Bicycle helmets and public health in Australia

This is a summary of an article by William J. Curnow published in Health Promotion Journal of Australia 2008 : 19 (1) 10-15

The Federal Government adopted the policy of compulsory bicycle helmets in 1989 to minimise the public cost of accidents and it induced the states and territories to pass the world’s first laws for it. This article evaluates effects on public health in Australia.

Governments ill-informed

Contrary to official views, risk to cyclists was falling in the late 1980s: Figure 1.

Figure 1.  Serious casualties compared with the strong growth in cycling, Australia

Governments in Australia ignored Australian research in 1987 which showed that helmets have potential to aggravate fatal and disabling brain injury. Instead, reliance was placed on a decline in head injuries to cyclists in Victoria while the wearing of helmets was increasing. But Figure 2 shows a similar trend for pedestrians; the decline was not due to helmets.

Figure 2. Most severe injury, per cent to head, Victoria

The Australian Transport Safety Bureau (ATSB) and the Cochrane Collaboration claim that helmets reduce the risk of brain injury, but articles by Curnow in Accident Analysis & Prevention rebutted this. In an ensuing debate in AA&P in 2007/8, Curnow had the last word; ATSB declined even to participate.

 

Compulsory wearing in practice

Official surveys before and after the helmet laws found declines in cycling: Table 1.

Table 1. Participation in cycling, Australia

State/territory    %Class of cyclistDecline pre-to post-law
NSW                33Children <1636%  in 1st yr of law, 43% by 2nd yr
Victoria             24ChildrenTeenagers36%  in 1styr of law in Melbourne46%  by 2nd yr, in Melbourne
Queensland       19Schoolchildren> 22%, in 1st yr of law
W. Australia      11SchoolchildrenAll crossing 2 bridges20%,  1991-93; > 50%, 1991-9638%  on Sundays, in 1st yr of law
S. Australia         8Schoolchildren38%,  1988-94
Tasmania             2No dataNo data
Aust. Capital Terr.All on bicycle paths33%,  1st yr week days, 50% weekend
Northern TerritoryChildren, teenage45%  in 1st yr

 

Australia-wide, the decline in cycling by children is estimated as 40%. The data are insufficient for a similar estimate for adult cyclists, but 29% fewer were observed in Melbourne after the first year of the law and declines in all-age cycling occurred in Western Australia and the ACT. Also, censuses show a 47% decline from 1986 to 1991 in cycling to work in the five States with helmet laws – a reversal of the rising trend of Figure 1.

Less cycling results in loss of the benefits of the exercise for health, which the British Medical Association estimated would outweigh the loss of life due to accidents. Also, studies indicate that motorists seeing fewer cyclists make less allowance for them, thus increasing their risk of casualty.

Table 2 shows serious casualties (fatal and hospitalised) to adults (16+) and children from 1989, before any helmet laws, to 1993, when all were in force.

Table 2. Serious casualties to road users, Australia 1989 – 1993

YearTotal road users Adult            ChildPedestrians      Adult             ChildBicyclists            Adult            Child
198927323            39382882               1083898                 760
199023921            33712664               1050950                 707
199121824            28172325                 866768                 502
199220734            27522316                 862775                 464
199321325            26342262                 752805                 442
Change, 1989-93-24%            -33%-22%               -31%-10%              -42%

Clearly, adult cyclists did not share commensurately in the general improvement in safety. Nor did child cyclists; the fall in casualties only matched their lower numbers.

In Victoria, cyclists’ claims for head injuries decreased more than non-head. Authorities ascribed this to helmets, but pedestrians showed a similar trend – see Figure 3. This suggests other causes; it is not evidence of efficacy of helmets.

Figure 3: Per cent head injury, of accepted TAC no-fault claims, Victoria

Efficacy of helmets would be shown if casualties had lower wearing rates than the whole population of cyclists, but Table 3 shows this not to be so.

Table 3. Helmet wearing of casualties and whole population

State         YearCasualties, helmet wornCasualties, not wornCasualties,     % wornPopulation,    % worn, year
Victoria   1999198518075
NSW,      1993192567774, 83* (1993)
Q’land,    19944411367667-89**(1993)
Sth Aust. 19946749486, 91*  (1993)

* child, adult   ** range of primary and secondary school students and adults

Deaths in Australia by head injury decreased from 1988 to 1994 by 42% for all road users and by 38% for pedestrians. But for cyclists, the decrease was only 30%. Considering the decline in their numbers, this suggests greatly increased risk to them.

 

Main conclusion

Compulsion to wear a bicycle helmet is detrimental to public health in Australia, but authorities have obfuscated evidence that shows this.

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