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Is There a Final Verdict on Bicycle Helmets?

By Siegfried Mortkowitz

Let’s try and find out if there’s an ultimate answer to the ‘do you need to wear a helmet on a bike’ question.

According to a 2013 study by the American Association of Neurological Surgeons, cycling accidents played a role in some 86,000 of the 447,000 sports-related head injuries treated in emergency rooms in 2009. By comparison, American football accounted for about 47,000 of those head injuries.

As a result, a variety of safety organizations, cycling associations and other cycling stakeholders have for years insisted that the solution to cycling head injuries and fatalities is wearing a helmet. But not everyone agrees and there have been spirited discussions about the benefits of wearing bicycle helmets over the years. Just stating the argument seems to be counterintuitive because one would think that it must be safer to ride with a helmet since it protects the head much better than wearing nothing at all. So, do you need to wear a helmet on a bike?

Cycling with a helmet
What’s the final verdict on helmets? © Profimedia

According to Dorothy Robinson of the Bicycle Helmet Research Foundation, “Countries where cycling is safest – those with low fatality rates per cycle-km – typically have high cycling rates but low helmet wearing. This indicates that helmets make only a minor contribution to overall cyclist safety. In fact, a review of the best quality data (where enforced helmet laws produced increases of at least 40 percentage points in helmet wearing) found no evidence of reduced head injury rates in response to the increases in helmet wearing.”

On the other hand, an analysis in the International Journal of Epidemiology from February 2017 concluded, after reviewing 40 separate studies, that helmet use by cyclists significantly reduced the odds of an injury, both fatal and not. How do you make sense out of those apparently contradictory conclusions?

To begin with, according to the site usa.streetsblog.org, the country with the highest percentage of helmet use, the U.S. (about 55 per cent), also had the highest cyclist fatality rate per distance travelled. On the other hand, the Netherlands, where almost no cyclist wears a helmet, was much safer.

The reason? Better street design and getting more people on bikes – not blind faith in helmets – are the keys to making cycling safer. This has been corroborated by research. A Canadian study found that helmet laws had no relationship to hospitalization rates, whether in areas where helmets were mandated and there was a high degree of self-reported helmet wearing or in areas where there was far less.

Cyclist on a road
Cycling becomes safer with better cycling infrastructure. © Profimedia

What worked much better was having a higher rate of cycling in the community. Using Canadian government data on cycling activity, researchers found that men and women were both less likely to be injured while biking in communities where more people bike.

The reason is that the more people in a community bike, the more likely the community is to improve the cycling infrastructure, especially by establishing a path network that separates the cyclists from motorized traffic. This is why advocacy groups in the U.S. focus so much on improving cycling infrastructure. Helmets do help mitigate specific head injuries but organizations such as People for Bikes want to prevent those crashes – particularly collisions between cars and bikes – from happening at all.

In a perverse way, mandatory helmet use can then actually lead to higher injury rates because it can dissuade people from riding bikes. When helmet use was made mandatory in New Zealand in 1994, the number of trips fell by 51 per cent over the next 10 years. And, as we’ve seen, fewer cyclists mean less infrastructure improvement, which means more accidents.

This doesn’t mean you shouldn’t wear a helmet when cycling or, more importantly, not put a helmet on your child. It simply means that all cyclists, whether they wear helmets or not, should cycle responsibly and lobby their local authorities to upgrade the infrastructure to put them out of harm’s way – that is, away from cars.