The data presented by LeBlanc and colleagues1 show that the risk of head injury per cyclist did not change as a result of the law, but rather the risk of other injuries approximately doubled. Their bicycle count data show a 40%–60% fall in the number of cyclists after the law was passed, from 88 per day down to 33 or 52 per day. Their injury data show a sharp fall in total injuries in 1997, but for 1998/99 the number of injuries was higher than before the law (443 v. 416). The absolute number of head injuries has fallen by half, but so has the number of cyclists, although the total number of injuries has increased. Likewise, the claim of a doubling in the rate of helmet use omits the more telling point that the absolute number of cyclists using helmets did not materially change.
The Nova Scotia helmet law experience strengthens the arguments against helmet laws. No reduction has occurred in the risk of head injury per cyclist, relative to this study's loose definition of head injury. However, a big increase has occurred in the risk of non-head injury per cyclist. Furthermore, there has been no material increase in the number of helmeted cyclists. Rather, cycling on a substantial scale has been deterred. The deterrence of the safest mode of urban transport will not contribute to overall road safety or public health.
Utility cycling is a low-risk activity. Although cyclists in Great Britain do not have a notably good safety record, the expectation for a fatal crash for the average cyclist is only once in 18 000 years (3 million regular cyclists, 165 deaths per year). Experience shows that strong helmet promotion or laws bring about a low-utility, high-injury cycling culture. In countries such as France, the Netherlands and Denmark, little interest is shown in helmets, despite high levels of utility cycling and much better safety records. Cycling is very safe where it is popular.2 In France and Denmark, an hour of cycling is much safer than an hour of driving.3 In all countries for which I have seen data, pedestrians are more at risk than cyclists.4,5
Research here in Great Britain by the Transport Research Laboratory shows that the public relates helmets and their promotion to danger, and this deters cycling.6 As the relevant report comments, “Fear of traffic peril is a huge deterrent, though fear usually exceeds true danger. Discussion of safety frequently sharpens fear and so deters cycling.” The report observes that local authorities who ran prominent helmet campaigns saw a sharp drop in cycling activity.
The British Medical Association reviewed the question of a national helmet law in 1999 and concluded that helmets should not be made compulsory anywhere in Great Britain.7 This decision recognizes real-world experience in countries where helmets have come into general use, but little, if any, benefit has been observed in time trends of serious injuries.8 Injuries may even have increased.9 It is clear that a helmet will not prevent death in a serious crash with a motor vehicle.
Malcolm Wardlaw Transport Safety Analyst Glasgow, UK
References
- 1.LeBlanc JC, Beattie TL, Culligan C. Effect of legislation on the use of bicycle helmets. CMAJ 2002;166(5):592-5. [PMC free article] [PubMed]
- 2.Rutter H. Transport and health: a policy report on the health benefits of increasing levels of cycling in Oxfordshire. Oxford, UK; 2002. Available: www .modalshift.org/reports/tandh/print_version.htm (accessed 2002 June 26).
- 3.Carre JR. La bicyclette: un mode de deplacement méconnu dans ses risques comme dans son usage. INRETS. Recherche Transports Securite 1995; 49:19-43.
- 4.Ramet M, Vallet G. Typologies des accidentes du trafic routier a partir de 5,459 dossiers. Rapports INRETS-LCB. Aug 1987. p. 106.
- 5.Robinson D. Head injuries and bicycle helmet laws. Accid Anal Prev 1996;28:463-75. [DOI] [PubMed]
- 6.Transport Research Laboratory. Achieving the aims of the National Cycling Strategy. TRL report 365. Crowthorne, England: TRL; 1998.
- 7.British Medical Association. Bicycle helmets. London: The Chameleon Press; 1999.
- 8.Hendrie D, Legge M, Rosman D, Kirov C. An economic evaluation of the mandatory helmet legislation in Western Australia. Nedlands, Australia: University of Western Australia Public Health Department; 1999. Available: www.transport.wa .gov.au/roadsafety/Facts/papers/bicycle_helmet_ legislation.html (accessed 2002 June 13).
- 9.Wardlaw M. Three lessons for a better cycling future. BMJ 2000;321:1582-5. [DOI] [PMC free article] [PubMed]