Do enforced bicycle helmet laws improve public health?

Editor—In a subject as polarised as the efficacy of cycle helmet research it is hardly surprising that Robinson's work disagrees with a considerable body of the evidence and that the same can be said of pieces suggesting helmet use is highly beneficial.¹,²

Much controversy still exists about the effectiveness of cycle helmets, and it shows no sign of abating. This uncertain state of affairs is not a reasonable basis for a major piece of public health legislation such as a compulsory helmet law for cyclists.

Before any further calls are made for such measures we must take a much more informed grasp of the true degree of the dangers of cycling. The data (summarised well by Wardlaw³) show that cycling is not particularly more dangerous than being a pedestrian and those accidents that do happen are not especially more productive of head injuries. Though a law requiring helmets for pedestrians might reasonably be assumed to have a similar effect on public health as one for cyclists, we know as a culture happy with the relative safety of being pedestrians that such a law would be absurd. In countries that have retained a cycling culture a similar view is evident for cycling: helmet use among cyclists is low, and so are rates of cyclist head injuries.

When asking why the UK public (including its legislators, civil servants, journalists, and doctors) has lost its confidence in the safety of cycling, a highly plausible answer is the extraordinary amount of time, money, and effort spent telling us that cyclists are in terrible danger so they should wear a helmet. In comparison, pedestrian safety campaigns do not tell us we are always in terrible danger without a piece of armour: they tell us we are typically quite safe if we behave sensibly, which is also true for cyclists.

Helmets are not a sensible answer for pedestrian safety, even though many of them are injured or killed on the roads every year, and cyclist safety should be approached the same way: promote skilled interaction with other traffic, and ensure the other traffic is in turn operating responsibly.