“Both read the Bible day and night,. But thou read’st black where I read white.”
- William Blake, “The Everlasting Gospel”

A group of academics from Sydney, the capital city with the lowest cycling rates in the country, have recently been engaging in an extensive debate about the effectiveness of mandatory helmet laws (MHL) in Australia. Their articles may be found in academic journals and their op-eds appear on such sites as the Sydney Morning Herald, The Age, ABC News, and The Conversation. Another commentator, Alan Davies, examines the research and history concerning the laws on his blog (now part of Crikey.com), The Urbanist. From the University of NSW, the main pro-MHL academics are Jake Olivier, Scott Walter, and Raphael Grzebieta - statisticians and road safety academics.

On the helmet choice side of the debate, from the University of Sydney, is Chris Rissel, a public health academic. Elsewhere in Sydney, at Macquarie University, Piet de Jong, a professor of actuarial studies and statistics, has written on the costs and benefits of a mandatory helmet law. Dorothy Robinson from the University of Newcastle and Simon Batterbury from the University of Melbourne are also actively involved in the online debate at The Conversation.

The problem with the UNSW studies is not in the statistics; a huge amount of work has been done in the paper (Bambach et al, 2013) to cross-reference injury and police data. Bambach et al note that previous case control studies have had limitations such as small sample sizes. The studies are purely observational and conducted in a mandatory helmet law environment where fines are enforced. Sydney is 64% of the population of the state of New South Wales and 2011 Census data shows that 0.9% of Sydney workers commuted to work by bicycle – 15,000 out of 1,646,000 on Census Day 2011, the lowest of all capital cities.

New South Wales as a state had the same 0.9% bicycle modal share of commuters in 2011, the lowest of any state except Tasmania. The study was conducted using data between 2001 and 2009 when cyclists were even more marginalised than today.  American cycling expert John Pucher in 2010 “found the level of the hostility of enough Sydney motorists worse than I had seen anywhere in the world”. The vice president of Cycling NSW, Richard Birdsey, said in 2010 concerning Sydney that “[upright bikes are designed ... for women] … If you are moving in the serious traffic here you need something a bit quick, something you can throw around, something more performance oriented.”

The paper refers to a “debate regarding the effectiveness of cycling helmets in preventing head injuries”. To some extent, the sides are arguing at cross purposes; the paper refers to the debate being about helmets but the commentary on the paper in the media is about helmet laws. Evidence that the focus of the paper is on helmets rather than helmet laws per se is that it does not cite any papers by Rissel, de Jong or Robinson.

The conclusion of the paper was that

“This case–control study of 6745 cyclist casualties resulting from collisions with motor vehicles has indicated that helmet use is significantly associated with reduced risk of head injury by up to 74%.”

and

“Given the large protective effect of helmets demonstrated in the present study, this issue should be addressed with preventative action.”

Presumably the preventative action would involve the stricter enforcement of existing mandatory helmet laws in NSW, as well as segregated cycling facilities. However, a well-known result in the Netherlands (Rijkswaterstaat, 2008), a country without MHLs (and helmet use among all cyclists <1%) found that “13.3% of cyclists admitted to hospital were wearing helmets when they were injured.”. Instead of drawing the conclusion that helmet use leads to injury, the most reasonable conclusion would be that the legal environment determines the behaviour of cyclists. Thus, in the Netherlands, the helmeted cyclists are the “risk takers”, the sports cyclists who are more likely to be injured, not the everyday cyclists.

The problem with the studies is more in the interpretation of the paper’s results; the “post-processing”. The media remarks made by the authors involve huge leaps of logic.

Grzebieta:

“…we had the information as to how it occurred, so in other words from the crash data we were able to determine whether a person was at fault or not.”

This fails to account for the possibility of the assignation of blame by the police being biased due to a lack of helmet wearing by the injured cyclist, as well as bias due to cycling no longer being a “normal” form of transport in Australia.

Olivier:

“The evidence says helmets work: they minimise the risk of injury.”

Again, as explained repeatedly by helmet freedom advocates, enforced mandatory helmet laws change the cycling population. Some potential cyclists will give up cycling.

Professor Rissel commented

“You’ve got helmets creating a barrier to cycling, particularly spontaneous, short-trip cycling”.

Thus, in an enforced MHL environment, cycling becomes associated almost exclusively with commuting and sports, or recreational cycling – the opposite of the Netherlands. In turn this has led to lower numbers cycling and may have to led poorer cycling facilities than would have existed without the law. This supposition is backed up by the statements of Pucher and Birdsey above.  In particular, the spontaneous trips associated with bicycle sharing schemes are drastically curtailed, and this can be seen in the trips per bike per day figures for the Brisbane and Melbourne schemes. A 2012 study by Forrest (Table 9) showed that helmet laws were the biggest barrier to the use of the schemes among non-cyclists, regular cyclists and bike sharing scheme users. Brisbane’s CityCycle scheme has 150 stations and at least 1800 bikes and has the potential to revolutionise inner-city travel, but is being held back by a misguided law and lack of dedicated facilities.

Remarks on The Conversation web site, where both Olivier and Grzebieta responded to their critics, smacked of “argument from authority”. Grzebieta challenged one of his critics asking about his academic papers in the area and cites the “head of the Dutch road authority” as saying at a Canberra conference that “if they could get MHL through they would do it in an instant”. **

This conflicts with the 2012 recommendation cited in the same thread that it is more important to build safe cycling infrastructure than impose a helmet law. Wegman, the head of SWOV, the authority, does not mention helmets in a 2011 column. Indeed another SWOV paper from 1994 draws a careful distinction between “everyday cycling” and “recreational cycling” which is a key omission from the UNSW academics’ entire output. 

** We have done some investigating and no such person visited Australia. Grzebieta is referring to a presentation given by Ms Nel Aland entitled, “What a small country can be good at (besides football)”, and she is on Linkedin. Her position is  the ‘unit head of a department for analysis and development, of the air transport inspector at the governmental inspection for the environment and transport’. She is not the ‘head’ of a ‘Dutch Road Authority’ at all and if you search for ‘bicycle’ or ‘bicycle helmet’ (in Dutch, of course) on their site you will find no mention of them. The Dutch Minister for Transport recently confirmed in the news that she does not support a mandatory bicycle helmet law and the only organisation that is pro-helmet (but not pro-helmet-LAW!) is the SWOV… but they were also against priority for cyclists on roundabouts! In The Netherlands, this is an outlier viewpoint. No Dutch organisation supports mandatory bicycle helmet laws. None.

In a mandatory helmet law environment, there are all sorts of confounding factors when examining the accident rates and severity of accidents, comparing helmeted and non-helmeted cyclists. The study attempted to account for alcohol use and disobeying traffic signals. This issue has been commented on extensively at The Conversation. In an MHL environment, it may well be that a lack of helmet use is associated with other factors which were not measured in the police data – for example cyclist speed. And how exactly does a “footpath cyclist” have an accident with a motor vehicle as in the study’s controls? In megacities such as Tokyo footpath cycling is considered the norm and does not require helmet use.

In summary, both sides rely on the same data but reach different conclusions.  The pro-helmet-law academics, who seem to be most prevalent in countries with existing helmet laws, rely on observational studies and make large leaps of logic to try to show the law is justified.

Helmet freedom supporters, in contrast, take a more international approach and concentrate on the public health benefits of cycling outweighing the costs and civil liberties issues.

The critical questions never answered satisfactorily by the coterie of UNSW academics are as follows:

• How is it that after more than twenty years of MHL in Australia and NZ, the other 191 countries in the world have not rushed to copy the laws? Aren’t good ideas supposed to travel? In fact, apart from these two examples, adult bicycle helmet laws are almost unique to regions of English speaking countries such as the United States and Canada, with the exception of Dubai. Naturally, these countries also have high car ownership rates.

• Why do foreign cycling experts such as John Pucher, Jan Gehl, and Mikael Colville-Andersen urge against bicycle helmet laws? Sure, this is an argument by appeal to foreign authority, but listening to foreigners can help overcome our blind spots.

• Why do Australian bicycle sharing schemes have such low usage rates compared to schemes worldwide? In fairness, one of the UNSW academics, Tim Churches, suggested the “tiny size” of the schemes at The Conversation but this is incorrect as Brisbane’s scheme is one of the larger schemes, with 150 stations.

If that were the case, then all driving would be banned immediately. Like most things in life the answer isn’t always as obvious as many have us believe.

Public health & safety is serious but it is important to weigh up all the risks and benefits so we may put them into perspective. Too often the issue is patronisingly simplified, with plenty of emotion, to justify a law. This is particularly the case when that law is imposed by people unaffected by it.

Mandatory bicycle helmet laws are one such example. It’s about time Governments looked at the issue more broadly, from a public health perspective. If they looked at the evidence it would be quite clear that mandatory bicycle helmet laws are a public health disaster, not to mention the disastrous effect it is having on our public bicycle hire schemes.

Don’t forget to add your support to the Freestyle Cyclists petition. Helmet choice is about just that: choice. It’s not about forcing you to wear helmets and it’s certainly not about banning helmets as some helmet law supporters would have you believe.

A recent study into the reasons for the disappointing usage of Australia’s two bike share schemes has confirmed what many people already know: public bike share will not work with mandatory helmet laws.

Usage rates of Brisbane’s CityCycle and the Melbourne Bike Share are terrible. This new research confirms what we have previously reported; that Brisbane and Melbourne are receiving only 5-10% of the usage we should expect of successful bike share schemes.

The authors note:

“Both schemes have approximately 0.3–0.4 trips per day per bike according to information supplied by the operators to the authors…..most other schemes internationally report usage rates of around 3–6 trips per bike per day.”

Every bike share scheme in the world except for Brisbane and Melbourne allows people to ride without helmets (which is perfectly safe). It is this compulsory helmet requirement that most people say is the main factor preventing them from using the Melbourne Bike Share, as shown in Figure 1 below.

Figure 1. Source: E. Fishman et al. (2012), Barriers and facilitators to public bicycle scheme use: A qualitative approach, Transportation Research Part F

Over 60% of respondents cite helmet restrictions as being the main reason stopping them from using bike share.

When you exclude those who claim bad weather as their main obstacle (which is surely beyond the power of any government or transport authority to influence), helmet laws become even more obviously predominant.

The study found similar reasons for the poor patronage of Brisbane CityCycle. Analysis of CityCycle was done through “focus group discussions” rather than a survey, so the results are descriptive rather than statistical. But a familiar story emerges.

The authors write:

“Participants who had not used CityCycle frequently described mandatory helmet laws as a reason for not using the scheme. Focus group participants felt the requirement to use a helmet reduced the spontaneity often associated with public bike share scheme use.”

Despite having some compelling evidence in front of them, the authors recommendations are weak and disappointing. They suggest Australian bike share needs:

• a more accessible, spontaneous sign-up process
• 24/7 opening hours
• greater incentives to sign up new members and casual users

While there is no doubt that these things are useful suggestions, they do not even come close to explaining why Brisbane and Melbourne are operating at one-tenth the usage they should be.

Melbourne Bike Share already has an instantaneous sign-up process (credit card swipe) and it doesn’t have significantly higher usage than CityCycle which has a longer, more complicated sign-up.

24-hour operation would be beneficial but it’s inconceivable that it would lead to anything more than a marginal increase in usage, certainly not the 10-fold increase that the schemes need.

Why do the authors not make any suggestions about what is clearly the main reason for the failure of Australian bike share: mandatory helmet laws? Why is there no consideration of an exemption from helmet laws for bike share users, as has been suggested by Fairfax journalist Michael O’Reilly and others in the media and community?

This seemingly strange omission becomes understandable when we note that the three authors of this study are from the Centre for Accident Research and Road Safety – Queensland (CARRS-Q), based at the Queensland University of Technology. CARRS-Q was the group that last year produced a publication in support of mandatory bicycle helmet legislation which was commissioned and paid for by (and included editorial input from) the Queensland government.

We have written extensively on the deficiencies and biases of this publication, including some general criticisms here and here and a seven-part in-depth critique beginning here.

Given the preconceived views of it’s authors it is unsurprising that this latest research fails to suggest that it might be time to rethink our stance on compulsory helmets. This is disappointing because their own evidence clearly shows that helmet laws are the primary reason for the failure of bike share in Australia.

The International Transport Forum (an intergovernmental OECD organisation of which Australia is a member) has recently released a publication on cycling safety, entitled Cycling Safety: Key Messages.

Amongst other things, the report considers the effectiveness of promoting or mandating helmet use for increasing safety.  It finds:

Helmet usage reduces the severity of head injuries in cycle crashes but may lead to compensating behaviour that otherwise erodes safety gains.

Studies addressing the safety impact of helmets can generally be split into two groups: those that focus on the way in which bicycle helmets change the injury risk for individual cyclists in case of a crash and those that focus on the generalised safety effect of introducing measures (typically campaigns and/or legislation) to increase helmet usage among cyclists.

The first group generally finds that wearing a bicycle helmet reduces the risk of sustaining a head injury in a crash (head injuries are among the most severe outcomes of cycle crashes) though recent re-analysis of previous studies suggests that this effect is less than previously thought (Elvik, 2011).

To be clear — these studies indicate the possible reduced risk of head injury for a single cyclist in case of an accident. The effects must not be mistaken for the safety effects of mandatory helmet legislation or other measures to enhance helmet usage.

The safety effect of mandatory helmet legislation as such has been evaluated in far lesser studies than the individual risk in case of an accident. The safety effect of mandatory helmet legislation is a result of a series of factors:

• reduced injury risk (due to increased helmet usage)
• increased crash risk (due to an often claimed change in behaviour amongst cyclists who take up wearing helmet)
• less cycling (leading to a reduced number of accidents and injuries, but also to a higher accident risk for those who still cycle)

Whether bicyclists change their behaviour when they start to use a bicycle helmet seems very uncertain (and difficult to prove) but it is evident that mandatory helmet use might reduce the total number of bicyclists. It is also possible that cyclists who continue to bike might represent a behaviour which is different from the behaviour of those who stop biking. In the end this could very well lead to an overall change in behaviour.

Although the report makes 11 recommendations of ways for governments to improve safety for cyclists, there is no recommendation to make helmets compulsory.

The publication also presents a number of other interesting findings and recommendations:

• On balance, the positive health impacts of cycling far outweigh negative health impacts
• Cyclists should not be the only target of cycling safety policies – motorists are at least as important to target
• Cycling is safer on roads with bicycle specific infrastructure such as segregated lanes than on roads without

These are the sort of points that Australian governments should be basing our cycling policies around. Any measures, such as compulsory helmet laws, which reduce cycling numbers are likely to produce a net detrimental effect on the overall health of the community.

Efforts to reduce serious injury for cyclists must focus on the main source of the danger itself – namely collisions with motor vehicles. Mandatory helmet legislation does nothing to prevent these collisions occurring in the first place and the reduction in population-wide injury risk is non-existent or at best very small.

This is why the OECD forum has found there is no case to recommend compulsory helmets and as such it would be prudent for the few jurisdictions like Australia that do have these laws to repeal them.

Freestyle Cyclists are launching their campaign for reform of Australia and New Zealand’s bicycle helmet legislation next month with a keynote address from Chris Rissel, Professor of Public Health, University of Sydney.

From http://www.change.org/petitions/repeal-mandatory-bicycle-helmet-legislation:

MANDATORY HELMET REGULATION HAS- 

-Drastically reduced bicycle use since it’s introduction.
-Discouraged commuters from using bicycles, as opposed to other forms of transport.
-Lead to a complete failure of our bike-share program.
(Bike-share programs in similar cities have on average 2500% more uptake!)
-Prevented/discouraged new users (locals & tourists alike) from taking up cycling.
-Contrary to popular belief; possibly lead to a HIGHER accidents to number-of-cyclists ratio, according to stats.

-Caused bike lanes/paths, costing the government millions (of our tax money), to lay practically unused.

All case-controlled studies supporting the legislation are all disputed.
A nation-wide review concluded that there was no evidence that the laws had reduced head injuries.
A district court judge agreed that there is no conclusive evidence to the benefits of wearing bicycle helmets.

Most similar/major cities/countries in Europe & elsewhere have successful widespread bicycle patronage, without helmet regulations, with very little in the way of injuries or accidents.

A Country Where An Adult Is Treated As Such - Anywhere but Australia & New Zealand! (Photo: Dr P Martin)

Why you should dismiss the CARRS-Q bicycle helmet research

CARRS-Q’s Analysis of Police & Hospital Data

This is the final post in a series (Read Part One, Part Two, Part Three, Part Four, Part Five, Part Six) looking at the non-peer reviewed CARRS-Q publication entitled ”Bicycle Helmet Research“, published in 2011 and widely relied upon to support mandatory helmet laws for cyclists.  This publication was commissioned by the State Government to support its policy of mandatory helmet laws in Queensland, Australia, in the face of criticisms of its lack of support for Brisbane’s public bike hire scheme.

In addition to selective reliance pre-existing analyses of the efficacy of helmet wearing discussed in previous posts, CARRS-Q also sought to conduct its own analysis of data.  Data was sourced from police records and hospital data provided by the State Government’s Department of Transport and Main Roads.

The data was restricted to the years 1993-2008, and so cannot give any comparisons of injuries before and after mandatory helmet laws were introduced in Queensland in 1991.  The limitations to this data were recognised by CARRS-Q as follows:

“Reliable earlier data were not available and so all of the crash data analyses relate to after the helmet law and penalty were introduced.” (CARRS-Q, 2011, page 25)

“Research indicates there is significant underreporting of bicycle crashes … International figures suggest between 11% and 13%of bicycle crashes are reported in police statistics.  The reporting rates are even lower in Australia, with analysis of Western Australia data suggesting that only 3.5% are reported.  Actual reporting rates may be even lower, as these rates are calculated using hospital data.” (CARRS-Q, 2011, page 25)

“There are also suggestions that police-reported data will not only underestimate the magnitude of the cyclist injury problem, but it is likely to be skewed to serious injury crashes and those that involve motor vehicles.” (CARRS-Q, 2011, page 25)

“Within the hospital data, only the primary reason for hospitalisation is reported.” (CARRS-Q, 2011, page 25)

“[C]rashes that occur on private roads or on public paths that are not within the road reserve (e.g. segregated bicycle paths through public paths) are excluded from official records.” (CARRS-Q, 2011, page 25)

“[A]ny changes in the patterns of crash severity, hospitalisation rates and other non-fatal data from 2006 onward may reflect changes in the reporting system, rather than changes in any actual injury outcomes.” (CARRS-Q, 2011, page 25)

Data analysis by CARRS-Q was restricted to after helmet laws were introduced, which is of some concern given that the Victorian research discussed in a previous post showed significant anomalies between pre-helmet law injury rates and post-helmet law injury rates that could not be attributed to helmet use.  Additionally, the data used probably only represents somewhere between 3.5% to 11% (possibly even lower) of all bicycle crashes, and is likely to only include crashes that occur on roads and only include the most serious injuries.

Limiting the analysis only to a period after helmet laws were introduced means that:

“… the data analyses cannot provide information on whether the introduction of helmet legislation led to a reduction in the percentage of injured cyclists who had head injuries.” (CARRS-Q, 2011, page 39)

Similar to some of the research discussed in a previous post, CARRS-Q concludes that the proportion of head injuries and facial injuries was lower for those riders who were wearing a helmet.  However, also consistent with that previous research, the CARRS-Q analysis of the data noted that helmet wearing rates were lower for children and youths:

“Recorded helmet use rates are highest (approximately 80%) among injured cyclists aged 25 years or older.  Helmet use trends are the lower for younger riders, with similar rates for primary and secondary school aged children (5-11 group and 12-17 group).” (CARRS-Q, 2011, page 39)

“Wearing rates were lowest by cyclists aged under 20, with a steady increase with age.” (CARRS-Q, 2011, page 40)

As demonstrated by the research discussed in a previous post, these age groups are much more likely to have a crash.  CARRS-Q also found that:

“[b]oth helmeted and non-helmeted cyclists aged 0-4 demonstrated a high proportion of head injuries, while cyclists without helmets also had a higher proportion of lower limb injuries in this age group.” (CARRS-Q, 2011, page 39)

“Most cyclists killed are males in collisions with motor vehicles with 15-29 year olds being most commonly involved.” (CARRS-Q, 2011, pages 39 and 40)

Limiting the data only to a period when helmets were required by law, and only to roads where helmets must be worn, means that any non-helmeted crash victims included in the survey fall into a very specific category: law-breakers.  As well as the likelihood that non-helmeted cyclists belong to an age group more likely to have a serious crash, it can also be assumed that any adults riding without a helmet against the law may also be risk takers (the ‘risk’ is a hefty fine – up to $150 in some states in Australia).

CARRS-Q also concluded that injury severity was lower for cyclists wearing a helmet.  However limiting the analysis only to the very small percentage of the most serious injuries will give a false representation of any association between helmet use and crash severity.

CARRS-Q also analysed Australian bicycle fatality data it obtained from:

“ … published reports and on relevant websites. Primary references will include the Australian Transport Safety Bureau reports, “Cycle safety: A national perspective.” (2004), “Deaths of cyclists due to road crashes” (2006) and “Road Deaths Australia 2008: A statistical summary” (2009). Some of the detailed data (such as helmet wearing) is dated and any fatalities occurring in off-road riding are not included.” (CARRS-Q, 2011, page 34)

From this data CARRS-Q concluded that:

“… the number of cyclists killed per year has approximately halved since 1991 (when helmet legislation was introduced in most jurisdictions.” (CARRS-Q, 2011, page 35)

Here is the graph used by CARRS-Q, generated from the data analysed, to justify this claim:

(Source: CARRS-Q, 2011, page 35)

Despite CARRS-Q’s claims, what the above graph clearly shows is that there was no clear drop in fatalities at the time helmet laws were introduced, followed by a constant plateau as helmet laws remained constant, which would be the expected result if helmet laws had any effect on injuries and no effect on cycling participation. In fact, what the graph shows is that while there was an initial drop in 1992, the number of cyclist fatalities in 1993 actually exceeded the number of fatalities immediately before the introduction of the helmet laws. Coincidentally, the penalty for not wearing a helmet was introduced in 1993. What follows is an unsteady but gradual decline in fatalities. This graph more appropriately supports the contention that helmet laws have simply continued to reduce the number of cyclists since their introduction.

CARRS-Q admits that:

“First and foremost in a discussion of the effectiveness of bicycle helmets, it should be noted that the datasets from which these reports are created do not record the helmet use of injured persons.  Direct comparisons of the outcomes of injured persons wearing or not wearing helmets are therefore not possible.” (CARRS-Q, 2011, page 36)

So what does the CARRS-Q analyses of existing data, and all the previous research discussed in previous posts actually prove?

CARRS-Q makes the headline-grabbing claim that current helmet wearing rates are halving the number of cyclists’ head injuries in Queensland.  This claim makes a number of rather dubious assumptions. In its conclusion CARRS-Q says that, because only crashes can be examined and there is no way to randomly assign helmeted and unhelmeted participants to certain road conditions:

“ … it can always be argued that the riders who wear helmets are somehow intrinsically safer riders than those who do not, or that those who ride on footpaths are somehow different than those who ride on the road or that people who chose to cycle would have been healthier anyway.” (CARRS-Q, 2011, page 41)

The actual conclusions that can be drawn from the above fall significantly short of CARRS-Q’s bold claim.

There are some consistent findings in the research discussed above and in previous posts, including the peer-reviewed research CARRS-Q chose to ignore. Such as:

• Children and youths are most likely to suffer a cycling related crash that is serious enough, or possibly serious enough, to be reported.

• Children who do crash are most likely to suffer a minor head laceration that is superficial (i.e. lots of blood, nothing seriously hurt, the type of inury that an adult would have avoided by instinct or experience, for example holding their hands out break their fall).

• Children, especially teenagers, are also the most likely not to wear a helmet.

• Children, especially teenagers, are also most likely to give up cycling if helmet wearing is mandatory.

• Helmet wearing significantly reduces the number of people choosing to cycle across all age groups.

• Significantly increased numbers of people cycling make cycling safer for those that cycle, however that increased safety is likely to diminish if cycling becomes the most popular form of road transport.

• The biggest killer of cyclists is motor vehicles, specifically articulated or rigid trucks.

• Cycling is inherently a safe means of transport.

• In social economic cost terms, increasing cycling will result in savings across the areas of health, transport infrastructure, pollution and productivity that outweigh any costs that can be associated with cycling-related injury.

• The possible decreased likelihood of a serious head injury that can be attributed to wearing a helmet, is probably negated by the likelihood of a neck injury.

These findings boil down to a couple of salient points:

First, the difference in the effect of helmet laws on children and adults means that any non-age group specific assessment of helmet wearing rates for crash victims is flawed. There are significant differences in cyclist injury rates for children compared to adults.  Children cyclists are much more likely to suffer injury:

(Source: CARRS-Q, 2011, page 37)

New research by CARRS-Q itself, confirms that teenagers and other cyclists who fail to wear helmets (in jurisdictions where they are required to wear them by law) are much greater risk takers.

Any change in the age demographic of riders over a period of time is going to significantly change the injury statistics over that same period of time. Unlike the efficacy of helmets which should be clear between a time when helmets were not mandatory and helmets were mandatory (e.g. pre- and post-introduction of mandatory helmet laws), changes in the age demographic of cyclists will evoke a gradual change in statistics, such as can be seen in the graph discussed above, entitled Figure 16: ‘Numbers of cyclist (rider and pillion) fatalities in Australia and Queensland from 1991 to 2009′.

Secondly, on a community scale, the economic advantages from increased cycling far outweigh the possible disadvantages of reduced helmet use.

Thirdly, there is no clear, unequivocal evidence that wearing a bicycle helmet provides any significant protection from serious or life-threatening injuries including neck injuries. It is only clear that helmets protect from minor injuries to the head such as superficial lacerations (cuts and bruises etc.)

Fourthly, the lack of real, unequivocal evidence allows political agendas to pick and choose certain findings, so that bad policy decisions can appear to be supported by ‘science’.

This concludes our comprehensive assessment of the CARRS-Q document used by the former Queensland Government to boost support for mandatory bicycle helmet laws.

Source: Sydney Morning Herald

Image Source

Why you should dismiss the CARRS-Q bicycle helmet research

Do Helmet Laws Discourage Cycling?

This is the sixth post in a series (Read Part One, Part Two, Part Three, Part Four, Part Five) looking at the non-peer reviewed CARRS-Q publication entitled ”Bicycle Helmet Research“, published in 2011 and widely relied upon to support mandatory helmet laws for cyclists.  This publication was commissioned by the State Government to support its policy of mandatory helmet laws in Queensland, Australia, in the face of criticisms of its lack of support for Brisbane’s public bike hire scheme.

Two key findings of the CARRS-Q publication are that mandatory helmet laws:

“discouraged people from cycling twenty years ago when it was first introduced … [however] there is little evidence that it continues to discourage cycling.” (CARRS-Q, 2011, page 53)

and

“ … there is little evidence that there is a large body of people who would take up cycling if the legislation was changed.” (CARRS-Q, 2011, page 53)

The CARRS-Q publication doesn’t address the fact that only two bicycle hire schemes in the world are failing, in Brisbane and Melbourne both where helmet use is mandatory; or that the CEO of one of those schemes admits there’s no doubt mandatory helmet laws are affecting the scheme.

While the above effects on bike hire schemes are not research based, CARRS-Q also doesn’t address the continuing decline in Australian children riding to school or anywhere else.  Australian modal share of cycling has only gone from 1.1% in 2000 to 1.5% in 2009. (Australian Bicycle Council, National Cycling Strategy 2011 – 2016, page 14)

The CARRS-Q publication says that:

“[c]ensus data from South East Queensland suggests that the number of journeys to work by bicycle fell after the introduction of helmet legislation … although the most recent available data suggests the absolute numbers now exceeds pre-legislation trip numbers. Measured as a proportion of mode share, bicycle trips to work have fallen from 1.6% pre-legislation … to 1.1% post-legislation.” (CARRS-Q, 2011, page 20)

So, after 20 years, the best that CARRS-Q can claim is that “absolute numbers” of cycling rates in South East Queensland now exceed what they were immediately before helmet laws were introduced.

The population of South East Queensland before helmet laws were introduced was 2.83 million. It is now 4.51 million, an increase of over 66%. The only conclusion to draw from this 20 year stagnation of absolute cycling numbers is that, around about the time of helmet laws being introduced, something happened that severely curtailed cycling in Australia.

The CARRS-Q publication also relies on Melbourne research that:

“ … demonstrated a doubling in the use of bicycles by adults in metropolitan Melbourne.  However, there was a decrease in the use of bicycles by children.  A decrease in cycling exposure of 10% was observed in children (5-11 years) and an even larger decrease of 44% for teenagers (12-17).” (CARRS-Q, 2011, page 20)

What this Melbourne research actually found was that there was a significant decrease in the numbers of children and teenage cyclists as a result of helmet laws. As discussed in a previous post, the Melbourne study also noted a possible increase in adult cyclists but recognised that this was difficult to confirm as the there was 4 years between the two surveys relied upon for ascertaining the number of adult cyclists.  The first survey was conducted in 1987/88, about three years before helmet laws were introduced.

The CARRS-Q publication also relies on data from Melbourne, Perth and Sydney that shows that cycling rates have increased over the last 5 years. Given that helmet laws were introduced 20 years ago in these cities, and rates have only increased in the last 5 years, it is difficult to draw any correlations between these recent increases and the effect of helmet laws.

During the regime of mandatory helmet laws, an entire generation has attained an age historically popular for cycling.  Australians under the age of 25 cannot remember a time when helmets were not mandatory.  It is extremely dubious to rely on these recent increases as evidence that helmet laws do not affect cycling rates.  However this is exactly what the CARRS-Q publication does.

The CARRS-Q publication concludes that:

“It is reasonably clear that [helmet laws] discouraged people from cycling twenty years ago when it was first introduced.  Having been in place for that length of time in Queensland and throughout most of Australia, there is little evidence that it continues to discourage cycling.” (CARRS-Q, 2011, page 53)

One can only assume that CARRS-Q is referring to some type of evidence other than the woeful cycling rates mentioned above.  Some kind of research specifically asking would-be cyclists whether mandatory helmet laws are the cause of their choice not to cycle.  Recent Sydney-based research addresses exactly this question, and identifies that 23.6% of adults would cycle more often if they didn’t have to wear a helmet. (Rissel et al: The possible effect on frequency of cycling if mandatory bicycle helmet legislation was repealed in Sydney, Australia: a cross sectional survey, Health Promotion Journal of Australia, page 181)

Of specific interest is the Sydney report’s findings that mandatory helmet laws discourage 19% of non-cyclists from any type of cycling. In other words, here is research that shows that existing cyclists would ride more often, and non-cyclists would start riding, if helmet laws were repealed.

It should be noted that, while criticism can be made of this study on the grounds that the questions were too subjective, the results are in accord with ABS Census data:

Percentage of trips made to place of employment by bicycle before and after introduction of mandatory helmet laws: Queensland

(Source: Summary of Characteristics of Persons and Dwellings Queensland, census data collected 1981, 1986, 1991, 1996, 2001 and 2006, Australian Bureau of Statistics.)

Recent New Zealand research also confirms these findings, finding that regular cyclists ride half as often as they did prior to mandatory helmet laws.

(Clarke: Evaluation of New Zealand’s bicycle helmet law, New Zealand Medical Journal, 2012)

CARRS-Q has ignored significant research showing that helmet laws are directly responsible for significant reductions in cycling. This position removes all credibility the CARRS-Q publication has in comparing the social economic benefits of cycling, including health, traffic congestion, pollution and infrastructure, to the possible costs associated with head injuries if mandatory helmet laws were repealed.

The last post in this series will look at CARRS-Q’s use of existing police and hospital data and available bicycle fatality data.  While CARRS-Q relies on this data to support its stance in favour of mandatory helmet laws, it is clear that the data is unreliable and that CARRS-Q utilises a number of very dubious assumptions to reach its conclusions.

Cycling without helmet laws is safe. Fear is unhealthy.

Why you should dismiss the CARRS-Q bicycle helmet research

Do Economic Benefits from Cycling Outweigh The Head Injuries Prevented By Helmets?

This is the fifth post in a series (Read Part One, Part Two, Part Three, Part Four) looking at the non-peer reviewed CARRS-Q publication entitled ”Bicycle Helmet Research“, published in 2011 and widely relied upon to support mandatory helmet laws for cyclists.  This publication was commissioned by the State Government to support its policy of mandatory helmet laws in Queensland, Australia, in the face of criticisms of its lack of support for Brisbane’s public bike hire scheme.

The CARRS-Q publication relies on a series of Victorian reports to find that:

“These reductions represented a considerable saving each year, for example a reduction of 40 severe head injuries (assuming $408,000 each) per year translated to savings of just over $16m per year.” (CARRS-Q, 2011, page 18)

Other researchers in other States have been critical of this series of reports.  A West Australian study has found that:

“The magnitude of the decreases suggested by [the West Australian study] are below those found by Carr et al (1995) in Victoria [the fourth study discussed in Part Four]. Their findings were that the number of bicyclists hospitalised with a head injury had declined by 40% in the first four years of the helmet wearing legislation in Victoria. The findings of the present study suggested smaller reductions of between 11% and 21% in the number of bicyclists hospitalised with a head injury …”

“The study provided no clear answer as to whether the helmet wearing legislation had been an effective countermeasure in an economic sense …”

“In monetary terms, it is unlikely that the helmet wearing legislation would have achieved net savings of any sizeable magnitude. Under the assumptions used in the study, the most favourable estimate of the Net Present Value of the bicycle helmet legislation was $2.0 million, and this calculation excluded any costs associated with reduced cycling activity.” (Hendrie et al, Road Accident Prevention Research Unit, Department of Public Health, University of Western Australia: An economic evaluation of the mandatory bicycle helmet legislation in Western Australia, Insurance Commission of Western Australia Conference on Road Safety, 1999).

This West Australian study was not mentioned at all in the CARRS-Q publication.

The CARRS Q publication also reviews a huge number of reports all of which found clear economically significant social benefits for cycling. (CARRS-Q, 2011, Chapter 2)

These benefits are estimated to be between 40 cents per kilometre to NZ$2.14 per kilometre. (CARRS-Q, 2011, page 5)

In finding that head injuries economically outweigh other benefits, CARRS-Q also quoted a 2009 survey conducted for Sydney Metropolitan Cycle Network project, stating health benefits from cycling are only 1.42 cents per kilometre.  (CARRS-Q, 2011, page 5)

However here is the actual cost analysis republished in the CARRS-Q publication (CARRS-Q, 2011, page 10):

Table 1. Estimated impact of cycling per bicycle kilometre travelled (Table 1 from PricewaterhouseCoopers, 2009).

As can be seen from the actual figures, the total social economic benefit far outweighs the costs associated with cycling injuries.

The CARRS Q report also conceded that a Copenhagen study that controlled for (and therefore negated) factors such as age, gender, education, smoking status, cardiovascular conditions and body mass index still found that the benefits of cycling:

“… equated to a 40% lower chance of dying in a given year compared to non-cyclists.” (CARRS-Q, 2011, page 3)

Despite all of this, the CARRS-Q publication states that:

“… [other researchers] conclude that “the combined evidence presented in these studies [from countries without universal helmet legislation] indicates that the health benefits of bicycling far exceed the health risks from traffic injuries, contradicting the widespread misperception that bicycling is a dangerous activity  … Our conclusion differs somewhat: cycling does have significant health benefits and therefore should be encouraged in ways that reduce the risk of the most serious of injuries … protection of the individual by simple and cost-effective methods such as bicycle helmets should also be part of an overall package of measures.” (CARRS-Q, 2011, page 10)

(Ed: we covered this strange conclusion by CARRS-Q in an earlier post)

Although a great body of research confirms there are significant health benefits to cycling, CARRS-Q position is that this research overstates the benefits because:

• Much of the work in this area has been carried out by “advocates.” (CARRS-Q, 2011, page 3)

• People who cycle more may be less likely to smoke and more likely to engage in other forms of physical activity. (CARRS-Q, 2011, page 3)

• People who are already healthy may be more likely to cycle. (CARRS-Q, 2011, page 3)

• Not enough people in Australia currently cycle long enough or often enough for there to be a significant health increase. (CARRS-Q, 2011, page 4)

• Costs relating to cycling crashes should be calculated not in terms of human capital, but in terms of willingness to pay. (CARRS-Q, 2011, page 7)

• The ‘safety in numbers’ effect will not be as effective if cyclists and pedestrians outnumber motor vehicles, because cyclists and pedestrians won’t know how to behave around motor vehicles. (CARRS-Q, 2011, page 8)

• Economic benefits don’t include health costs incurred from non-crash injuries from over-exertion, such as sprains and strains. (CARRS-Q, 2011, page 10)

CARRS-Q believes that the solution is to successfully encourage cycling while retaining helmet laws. This position denies the evidence that helmet laws reduce cycling.

In March 2012 the incumbent Queensland Government (responsible for commissioning the CARRS-Q publication) released an election commitment about cycling that states:

“Cyclists currently save the economy $63.9 million dollars per year in reduced congestion costs and $9.3 million in greenhouse gas emissions.” (On your bike: Getting more Queenslanders cycling, Queensland Labor Party, 2012, page 2)

This estimate of economic benefits, just for reduced congestion and greenhouse gas emissions not including personal health benefits, noise pollution or infrastructure provision, far outweighs the social health costs of head injury considered by CARRs-Q to be only $16 million per year. (CARRS-Q, 2011, page 18)

It is clear that the CARRS-Q publication fails to take a full account of all the social economic benefits of cycling in its assessment.  It is also clear that CARRS-Q took an extremely conservative view of the proven health benefits of cycling, choosing to compare this to an overestimation of possible costs associated with cyclists’ head injuries.   In this respect, the CARRS-Q publication fails to provide a proper, unbiased costs analysis of mandatory helmet laws.

The next post in this series will look at CARRS-Q’s claims that mandatory helmet laws do not discourage cycling.  This position is fundamental to CARRS-Q’s claims about cyclists’ head injury rates (which CARRS-Q denies could be primarily caused by fewer cyclists), and CARRS-Q’s dismissal of the likelihood of significant social economic gains from increased cycling if the helmet laws were repealed.

MHLs are not only unnecessary and unjust, they are inconsistent. Pedestrians and car occupants are each responsible for more hospital patient days for head injuries than cyclists. Despite this, few argue that compulsory walking and driving helmets are essential for safety.

After 20 years, the results are clear: the compulsory bike helmet experiment has failed. We need to amend the law to allow adults the freedom to choose if a helmet is necessary when they cycle.

Some will still choose to wear helmets at all times, and this is a totally reasonable decision. However in many situations it is perfectly safe to go without and Australia should join the rest of the world in allowing this simple freedom.