high number of tiny air pockets. The process of crushing absorbs energy. It is these facts which make it ideal for the construction of bicycle helmets.

Any moving object has energy. To stop an object from moving, this (kinetic) energy must be removed by conversion to other energy forms, eg heat and sound OR by using it to alter the chemical or structural composition of a material.

Cars have "crumple zones": the front end is designed to concertina, absorbing terrific amounts of energy whilst bringing the car to a halt (decelerating it) less abruptly and hopefully protecting the driver/passengers by lessening the effects of the impact on them. But there is only so much energy that can be absorbed by this crumple zone, and at higher speeds (increased speed = increased kinetic energy) insufficient energy can be absorbed to adequately protect the occupants.

A helmet is designed to work in a very similar way, the polystyrene acting as the crumple zone, lessening the impact on the skull. The helmet will make contact first and stop moving. However, because it can be crushed, the head inside it is allowed to carry on moving for a short period of time as it crushes the polystyrene, an amount of energy being absorbed in the process. Because the skull is decelerated slightly more gradually, there is a lesser impact between both the skull onto the ground AND subsequently the brain onto the inside of the skull. Brain damage occurs if the impact between it and the skull is too great, ie too much energy has to be absorbed by the brain.

The maximum amount of energy is absorbed if the impact area is at its largest, but as the impact area decreases, so does the amount of energy that can be absorbed. If we look back at the example of a car, modern crash safety tests now include a test which only involves half of the crumple zone because very few real collisions involve a perfect head on impact. Cycle helmet standards also try to follow this principle, hence the impact test against a "kerb" shaped object.

The illustration to the left is designed to demonstrate the effect of a helmet which does not fit correctly. On the left, the helmet is not a snug correct fit to the head. On the right, the helmet fits snugly and touches the head at all points. The red areas denote the effective crumple zone in each case. As you can see, the area covered when the helmet is the correct size is quite noticeably larger than that in the helmet which does not fit. This in turn means that there is less material which can be crushed leading to less energy absorption.

Try the helmet on before you buy!

You should try on a number of helmets before buying. Each manufacturer uses a different "model" head form and even same size helmets can be dramatically different. The helmet should be close fitting all the way round. Minor gaps can be filled using the soft foam pads generally supplied. Some helmets use a "sizing ring" which adjusts to fit your head. If this is the case, ensure that the helmet shell is fairly close fitting. Do not rely solely upon the snug fit created by the sizing ring. The sizing rings and soft foam pads offer absolutely NO protection. Only the polystyrene shell will absorb any energy and it is therefore very important that this shell be as close a fit to your skull as possible without it being uncomfortable.

Price vs. Features.. Are all helmets created equal?

Although all helmets available comply with the same safety standards, there is a big variation in cost - so if they're all as safe as each other, what does your extra money get you? and is it worth spending extra?

  • cycle helmets can get a bit warm, especially in summer.
    • More expensive helmets generally have more air vents and better internal airflow to keep your head cool.
  • comfort is a very important issue with helmets
    • if a helmet is uncomfortable, then you're less likely to wear it, and it is useless if you leave it at home!
    • More expensive helmets may have fancier fitting systems, which make them more comfortable and easier to fit.
  • some more expensive helmets have a crash replacement policy - they give you a replacement at a reduced price - so you are buying an insurance policy along with the helmet!
  • fit - Helmets created by the big name specialists in bicycle helmet production generally undertake exhaustive research and design. - the fit is often better and more accurate to real head shapes and as a result the comfort is higher.

But bear in mind that a helmet is also a fashion accessory - so you are also paying more for fancy colours and design flourishes...

Closing thoughts .. by whycycle.co.uk

"The safety benefits offered by wearing a helmet do exist, but these benefits should be neither over-estimated nor under-estimated. Surely anything which can offer an extra amount of safety is worthwhile as long as it does not leave you with a false sense of security.

We would recommend the wearing of a correctly fitting and fitted bicycle helmet but ultimately the decision to wear a helmet or not has to be a matter for the individual."

 

Saturday 6th November 2004 (news reported by Bikebiz.com) edited by BeSeenOnABike
All child and adult cyclists should be forced to wear helmets - BMA

In a submission ahead of the publication of the UK government's Public Health White Paper - due within the next few days - the British Medical Association argues for a raft of health measures, including cycle helmet compulsion.

Since 1999, the BMA has argued that the health benefits of cycling outweigh all of the (comparatively low) risks. The BMA still does, but now argues the case for cycle helmet compulsion. And not just for children. Safe cycling networks should be encouraged, and the Government should legislate for the compulsory wearing of cycle helmets.

Lobby groups including 'Be-Hit', the Reading-based Bicycle Helmet Initiative Trust - have had discussions with the BMA.

The BMA says that "even in the current hostile traffic environment, the benefits gained from regular cycling are likely to outweigh the loss of life through accidents for regular cyclists."

The BMA argues for the creation of a safer cycling environment; reductions in vehicle speeds and traffic volume in urban areas; cycling proficiency education, as part of the curriculum for all school children....

But can helmets designed for low-speed crashes from a height of 1m be a major life savers - if only their use was enforced?

"Recent evidence has indicated that the introduction of compulsory legislation does not have a significant negative effect on cycling levels," claimed a BMA position paper.

"In light of this evidence, the Board of the Directorate of Professional Activities of the BMA agreed that the BMA support the introduction of legislation making the wearing of cycle helmets compulsory for both children and adults."

FURTHER READING

The full text of the BMA's helmet compulsion arguement

THE CYCLE HELMET: FRIEND OR FOE?
Dr Mayer Hillman has long argued helmet compulsion is "victim blaming."

"By wearing helmets, cyclists are at best only marginally reducing their chances of being fatally or seriously injured in a collision with a motor vehicle which is the predominant cause of these injuries. Even the most expensive ones provide little protection in these circumstances.

"People are discouraged from cycling if their perception is heightened that it is a 'dangerous' form of travel and that it is only safe to do so if a helmet is worn. The result of this is that the considerable latent demand for cycling - an ideal mode for the majority of the population for most of their journeys - continues to be suppressed. As cycling is also a convenient and routine way of maintaining fitness, a significant route to public health is prejudiced.

"The primary means of reducing serious head injury among cyclists is to create an environment in which accidents are less likely to occur. Such a strategy based on tackling the source of accidents in which cyclists are involved has far greater scope for reducing head injuries than the questionable benefits of promoting helmet wearing among cyclists."

GOVERNMENT-APPOINTED CYCLE ORG IS ANTI-COMPULSION
The National Cycling Strategy Board made an anti-compulsion statement in January 2004:

"Campaigns seeking to present cycling as an inevitably dangerous or hazardous activity, or which suggest that helmet wearing should be made compulsory, risk prejudicing the delivery of those very benefits to health and environment which cycling can deliver: they also serve to confuse the general public about the wider social and economic advantages of cycling."

RELATED ARTICLES:

Friday 16th April 2004 - Helmet compulsion article index -stories carried on Martlew's private members' bill 'protective headgear for young cyclists' as well as post-bill helmet compulsion articles, including the BMA helmet advice.

Note: BikeBiz.com is pro-helmet, anti-compulsion.

 

Legislation for the compulsory wearing of cycle helmets
source: Board of Science and Education

British Medical Association
November 2004

text made bold by BeSeenOnABike, for emphasis, otherwise unedited.

Introduction
The BMA has strongly supported the advice that all cyclists should wear properly fitted helmets but has not supported the proposal that this be made compulsory. This was not Annual Representative Meeting (ARM) policy but followed a recommendation made in the Cycle helmets (1999) report.

In the past year we have received correspondence from a number of BMA members, in particular those treating injured victims of cycle related accidents on a daily basis, requesting that the BMA reconsider its existing policy on this issue [1]. In our 1999 report significant emphasis was placed on the BMA’s wish not to discourage cycling by making helmets compulsory.

This advice was based on evidence from Australia indicating that cycling levels decreased following the introduction of legislation. This evidence is now outdated and contains distortions from variables including a reduction in the legal age of driving that meant more teenagers travelled in motor vehicles. A study from Ontario, Canada has demonstrated that introduction of helmet legislation did not reduce numbers of children cycling [2].

Research published in June 2003 for the Department for Transport revealed a growing trend for wearing cycle helmets in the UK. Wearing rates for the population as a whole rose from 16% in 1994 to 25% in 2002 [3,4].

The evidence
Cycle helmets are now compulsory in Australia [5], New Zealand [6], Spain, Iceland (aged under 16), the Czech Republic (aged under 16), Canada (aged under 18) [7] and twenty states in the USA. Studies in a number of these countries have shown that high usage rates of helmets as a result of legislation is associated with a reduction in cycle related deaths and head injuries. Evidence supporting the wearing of cycle helmets continues to mount:

It is estimated that 90,000 road-related and 100,000 off-road related cycling accidents occur every year in the UK, of which 53% (100,000) involve children under sixteen [8].

In 2002, 594 children and 1,801 adults were killed or seriously injured as a result of road-related cycling accidents [10].

Significantly, with child cyclists, 85 per cent of accidents occur off road where primary prevention measures such as cycle lanes, vehicle speed reduction and driver education are ineffective [9].

Several recent studies and discussions [14] have provided scientific evidence that bicycle helmets protect against head, brain, severe brain and facial injuries, as well as death, as a result of cycling accidents:

  • In the USA, a 30-month study of 3,854 cyclists showed that helmet usage decreased the overall risk of brain injury by 65 per cent and severe brain injury by 74 per cent in all age groups [9].
  • An Australian study showed that wearing cycle helmets reduces both the incidence of facial injuries by 28 per cent and their severity [11].
  • A Cochrane review considering five case-control studies from the UK, Australia and the USA illustrates a large and consistent protective effect from cycle helmets, reducing the risk of head and brain injury by 65 to 88 per cent and injury to the upper and mid face by 65 per cent [12].
  • A study of primary school, secondary school and adult cyclists in New Zealand demonstrated a 19 per cent reduction in head injuries to cyclists in the three years after the introduction of legislation [13].
  • In Victoria, Australia, an increase in helmet use from 31 per cent prior to legislation to 75 per cent one year after was accompanied by a decrease in head injuries by 40 per cent in the following four years [12].

Enforcement
As with any other legislation enforcement is as important as the law itself. Without compliance the law is at best ineffective. To achieve maximum compliance, the legislation should be complemented by mass educational and promotional campaigns. Evidence from Australia and New Zealand showed that educational campaigns prior to the introduction of legislation resulted in an increase in helmet wearing from two per cent to up to 95 per cent [8].

An education programme in Reading that promoted cycle helmet use among children and teenagers resulted in a local increase in usage from 18 per cent to 60 per cent and a concurrent decrease in cycle-related injuries [9]. The most difficult group in which to increase helmet use was teenagers, who are often the category most at risk. One approach is to target educational programmes at adults, as evidence from a Seattle-based study suggests that helmet usage is greatest in children riding with helmeted adults [12].

At a practical level, enforcing the legislation can be achieved through on-the-spot fines or tickets issued by police and traffic wardens, while schools can ensure all children wear helmets on journeys to and from school. Cycle helmet legislation and other safe cycling promotions are not mutually exclusive, and there is a clear role for the simultaneous introduction of more primary prevention measures including cycle lanes, driver education and vehicle speed reduction initiatives.

Further measures to improve cyclists' safety
The BMA believes that cycling has many advantages to the individual in terms of improved health and mobility, as well as to society via, for example, reduced air pollution and traffic congestion. Even in the current hostile traffic environment, the benefits gained from regular cycling are likely to outweigh the loss of life through accidents for regular cyclists.

We need to reinforce the points made in our 1999 report, that action to reduce the high rate of fatal and serious accidents suffered by cyclists must include:

  • the creation of a safer cycling environment
  • reductions in vehicle speeds and traffic volume in urban areas
  • the provision of cycling training for all children
  • recognising road safety, including cycling proficiency education, as part of the curriculum for all school children. This should include basic cycle maintenance, and safety precautions (eg lights, reflective clothing), information on the health benefits of cycling, as well as encouraging cycle helmet use.
  • Information on current cycle helmet standards and the level of protection they provide should be more easily accessible to consumers.
  • Advertising Standards officials should ensure that the public are protected against misleading safety claims from manufacturers.
  • Cycle manufacturers and retailers should consider supplying a free cycle helmet (or helmet voucher) with every bike sold.
  • Helmet costs should be reduced substantially, eg through Government subsidy schemes and the reassessment of VAT on safety products on a European wide basis.

Summary of evidence
The evidence from those countries where compulsory cycle helmet use has already been introduced is that such legislation has a beneficial effect on cycle-related deaths and head injuries. This strongly supports the case for introducing legislation in the UK. Such legislation should result in a reduction in the morbidity and mortality associated with cycling accidents.
Recent evidence has indicated that the introduction of compulsory legislation does not have a significant negative effect on cycling levels. Such legislation in the UK should not discourage cyclists and lead to a more sedentary lifestyle with consequent health risks.

Recommendations
In light of this evidence on 20 October 2004, the Board of the Directorate of Professional Activities of the BMA agreed that the BMA support the introduction of legislation making the wearing of cycle helmets compulsory for both children and adults.

Further, as stated in the 1999 report we strongly recommend that all cyclists wear proper fitting helmets which as a minimum should be certified to the EN 1078 standard, but preferably certified to the Snell B95 standard. It is also important that helmets are replaced after an accident.

References and footnotes
[1] For example, John Black. Emergency Medicine Consultant and Emergency Department Clinical Director. John Radcliffe Hospital, Oxford

[2] Macpherson AK et al. Mandatory helmet legislation and children’s exposure to cycling. Inj Prev 2001;7(3):228-230

[3,4] K Gregory, C Inwood and B Sexton, Cycle helmet wearing in 2002, Prepared for Road Safety Division, Department for Transport, Teenage boys appeared to be the only exception to the rule with rates dropping from 16% to 12%. Alongside data showing that deaths and serious injuries for boy cyclists were about 5 times the rate for girls. This research endorsed the need to encourage teenage boys to wear cycle helmets. The Government is already targeting teenage boys with the THINK! Campaign under Road safety banner, launched in May 2003.

[5] Compulsory legislation introduced in 1990.

[6] Compulsory legislation introduced in 1994.

[7] Compulsory legislation introduced in 1995.

[8] Chapman HR, Curran ALM. Bicycle Helmets 1- Does the dental profession have a role in promoting their use? British Dental Journal 2004;196(9):555-560

[9] Lee AJ, Mann NP. Cycle Helmets. Arch Dis Child 2003;88: 465-466

[10] Statistics from the Department of Transport: Road accident casualties by road user type and severity: 1992-2002: http://www.dft.gov.uk/stellent/groups/dft_control/documents/contentservertemplate/dft_index.hcst?n=8836&l=4

[11] Chapman HR, Curran ALM. Bicycle Helmets 1- Does the dental profession have a role in promoting their use? British Dental Journal 2004;196(9):555-560.

[12] Thompson et al. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev. 2000;2:CD001855

[13] Scuffham P et al. Head injuries to bicyclists and the New Zealand bicycle helmet law. Acci Anal Prev 2000;32(4):565-573

[14] Making cycle helmets compulsory: ethical arguments for legislation Aziz Sheikh MD MRCGP, Adrian Cook BSc MSc, Richard Ashcroft BA PhD

Cycle Helmet Laws in USA - Bicycle Helmet Safety Institute

A summary of cycle helmets laws in USA.See map. A consumers Guide to Cycle Helmets.

World Health Organisation - Helmet Initiative

WHO: Requiring helmet wearing - by law - is an effective strategy to increase helmet use and to reduce death and injury. Bicycle helmet laws increase wearing rates to between 70 and 90 percent. Over 400 references to Bicycle Helmet use updated to June 2004 (pdf).