A case for making cycling helmets mandatory — in the States! by Andre Jute

[Andre Jute]

If you get hot under the collar at the mere mention of cycle helmets being made compulsory, don't read this. It is an article I wrote in 2010 to explain why the US is a good case for instituting mandatory helmet laws. It is long, closely argued, and you need to pay attention to the math.

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THE CASE FOR A MANDATORY CYCLE HELMET LAW ?(IN THE UNITED STATES OF AMERICA) ?by Andre Jute

It is a risible myth that your average American is a tall-walking free ?individual untrammeled by government: he is in fact just as much ?constricted as a European soft-socialist consumerist or Japanese ?collective citizen, though it is true that the American is controlled ?in different areas of his activity than the European or the Japanese. ?To some the uncontrolled areas of American life, for instance the ?ability to own and use firearms, smacks of barbarism rather than ?liberty. In this article I examine whether the lack of a mandatory ?bicycle helmet law in the USA is barbaric or an emanation of that ?rugged liberty more evident in rhetoric than reality.

Any case for intervention by the state must be made on moral and ?statistical grounds. Examples are driving licences, crush zones on ?cars, seatbelts, age restrictions on alcohol sales, and a million ?other interventions, all now accepted unremarked in the States as part ?of the regulatory landscape, but all virulently opposed in their day.

HOW DANGEROUS IS CYCLING? ?

Surprisingly, cycling can be argued to be "safe enough", given only ?that one is willing to count the intangible benefits of health through ?exercise, generally acknowledged as substantial. Here I shall make no ?effort to quantify those health benefits because the argument I'm ?putting forward is conclusively made by harder statistics and ?unexceptional general morality.

In the representative year of 2008, the last for which comprehesive ?data is available, 716 cyclists died on US roads, and 52,000 were ?injured.

Source: National Highway Traffic Safety Administration

The most convenient way to grasp the meaning of these statistics is to ?compare cycling with motoring, the latter ipso facto by motorists' ?average mileage accepted by most Americans as safe enough.

Compared to a motorist a cyclist is: ?
11 times MORE likely to die PER MILE travelled
?2.9 times MORE likely to die PER TRIP taken

By adding information about the relative frequency/length/duration of ?journeys of cyclists and motorists, we can further conclude that in ?the US:

Compared to a motorist, a cyclist is: ?
3 to 4 times MORE likely to die PER HOUR riding
?3 to 4 times LESS likely to die IN A YEAR's riding

Source: http://www.ta.org.br/site/Banco/7manuais/VTPIpuchertq.pdf

It is the last number, that the average cyclist is 3 to 4 times less ?likely to die in a year's riding than a motorist, and enjoys all the ?benefits of healthy exercise, that permits us to ignore the greater ?per mile/per trip/per hour danger.

This gives us the overall perspective but says nothing about wearing a ?cycling helmet.

HELMET WEAR AT THE EXTREME END OF CYCLING RISK

What we really want to know is: what chance of the helmet saving your ?life? The authorities in New York made a compilation covering the ?years 1996 to 2003 of all the deaths (225) and serious injuries ?(3,462) in cycling accidents in all New York City. The purpose of the ?study was an overview usable for city development planning, not helmet ?advocacy, so helmet usage was only noted for part of the period among ?the seriously injured, amounting to 333 cases. Here are some ?conclusions:

• Most fatal crashes (74%) involved a head injury.
?• Nearly all bicyclists who died (97%) were not wearing a helmet. ?
• Helmet use was only 3% in fatal crashes, but 13% in non-fatal ?crashes

Source: ?http://www.nyc.gov/html/doh/downloads/pdf/episrv/episrv-bike-report.pdf

This concatenation of facts suggests very strongly that not wearing a ?helmet may be particularly dangerous.

• It looks like wearing a helmet saved roundabout 33 cyclists or so ?(of the 333 seriously injured for whom helmet use is known) from ?dying. ?
• If those who died wore helmets at the same rate of 13% as those in ?the study who survived, a further 22 or so could have lived. ?
• If all the fatalities had been wearing a helmet (100%), somewhere ?between 10% and 57% of them would have lived. This number is less firm ?to allow for impacts so heavy that no helmet would have saved the ?cyclist. Still, between 22 and 128 *additional* (to the 33 noted ?above) New Yorkers alive rather than dead for wearing a thirty buck ?helmet is a serious statistical, moral and political consideration ?difficult to overlook.

SO HOW MANY CYCLISTS CAN HELMETS SAVE ACROSS THE NATION?

New York is not the United States but we're not seeking certainly, ?only investigating whether a moral imperative for action appears.

First off, the 52,000 cyclists hurt cannot be directly related to the ?very serious injuries which were the only ones counted in the New York ?compilation. But a fatality is a fatality anywhere and the fraction of ?head injuries in the fatalities is pretty constant.

So, with a caution, we can say that of 716 cycling fatalities ?nationwide, helmet use could have saved at least 70 and very likely ?more towards a possible upper limit of around 400. Again the ?statistical extension must be tempered by the knowledge that some ?impacts are so heavy that no helmet can save the cyclist. Still, if ?even half the impacts resulting in fatal head trauma is too heavy for ?a helmet to mitigate, possibly around 235 cyclists might live rather ?than die on the roads for simply wearing a helmet. Every year. That's ?an instant reduction in cyclist road fatalities of one third. Once ?more we have arrived at a statistical, moral and political fact that ?is hard to ignore: Helmet wear could save many lives.

THE CASE AGAINST MANDATORY HELMET LAWS

• Compulsion is anti-Constitutional, an assault on the freedom of the ?citizen to choose his own manner of living and dying ?
• Many other actitivities cause fatal head injuries. So why not insist ?they should all be put in helmets? ?
• 37% of bicycle fatalities involve alcohol, and 23% were legally ?drunk, and you'll never get these drunks in helmets anyway ?
• We should leave the drunks to their fate; they're not real cyclists ?anyway
?• Helmets are not perfect anyway ?
• Helmets cause cyclists to stop cycling, which is a cost to society ?in health losses
?• Many more motorists die on the roads than cyclists. Why not insist ?that motorists wear helmets inside their cars? ?
• Helmets don't save lives -- that's a myth put forward by commercial ?helmet makers ?
• Helmets are too heavily promoted ?
• Helmet makers overstate the benefits of helmets ?
• A helmet makes me look like a dork ?
• Too few cyclists will be saved to make the cost worthwhile

THE CASE FOR A MANDATORY HELMET LAW IN THE STATES ?

• 235 or more additional cyclists' lives saved ?
• 716 deaths of cyclists on the road when a third or more of those ?deaths can easily be avoided is a national disgrace ?
• Education has clearly failed
?• Anti-helmet zealots in the face of the evidence from New York are ?still advising cyclists not to wear helmets ?
• An example to the next generation of cyclists ?
• A visible sign of a commitment to cycling safety, which may attract ?more people to cycling

© Copyright Andre Jute 2010, 2015. Free for reproduction in non-profit ?journals and sites as long as the entire article is reproduced in full ?including this copyright and permission notice.

[John Saxby]

Thanks for this, Andre--a good piece of work.  What responses did you get from readers in the U.S.?

I don't need to be convinced of the value of a helmet: as a longtime motorcyclist, I've always worn one on my two-wheelers, motor- or pedal-powered. 2 months or so ago, I think it was, Crazyguyonabike featured a forum where the OP asked readers what had prompted them to wear a helmet. (Can't find the specific reference -- a search for 'helmet' generates 100 pages!) This thread managed to get beyond the usual point-counterpoint merry-go-round, perhaps because those replying were helmet-wearers. My story involved my only fall on a 2-wheeler: pottering along at about 25-30 km/h on my motorcycle on a tiny backroad in central Ontario on a summer day about 50 years ago, dodging a kid on his bicycle, I clipped his rear fender and went over the bars, doing a three-pointer on my helmeted head, my shoulder and elbow.  I lost a bit of skin from my elbow, but otherwise, no harm done to anyone, and I'm at least able to write this half a century later.

[Andre Jute]

Thanks for this, Andre--a good piece of work.  What responses did you get from readers in the U.S.?

Thanks, John. I published that piece on rec.bicycles.tech as the culmination and summary of a series of articles in which I demonstrated the derivation of my statistics and conclusions that cycling is safe enough, extends life, and the more so if one wears a helmet. In resisting the earlier articles the anti-helmet zealots (AHZ) had been burned so badly as a reward for trying amateur polemics on me that several had slunk off. The remnant pretended sullenly not to see the article. Entertainingly, they now all use my numbers and rationale, while still claiming that I say cycling is dangerous!

Cyclists elsewhere should be careful about extending conclusions about helmet mandation from American data and circumstances. In particular, many of the questions to be answered are psychological, cultural and sociological rather than merely statistical, even in nations that superficially resemble America in its domination by the automobile, of which Canada and Australia are prime examples. On the other hand, a personal decision on whether to wear a helmet informed by the New York study seems to me universally logical, if you aren't already convinced by the many reasonable cyclists who wear helmets.

[triaesthete]

 
 TL:DR:      Bikes are dangerous. Helmets might marginally improve this.

  Reductio ad absurdam: Reasonable person would buy car with curtain airbags.

 

[Andre Jute]

   TL:DR:      Bikes are dangerous.

I don't agree. In the context of the extended lifespan that follows from the health benefits of cycling, cycling is safe enough.

Also, it can be shown that the most experienced cyclists are much safer than casual cyclists. I suspect that your average touring cyclist will as and when reliable numbers become available be shown to be in the higher percentile of safety, even taking into account the longer distances he covers.

Helmets might marginally improve this.

According to the New York study cited above, not wearing a helmet — even the low-spec helmets we now have — makes cycling three times more dangerous than wearing a helmet (at least in the city).

The problem with helmets is that they are certified for a pretty limp spec, to protect the profits of the makers. It would be easy to make a better helmet inside the same average weight, or even lighter, but no one does because the specification is so artificially low. It really amazes me that cyclists spend their energy raging against helmet-wearers rather than campaigning to get helmets certification requirements upgraded.

[triaesthete]

 If it's safe enough and we're experienced why champion compulsion then 

Ultimately it's a political/civil rights/free society matter just like motorcycle helmet compulsion was. Fred Hill died in prison for this  http://www.mag-uk.org/en/aboutmag/a6325

[Andre Jute]

If it's safe enough and we're experienced why champion compulsion then 

I'm not championing helmet compulsion. That's a political matter and I'm not an American. What I did was to make a statistical analysis and list its most obvious conclusion, that mandatory cycling helmets in the States would save lives. It's up to Americans whether they want to save American cyclists' lives.

Ultimately it's a political/civil rights/free society matter just like motorcycle helmet compulsion was. Fred Hill died in prison for this  http://www.mag-uk.org/en/aboutmag/a6325

That immediately raises the question, if you conceded helmets for motorcyclists, and seatbelts for the occupants of cars, what's the problem with conceding helmets for cyclists? Your case is already fatally undermined by precedent.

[Slammin Sammy]

Appropriate of this discussion, an interesting study was recently brought to my attention: http://usa.streetsblog.org/2015/01/09/study-what-puts-cyclists-at-greatest-risk-its-not-what-you-wear/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+streetsblog%2Fehob+%28Streetsblog+USA%29

The report says "When a cyclist is killed or seriously injured, the responses you hear often pin the blame squarely on the victim. “Why wasn’t she wearing a helmet?” Or, “Why was he wearing dark clothing? “

"But according to a new study [PDF] by a team of Canadian university researchers, those factors don’t seem to have much impact on the overall severity of injury when cyclists are hurt in collisions."

"The report looked at injury severity among about 700 adults in Toronto and Vancouver who were hospitalized after a bike collision or fall. Researchers teased out which factors had the biggest impact on the extent of people’s injuries."

In particular, "The study looked at all types of injuries, not just head injuries. Helmets only prevent head injuries and only certain types, researchers noted. Those effects did not register in this study, which found helmets had no statistically significant impact on overall injury severity."

You can certainly reduce bike accident injury frequency and severity by not riding a bike, but that's not the point, is it? Wearing full motorbike gear might also help, although it'd be mighty uncomfortable and would probably cause some accidents.

While wearing helmets may make us feel a little more secure, and may just work to prevent a particular injury from occurring, it actually distracts us from the real issues of safe riding, including separation from motorised traffic, riding behaviours, equipment condition, etc.

Theoretically, the more people encouraged onto bikes by removing these disincentives (anecdotally, MANY people don't ride because of helmet laws), the more bike friendly the culture becomes. It worked for Denmark and Holland, didn't it?

[Andre Jute]

The Netherlands and Denmark enjoyed the benefit of already having a cycling culture, an incalculable advantage.

That's a really good point, that a helmet isn't a magic bullet that will save you from a broken collar bone or leg or worse. The problem with a systems approach to cycling is that the most likely outcome is licensing of cyclists and their bicycles, to control their skills and machinery, exactly as for cars, a worse intrusion upon privacy than merely mandating helmets.

At present neither cyclist nor cycle needs anyone's permission to be on the roads. So I take the view that cyclists own those roads, and the motorists are there by license, a license which can be withdrawn in cases of anti-social behavior. If this sounds strange to you, that is precisely the case in The Netherlands, when you reduce it to bare bone. We don't want to upset that balance by attracting the attention of politicians to an area they haven't yet legislated for.

What all this comes down to isn't really about cyclists, it is about educating intransigent motorists. Which bring us back to the Dutch and Danish cases, where every motorist is also a cyclist, and many cyclists are also motorists, and the culture we admire so much was thus in place before the infrastructure grew so massively.

[triaesthete]

  Wasn't making a case m'lud. Jus' sayin'. Fred took the stance he did precisely because it was a precedent....

This might make the case for helmets stateside though:   https://www.youtube.com/watch?v=0npCFw9TEnA

Namaste

[JimK]

This might make the case

New York City! It really is nuts!

[honesty]

your maths is wrong, and your assumptions are incorrect.

you assume that because 74% of fatal accidents included a head injury that all these fatalities were caused by the head injury. 100% of the fatal accidents included clothing, but clothing did not cause the fatalities...

[Slammin Sammy]

Denmark and the Netherlands have not had their bike cultures as long as you think, although it's fair to say they never had the car culture to the same degree as the USA, Canada, Australia or even the UK. AFAIK, their bike culture is largely postwar, and in the case of Denmark, post 1960. (Of course, bikes had always been popular, just not as well catered for.)

The bike culture arose from a realisation that by adopting the USA-style car culture sweeping the world after WWII, their cities would literally have to be destroyed and rebuilt to accomodate motor transport. Luckily, it was unaffordable and unacceptable. The growth in their bike (and pedestrian) culture grew out of necessity, but was enabled by a new approach to urban planning which emphasised the human scale. The flow-on effect of a bicycle-inclusive transport infrastructure and the huge adoption of bikes for transport, is a much greater respect for cyclists' rights on the road and a far lower accident frequency.

So it is our great hope that if this culture can be adopted or "learned" in those places, we can get at least part of the way here.

[Andre Jute]

your maths is wrong, and your assumptions are incorrect.

In that case, we can stop wasting time on that article right here. Thanks.

you assume that because 74% of fatal accidents included a head injury that all these fatalities were caused by the head injury.

Read what I said again. In particular, try to get a feeling for the connection between these four items:

• Most fatal crashes (74%) involved a head injury.
?• Nearly all bicyclists who died (97%) were not wearing a helmet. ?
• Helmet use was only 3% in fatal crashes, but 13% in non-fatal ?crashes
.... [for sources and reasoning see original article] ....
• If all the fatalities had been wearing a helmet (100%), somewhere ?between 10% and 57% of them would have lived. This number is less firm ?to allow for impacts so heavy that no helmet would have saved the ?cyclist. [Emphasis added]

What you see is just the executive summary article. I explained in earlier articles how the numbers are derived. The anti-helmet zealots on RBT, at whom the article was aimed, were desperate to discredit it, and include several professional mathematicians, and guess what, not one of them was foolish enough to accuse me of incompetence, or even of the lesser crime of rash math. Objectively, I'm being overly cautious.

The inescapable fact is that many American cyclists, very likely hundreds of American cyclists, every year die needlessly on the roads because of irrational resistance to helmets by people who in cars automatically belt in. Quibbling around the edges of the numbers and the logic chances nothing because I've already built in huge (5.7x) safety margins to the statistical extensions.

The statistics and logic are unassailable. It is now a moral and political question. Do Americans want to save those cyclists or will they let them die for a "principle" they betray daily?

You are of course welcome to make your own analysis. You could start with my numbers (above) showing that in terms of total life expectancy and social benefit, cycling is safer than was previously thought by even the most rabid anti-helmet zealots. After that, you'd better ignore the New York study altogether, pretend it doesn't exist, because as a multi-year full universe headcount (not a sample) conducted by thousands of unimpeachable witnesses (policemen, nurses, doctors), it is rock-solid, no fingerhold for quibbling, and it points only one way.

100% of the fatal accidents included clothing, but clothing did not cause the fatalities...

Let's apply your argument to a proven commonality: 100% of the dead cyclists were by definition on bicycles, but being on bicycles did not cause a higher rate of fatality than being in an automobile. That's an obvious falsehood, arrived at by the same method you choose.

[honesty]

Look you can post your long "articles" as much as you like, but the basic statement you made at the start is plain wrong. You state 74% of deaths had head injuries. You then seem to take this to mean died from head injury. If you cannot see the difference then there really is no point.

Reading your guff again, bonus logic fail - that 13% of the serious injuries were saved from death because they were wearing helmets. No attempt at removing other causes.