Cycle Helmets

(Image by Mohamed Hassan/ Pixabay)

Summary

 

In this commentary I describe my own views on why cycle helmets became such a controversial subject. I conclude there are two main (causes:

  • the politicisation of cycle helmets in the 1980’s by institutions apathetic to the value of cycling.
  • confusion about the actual risks of cycling in countries like the UK, which lack specialist infrastructure for cyclists.

This commentary does not review the medical evidence regarding the effectiveness, or otherwise, of cycle helmets. The kind of everyday, utility cycling that normalization involves does not incur risks high enough to justify helmets. Risk in cycling is examined in more detail on this page.

I see the ongoing fixation with cycle helmets as a social problem rather than an issue in objective health and safety. However, since the topic of helmet effectiveness recurs with a tedious importunity, I have reviewed the strengths and weaknesses of different types of research here. [page to be written]

Introduction

Cycle helmets have long been the field of bitter dispute; amongst cyclists,  doctors, lawyers, politicians… Name any group – they’ve bickered. A former editor of the British Medical Journal, Richard Smith, once told me that in his experience, the only other dispute contested on the pages of his journal as intensely as cycle helmets was male circumcision. Officials at the UK Department for Transport have also said they find cycle helmets to be the most difficult issue on their agenda.

None of this should have happened, nor would it have happened had cycle helmets been competently treated within the framework of the Hierarchy of Hazard Controls.

Cycle Helmets in the Hierarchy of Hazard Controls.

The Hierarchy of Hazard Controls is a well-established process for achieving the highest practicable level of safety in a potentially dangerous environment. It is an agenda of actions, starting with the most effective and proceeding through to the least effective (which are only adopted faute de mieux if adequate safety has not been achieved by preceding steps). The hierarchy is:

  • Eliminate the hazard (no hazard, no risk)
  • Substitute the hazard for a lesser hazard (amelioration)
  • Engineering controls (such as physical barriers)
  • Administrative controls (such as training or signage)
  • Protective equipment (helmets, hi-viz clothing)

The Heath and Safety Executive (HSE) applies the Hierarchy as the basis of industrial safety. Indeed, the Hierarchy has been applied across the world to achieve safe travel by air, sea and rail, as well as safe chemical works and refineries. Crashes and explosions do occasionally happen of course, generally in circumstances where the Hierarchy was not rigorously applied, or not applied at all. It may surprise you to know that HSE inspectors take a dim view of helmets and high-viz clothing. They will question why more effort was not made to create a safe environment.

It is only fair to ask the same question of those countries in which cycle helmets have been most forcefully promoted, and in some cases made compulsory. This touches on one reason for the cycle helmets controversy: politics.

There is a stark contrast between industrial safety practices and what is traditionally understood as road safety. A mile of walking through a typical UK city incurs similar risk to a transatlantic commercial flight. It is not that a mile of walking is dangerous by everyday standards, but there is a material risk of death from motor traffic that could be largely removed through more determined application of the Hierarchy in road safety. This is also true for cycling.

By way of illustration, Dutch child cyclists are roughly ten times safer  (per KM travelled) than British children. This particularly scandalous result emerged in my investigation of Dutch versus UK cycling policies since 1950. Read more on this page.

In the Netherlands, the Hierarchy has been applied to protect children whether walking or cycling. The first action of the Hierarchy is to remove the hazard: fast and heavy traffic is excluded from Dutch suburbs and city centres. The second action is to substitute a greater risk for a lesser risk: urban traffic speeds are kept very low. The third action is engineering measures: principal roads in the Netherlands have proper separate paths for cyclists. In urban areas, fast traffic is segregated from living areas.

Therefore, cycle helmets are not considered much of an issue for the Dutch. Effective actions have already been taken to reduce the actual and perceived risk in cycling (although, no doubt more could be done). Helmets are worn by elite level sporting riders and some children. The wearing rate is otherwise very low

(Photo by Alfredo Borba/CC)

Whereas in the UK and most other nations, planners have built (or demolished and rebuilt) conurbations to be places of driving. For the vast majority of the post-war period, cycling was simply ignored as a barbarous relic, whilst pedestrians were corralled out of the way or confined to shopping centres. Helmet promotion was started by cyclists in the 1970’s, mainly in America. Richard Ballantine’s best-selling classic Richard’s Bicycle Book of 1975 is an example of early promotion. Medical and official interest was limited until the late 1980’s, when several studies suggested large reductions in head injuries would follow general helmet use. The process was one of social evolution based on opinion and (as we now know) bad science. This prompted a reaction from those who perceived helmet promotion was merely a sop for institutional apathy. In addition, careful research into risk has shown that cycling is not a high-risk mode of travel even in the UK. To those taking a public health perspective, it made little sense to stir unfounded fears about danger given that cycling is healthy, eases congestion and imposes negligible risk on others

(Photo by Skitterphoto/Pixabay).

During the COST TU1101 “Towards safer bicycling through optimization of bicycle helmets and usage” programme, I gave a presentation of the conclusions of the Transport and Health Study Group concerning how helmet use should be optimised (in Lisbon, Oct 2012). The final slide and associated commentary are reproduced here:

Last Slide of PP Lisbon Oct 2012

These are the main conclusions from the risk analysis, and from our broader study of cycling for “Health on the Move 2”. We conclude that the risks of walking, cycling and driving are similar when fairly assessed, even in the UK where cycling is perceived to be relatively hazardous and driving is relatively safe. In other countries, the results would be more to the favour of cycling. In addition, there are powerful effects achieved by a revival of cycling, notably public health improvement and better road safety. We feel it is misleading to suggest cycling is hazardous when young people will actually face higher risks as drivers, in which mode they also present a major risk to third parties. This is why the THSG concluded against the promotion of cycle helmets and strongly against their compulsion. The former Chief Medical Officer for England, Sir Liam Donaldson, has called for a eight-fold increase in cycling in the UK, and we agree with this.

Our experience in the UK is that there is a great deal of concern regarding the safety of cycling. This means that the promotion of cycling has become controversial, when it should be welcomed by society. Although there is no way of proving it, we believe that helmet promotion has made the situation worse.

Our recommendation for TU1101 is that cycle helmets be considered in the same way as helmets for walking or driving; for specialised use, rather than ubiquitous use. This means helmet design would concentrate on those types of cycling where the risks are higher, such as road racing, MTB and BMX riding. Helmet design could then be optimised for those purposes.

Progressive official thinking is now moving towards risk reduction. Safer City Streets aims to spread best international practice in road danger reduction under the management of the International Transport Forum.

Now it must be said that British practice has also  been reformed in recent years: the UK state is increasingly firm in its ambitions to make cycling normal again. Providing safer road conditions (really safer, not just statistically safer) is recognised as being fundamental to that aim. However, this is taking place after decades of policies unsympathetic (or at least indifferent) to cycling. There is a legacy of accumulated ignorance and misconception within institutions, the media and the general public. This legacy is the gunk clogging efforts to rebuild the credibility of cycling as a way for everybody to get about.