Henderson Paper Reviewed

The 1995 Henderson report can be found here.  It is another report exaggerating the benefits of helmets, funded by the NSW government.

Another critique of this report can be found here.

Individuals and organizations zealously pushing mandatory helmet use for cyclists are continuing to churn out reams of propaganda. One of the more voluminous efforts is Michael Henderson’s “The Effectiveness of Bicycle helmets: A Review” 1995, a politically motivated paper prepared on behalf of the Motor Accidents Authority of New South Wales, Australia apparently in a desperate effort to justify the State’s botched law outlawing cyclists who ride without a helmet.

Henderson’s report recycles much of the same old material that’s been cited by others over the years. The studies he references fail to provide a real world context, and to show any particular understanding of cycling. Although presenting bicycle head injuries as a worldwide problem, Henderson neglects to provide us with any sense of the size or scope of it. Worldwatch Magazine in its Jan/Feb 1993 edition reported that bicycles outnumber cars globally two to one, but only 2% of the world’s traffic fatalities are cyclists. Mayer Hillman in “Cycle Helmets – the case for andagainst” states that only 2% of all cycling injuries are severe or critical head injuries. So why didn’t Henderson paint the background? Maybe it was fear of having his grand illusion exposed.

Nowhere in the report does Henderson respond to other issues raised by Mayer Hillman in his authoritative 1993 review of available helmet research. Hillman identified deficiencies in the methods used by researchers. Ironically, Henderson relies heavily on many of the same researchers. It is inconceivable that Henderson was not aware of Hillman’s widely quoted study. We believe that he chose to ignore it because it completely undermines his own report. Such is the nature of those who are so obsessed by the means that they lose sight of the end, in Henderson’s case – his commitment to universal helmet use by legislated means causes him to ignore evidence of the negative effects such a measure has on community health.

Here are some strong reasons why we should be concerned about Henderson’s paper.

Henderson Ignores Safer Cycling Environment

Henderson uses the growth worldwide of bicycle sales in comparison to car sales over the last 20 years and fatality rates to show that he believes there is a cycling problem. “The number of new bicycles produced is now three times the number of new cars” he says, and elsewhere “over the 20 years 1970 to 1990, bicyclist fatality rates per l00,000 people have fallen by an average of 1.0 per cent each year, but this is a rate of fall less than one-third of that shown by other road-user groups.” Although his point is unclear, he seems to be saying that the decline in the fatality rate of cyclists among the population should have matched the fatality rates of other road users. Such a comparison and any conclusion derived from it would be erroneous because it is based on rates among the population, not cycle usage. Besides a slower fall in the cyclist fatality rate is to be expected given that the number of cyclists among the population is increasing faster than other road user groups, and given that some groups may not be increasing at all, for example pedestrians. Evidence suggests that walking is declining as population switches to car use. In the 10 years ending in 1986, UK commuters reduced journeys on foot by 7%.

Henderson’s interpretation of the statistics he presents conceals the much greater problem for society, which is the large number of head injury fatalities among motor vehicle users. In Ontario, Canada this number annually outstrips head injury fatalities among cyclists by a factor of over 10 to 1 (over 200 vs.20) among a population of 11 million of which more than half are cyclists. Laboratory tests show that a bicycle helmet provides protection to parts of the head in a narrow range of impact velocities. It matters little whether an impact in that range occurs when the helmet wearer is on a bicycle or in a motorvehicle. If Henderson’s case for universal helmet use for cyclists, based on a reduced fatalities, could be upheld, then there would be a better case by a factor of 10 to support universal helmet use for car users. It is not for us to pursue that one, but we are overjoyed that Henderson’s statistics reveal that cycling is increasing at the same time as cyclist fatality rate is falling. This suggests to us healthier populations and a safer environment for cyclists.

Merits of Helmet Legislation confused with Merits of Helmet Use

Henderson states “There remains a proportion of the riding population who are opposed to legislation requiring the use of helmets on grounds of principle. They simply cannot accept that society has the right to make them do something that protects only them.”

This is one of Henderson’s straw man arguments. The object of his supposition is false anyway. Western democracies have consistently upheld the rights of individuals to choose whether or not to accept preventive medical treatment which essentially is what forced helmet-use is.

A more accurate comment would have been “They simply have not been convinced that there is a societal interest in helmet legislation.” They have good reason for this. There isn’t one. To date, all the evidence from Australia’s experience counters the claim of a societal interest. No one, and certainly not Henderson in his report, has demonstrated such an interest. To do that would require the issue to be studied from a broader perspective, as we explain in the next paragraph. And even if net benefits could be determined, democracies still have to deal with the discrimination inherent in a law which would select cyclists for special treatment as though they were the only road users to suffer head injuries.

Henderson also makes the common error of equating the merits of helmet use with the merits of helmet legislation. In those jurisdictions which have already mandated, legislation has been justified solely on the effectiveness of helmets. The possible change in behaviour of cyclists from forced helmet use and the consequential negative impact on the health of a community has been ignored. The health and environmental benefits of cycling have been well documented by others. In compiling a British Medical Association report – Cycling to Health and Safety, the authors found a 20 to 1 advantage in life-years gained through cycling compared to those lost due to death and injury. Countries where cycling represents a significant form of transportation benefit from the added advantage of reduced pollution. Less automobile use results in lower levels of toxic emission.

In the Canadian provinces of Ontario and British Columbia, governments ignored cyclists’ warnings about inevitable loss of such benefits and legislated anyway. Henderson’s report follows the same path by refusing to recognize that helmet performance is only one factor in the effect of legislation. Fortunately for Ontario cyclists, a new government rescinded the helmet law for adults before it went into effect. Count one victory for cyclists.

Cited Source Disagrees with Henderson

Henderson references a study by Dorsch, Woodward and Somers (1984) of 197 cyclists who had struck their heads or helmets. He calls the cyclists “enthusiasts” presumably to mask that they were drawn mostly from South Australian bicycle racing clubs. Henderson must have known that identifying them as such would expose the fact they were unrepresentative of the cycling population, and thus render any conclusions extremely suspect. Even one of the authors warned about interpretation of the findings. In evidence presented to the House of Representatives Standing Committee on Road Transport Safety inquiry (1985) on page 901(a) of evidence, Dr. Dorsch said

“One has to be very careful in making estimates of how effective universal bicycle helmet usage would be in reducing deaths and serious injuries. … people who are wearing what we regarded as the good, hard helmet … had 19 times less risk of suffering a fatal head injury. That was a hypothetical procedure. ……. In our paper we did, sure, put estimates on it but as a very hypothetical procedure. I was a bit distressed by some of the reports I had seen that suggested that 75 per cent of deaths could be prevented by everyone wearing very good, hard helmets.”

She later added: “When you read those [coroners’] reports … you start to have some doubt that even the best helmets available would be as effective as we might think.”

Henderson Unable to Interpret Source Material

Henderson should have been more sceptical of his own sources. In a section on crash studies, he reports that for helmeted cyclists, the average mean peak impact velocity was 14 km/h for no injuries, 20 km/h for head injuries, and higher than 20 km/h for fatally injured cyclists. Other medical studies have shown that head injury will start to occur at an impact velocity of around 6 km/h. This suggests that a helmet is generally effective in reducing injuries in a narrow range of impacts from 6 to 20 km/h. Any higher and the injury is usually so severe that the impact is lethal regardless of helmet use.

Despite this, in a subsequent section on time-series analysis, Henderson cites the conclusions of the Sacks et al, 1991 report which claimed as many as 2,500 of 2,985 US head injury deaths from 1984 through 1988 could have been avoided through universal helmet use. This study based its estimates not on the fatal velocity data that he cited earlier, but on a helmet-effectiveness factor borrowed from a study of non-fatal cycle accidents! The Sacks report has been criticized by other researchers because the definition of head injury included facial injuries against which a helmet provides no protection.

Straight Line Distortions

In assessing the results of helmet legislation in the Australian states of Victoria and New South Wales, Henderson elects not to address the evidence of reductions in the number of cyclists in both jurisdictions following legislation. Despite immediate pre and post- law counts which showed large declines in child cycling in Victoria, he suggests that the higher 1991 count of adult cyclists compared to a 1987 count showed that cycling had INCREASED overall post-law. However, in the case of adult counts he neglected to point out that the counts were taken three and a half years apart and at different times of the year. Such discrepencies invalidate any comparisons. A valid comparison would have been between actual post-law counts and projected post-law numbers with pre-law trends of increased cycling factored in. Nonetheless, a likely conclusion from the Victoria data is that adult cycling post-law DECLINED from the immediate pre-law levels but still remained higher than in 1987 because of the strong pre-law growth in cycling. Although Henderson blatantly disregarded these probabilities, the authors of the Victoria study did not. They said in a 1994 workshop “.. because there was no adult survey in 1990, the direct effect on total bicycle use cannot be determined.”

Conclusion

The size of this report provides the hint to what is missing from it – a qualitative discussion of the pros and cons of universal bicycle helmet use. In substituting quantity for quality, Henderson exposes his bias in favour of forced helmet use, and his hatred for those who choose not to wear helmets. Henderson gave us a clue right up front. He started his report on the basis that cycling is a problem even though as he noted, the fatality rate among cyclists is declining. Yet those of us who know cycling and have practiced it for 30, 40, 50 years and more know it to be an extremely safe activity with or without a helmet. Persons who abide by the rules of the road and operate their bicycles as a vehicle have little to fear and much to gain. Had Henderson started with an open mind, he might have learned something and arrived at different conclusions. But he didn’t, and as a result, Henderson added nothing to the body of knowledge on safe cycling, but rather makes an extremely benign and beneficial activity falsely appear dangerous.

References

  • British Medical Association (1992), Cycling towards Health and Safety, Oxford University Press
  • Cameron, M.H., Newstead, S.V., Vulcan, A.P. and Finch, C.F. (1994) Effects of the Compulsory Bicycle Helmet Wearing Law in Victoria during its First Three Years”, Australian Pedestrian and Bicyclist Safety and Travel Workshop
  • Curnow, B. (1993), submission to Select Committee on Road Safety, Parliament of Western Australia
  • Hillman, M. (1993), Cycle Helmets – the case for and against, Policy Studies Institute, London
  • Robinson, D., (1996) Head Injuries and Bicycle Helmet Laws, Accident Analysis Prevention, in press
  • Ontario Road Safety Annual Reports (1990, 1991 and 1992), Ministry of Transportation of Ontario

 

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Medical Doctors, and the Compulsory Helmets Law

Introduction

by Peter van Schaik

Medical Doctors have frequently claimed the right to enforce compulsory helmets on cyclists, to protect the public purse. For example in his review entitled “The Effectiveness of Bicycle Helmets: A Review” (1995), Dr. Michael Henderson says: “There remains a proportion of the riding population who are opposed to legislation requiring the use of helmets on grounds of principle. They simply cannot accept that society has the right to make them do something that protects only them.”

Henderson is completely wrong. He has nothing to back up his claim that societal interest prevails. Society has in fact consistently protected the rights of individuals to choose whether or not to accept a medical treatment. Wearing a helmet is really just another form of medical treatment, and in the form of legislation it is a medical treatment which has been administered by doctors onto their patients against their will.

Doctors tend to only see the end result of an accident, which they may reasonably feel a helmet would have prevented, from which they decide that all cyclists must wear helmets. Medical doctors and other medical staff are really just another minority group with extreme views. They have had an unreasonably large influence over the Government in the bicycle helmets issue. They have a lot to answer for! It could be said that if you can’t stand the sight of blood or human suffering, you shouldn’t become a doctor in the first place.

Compulsory helmets considered as a medical treatment

by Bill Curnow

The Royal Australasian College of Surgeons, Victorian Branch, was the prime mover towards compulsory helmet wearing. The Federal Government then took action to bring it about. Announcing this, then Prime Minister Mr Hawke said:

“I pay tribute in the development of this proposal to Sir Dennis Paterson, President of the International Society of Orthopaedics and Traumatology, whom I met earlier this year. As a result of his advocacy of the need for the Commonwealth to take the lead in this area, I asked Bob Brown and Neal Blewett to put together this package.”

Who’s who in Australia notes Sir Dennis’s prominent role in the Royal Australasian College of Surgeons.

In effect, then, surgeons, per medium of statute, are imposing upon cyclists a treatment intended to reduce head injury. This action runs counter to the common law governing medical treatment.

Fetal welfare and the law, a report of an inquiry commissioned by the Australian Medical Association, provides a useful summary of relevant common law concerning the rights of the patient versus those of the surgeon and the duty owed by the surgeon to the patient.

1. Rights of the patient

Courts have consistently upheld the right of the individual to decide how to protect his or her own body from injury or death, and have rejected claims that the medical profession has a right to impose treatment.

The report on fetal welfare says it is for the patient, not the doctor, to decide whether the treatment will be performed. In Canada, the Ontario Court of Appeal, in Malette and Shulman, awarded damages against a doctor who transfused blood into a patient who was unconscious as a result of a motor accident, but who carried a card saying that she would refuse blood transfusions. In delivering the court’s judgment, Justice Robins said at page 328, quote: ”

“A competent adult is generally entitled to reject a specific treatment, or all treatment, or to select an alternate form of treatment, even if the decision may entail risks as serious as death and may appear mistaken in the eyes of the medical profession or of the community. Regardless of the doctor’s opinion, it is the patient who has the final say on whether to undergo the treatment. … The doctrine of informed consent is plainly intended to ensure the freedom of individuals to make choices concerning their medical care. For this freedom to be meaningful, people must have the right to make choices that accord with their own values regardless of how unwise or foolish those choices may appear to others.”.

Justice Robins posed the question why Mrs Malette should be transfused against her will. Quoting him again, at page 333:

“The appellant’s answer, in essence, is that the card cannot be effective when the doctor is unable to provide the patient with the information she would need before making a decision to withhold consent in this specific emergency situation.”

The doctor’s emphasis on the need to take account of specific circumstances at the time contrasts strongly with a law that compels cyclists to wear helmets in all circumstances. Justice Robins continued:

“In the absence of an informed refusal, the appellant submits that Mrs Malette’s right to protection against unwanted infringements of her bodily integrity must give way to contervailing societal interests which limit a person’s right to refuse medical treatment. The appellant identifies two such interests …” – end of quotation. He went on to say that the first was the interest of the state in preserving life, but declared that, quote:

“The state’s interest in preserving life or health of a competent patient must generally give way to the patient’s stronger interest in directing the course of her own life.”

On page 334, Justice Robins added:

“Recognition of the right to reject medical treatment cannot be said to depreciate the interest of the state in life or in the sanctity of life. Individual free choice and self-determination are themselves fundamental constituents of life. To deny individuals freedom of choice with respect to their health care can only lessen, and not enhance, the value of life. This state interest cannot properly be invoked to prohibit Mrs Malette from choosing for herself whether or not to undergo blood transfusions.” At page 336 he said, “The right to determine what shall be done with one’s own body is a fundamental right in our society. The concepts inherent in this right are the bedrock upon which the principles of self determination and individual autonomy are based. Free individual choice in matters affecting this right should, in my opinion, be accorded very high priority.” – end of quotation.

In England, in Re T (Adult: Refusal of medical treatment), the House of Lords has made it plain that the right to refuse medical treatment extends even to the point where refusal will result in the likely or certain death of the patient. In this case, at pages 652 to 653, Lord Donaldson acknowledged the “absolute right to choose whether to consent to medical treatment, to refuse it or to choose one rather than another of the treatments being offered … notwithstanding that the reasons for making the choice are irrational, unknown or even non- existent.” At page 661, he said:

“This situation gives rise to a conflict between two interests, that of the patient and that of the society in which he lives. The patient’s interest consists of his right to self-determination – his right to live his own life how he wishes, even if it will damage his health or lead to his premature death. Society’s interest is in upholding the concept that all human life is sacred and that it should be preserved if at all possible. It is well established that in the ultimate the right of the individual is paramount.” – end of quotation.

In Australia, the same doctrine has been affirmed by superior courts. In F against R (1993) 33 SASR 189, the Supreme Court of South Australia considered a surgeon’s duty to inform the patient of the risk that an operation will not succeed in its aim. Chief Justice King remarked at pages 192/193, quote:

“The governing consideration is the right of every human being to make the decisions which affect his own life and welfare and to determine the risks which he is willing to undertake.” He also referred to, quote, “the paramount consideration that a person is entitled to make his own decisions about his life”, a passage which the High Court of Australia cited in Rogers and Whitaker (1992) 175 CLR 479, at page 487.

In summary, superior courts have upheld the right of the individual to decide how to protect his or her own body from injury or death and have rejected claims that the medical profession has a right to impose treatment. As the report on fetal welfare puts it, “Consent is the crucial concept”.

Against this background of common law, it would be reasonable to expect that governments and legislators would give careful consideration to the principles developed in the common law before abrogating them by statute. In fact, the reports of the introduction of and debate on the Traffic (Amendment) Bill 1992, Hansard 9 April 1992 pages 143 to 145 and Hansard 19 May 1992 pages 568 to 586, make no mention of its effect of overriding common law applicable to medical treatment. Similarly, there is no mention of it in documents received from the Department of Urban Services in response to a wide- ranging request of 4 October 1994 under the Freedom of Information Act 1989.

2. Duty of the surgeons

(a) The applicable law

The applicable law is summarised in the report on fetal welfare. It says on page 69, that, in broad terms the law imposes on a medical practitioner a duty to exercise reasonable care and skill in the provision of professional advice and treatment. In the past, identification of the appropriate standard of skill and care has been greatly infuenced by the views of the profession. This test was known as the Bolam standard. It is derived from the direction given to the jury in Bolam v Friern Hospital Management Committee (1957) 2 All ER 118. It was explained in the following way by Lord Scarman, in Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital (1985) AC 871 at 881:

The Bolam principle may be formulated as a rule that a doctor is not negligent if he acts in accordance with a practice accepted at the time as proper by a responsible body of medical opinion even though other doctors adopt a different practice. In short, the law imposes the duty of care; but the standard of care is a matter of medical judgment.

In Australia, in Rogers v Whitaker, Chief Justice Mason and Justices Brennan, Dawson, Toohey and McHugh of the High Court said at page 487, quote, “the Bolam principle has been discarded and the courts have adopted the principle that, while evidence of acceptable medical practice is a useful guide for the courts, it is for the courts to adjudicate on what is the appropriate standard of care after giving weight to the paramount consideration that a person is entitled to make his own decisions about his life” – end of quotation.

The duty of care of the common law would require that those responsible for imposing upon cyclists the medical treatment of helmet wearing, surgeons in particular, should have certain knowledge of the efficacy of helmets in mitigating injury and should draw attention to any uncertainties or adverse effects.

(b) Evidence relevant to standard of care

(i) Evidence of surgeons

There is evidence that the care taken by those responsible for imposing the medical treatment of helmet wearing falls short of an appropriate standard.

The Hansard record of the evidence which the Royal Australasian College of Surgeons, per Drs Dooley and Trinca, submitted to the House of Representatives Standing Committee on Road Safety in the course of its inquiry on motorcycle and bicycle safety in 1978, shows that they had no evidence of efficacy, merely of numbers of cyclists killed and injured.

Evidence given by Dr Trinca shows that he was negligent about establishing the efficacy of helmet wearing with certainty before taking action towards it. He said, “If we could perhaps worry a little less about and take a little less time in proving what is precisely right according to all standards and get something that protects and get it agreed to by that particular group, at least we would be getting somewhere. I have a feeling that it is in much of our research work that a lot of delay happens. As doctors we are impatient. We cannot wait for 2 or 3 years’ evaluation.”

(ii) Evidence adduced by parliamentary committees

Following the impetus of the surgeons, public authorities took up the task of imposing upon cyclists the medical treatment of helmet wearing, starting with recommendations by parliamentary committees.

Recommendations by parliamentary committees in New South Wales in 1988 and Victoria in 1986 were influential in forming the Federal Government’s policy of compulsory helmets. The House of Representatives Standing Committee on Transport Safety also recommended compulsory helmets in its 1985 report. The evidence of efficacy of helmets that these committees adduced is examined in a paper by Bill Curnow entitled “Review of evidence on the efficacy of helmets”. The paper concludes that the Federal Government’s policy on compulsory helmets was decided without sufficient knowledge of the efficacy of helmets in reducing injury to cyclists.

(iii) Evidence used by Commonwealth and ACT Governments

The ACT introduced the helmets law in response to a financial inducement from the Commonwealth Government. An FOI request made by CRAG to the Department of Urban Services on 6 January 1992 requested, among other things, the rationale which the Commonwealth provided to ACT authorities. We expected that it would at least describe the social ill requiring a legislative remedy, provide evidence that helmets are efficaceous, and discuss possible adverse effects of helmet wearing. Concerning the matter of a social ill, one would expect evidence of a sharp increase in casualties to cyclists, but deaths to cyclists had actually been declining.

The response received shows that neither the rationale nor the written advice to the then Minister included any of these matters. This shows that both the Commonwealth and the ACT authorities exercised a less than acceptable standard of care.

Further, in our FOI request of 4 October 1994 to the Department of Urban Services we sought documents concerning any consultations with, or requests for advice from health authorities and any advice received. No such documents were provided in the Department’s response of 2 February 1995. Again, the ACT authorities exercised a less than acceptable standard of care.

Other evidence of ACT authorities’ lack of care is evident in the matter of exemptions for medical reasons. In a letter of 4 May 1993, the then Minister for Urban Services said that he did not intend allowing exemptions under any medical circumstances. He said that this view had been supported by the Australian Medical Association and the National Road Trauma Advisory Council – NRTAC. Through FOI, CRAG requested from the Department documents showing the terms in which the organisations which had advised their support for compulsory helmets had expressed it. The letter from NTRAC merely says that it supports the advice of the Royal Australasian College of Surgeons, but the Department did not obtain that advice. The Minister’s claim of support from the AMA is false, as is shown in another document. Again, ACT authorities exercised a less than acceptable standard of care.

The ACT Government’s 1992 information bulletin, “Compulsory wearing of helmets for bicyclists in the ACT”, which is currently being promulgated through official outlets, says helmets are extremely effective in reducing injuries to the head. Although the Minister for Urban Services was advised by letter of 6 April 1995 of the NHMRC’s warning of possible increase in brain injury from wearing a helmet, the bulletin makes no mention of it – a less than acceptable standard of care.


Other Considerations

by Peter van Schaik

Henderson says: “When protection can be proven by good science- -as is the case for helmets and seat belts–then even those who hold most firmly to civil libertarian principles must concede that to compel protection for a few does bring benefit to many”.

Henderson makes these claims of helmets being proven by good science, but doctors pushed for compulsory helmets before any scientific evidence even existed. As for those studies that have since appeared in the world literature, the tag “good science” is a very questionable one. Nevertheless, Why are these same principles not extended to other areas? Why is it just cyclists who must wear helmets?

Pedestrians suffer many more head injuries than cyclists, and most of these are resultant from a collision with a motor vehicle, much the same as the accidents Henderson describes: “The predominant collision was between a cyclist and the front of a car” (Otte, 1989). According to the UK Govt yearly digest of statistics published by HMSO, called “Social Trends”, the deaths per billion kilometers travelled are: bicyclists (53), pedestrians (71). Using data derived from fatality rates per million hours (Vicroads, 1990), percentages of deaths from head injury (FORS, 1992), and ratio of hospital admission for head injury (HI) to death from HI (Queensland Health Department Statistics), it is possible to estimate the risks of serious HI and death by HI per million hours of activity. These are: cyclists (2.39), pedestrians (2.34), motor vehicle occupants (1.77), motor cyclists (20.9). Pedestrians are at about the same risk as cyclists.

Motor vehicle occupants are at a slightly lower risk, but they account for 17 times as many head injuries as cyclists. The mechanics of their head injuries are not necessarily the same, but a great many result from their head striking the door frame (despite wearing a seatbelt) – surely a helmet would help there. At least one researcher has stated that bicycle helmets would be suitable, and a standard for car helmets is now available.

Bicycle helmets first became popular amongst racing cyclists, then spread to other cyclists. In the form of helmet laws, the standards of the professional and ‘more serious’ cyclists have been forced upon the general cycling public. Professional motor racing drivers wear helmets, so by the same reasoning, if it is good enough for them it’s good enough for the general motoring population, the same as with cycle helmets.

Given his great concern about head injury, I could fully expect Dr. Henderson to be wearing a helmet if I met him on the street, or saw him driving a car.

And what about people who use stairs? They account for a great many head injuries of a preventable nature, and their risk per time factor or risk per kilometre must be absolutely overwhelming!

There are many other areas where protection has been proven by “good science”. Here in Australia, many people die from skin cancer each year. In NSW in 1992, skin cancer claimed the lives of 226 men and 141 women, but 1990 (the last pre-helmet law year) saw only 20 cyclists killed. Why not compulsory shirts and wide brimmed hats whilst outdoors? Acceptance is already high so surely this legislation would be easy to implement. Then there are those other activities where compulsory abstenance would certainly be beneficial to the societal purse: smoking, drinking, overeating, growing old. Why stop at bicycle helmets?

Although compulsory bicycle helmets may not be of much concern to most people at this time, the real concern should be: what will the ‘Safety Nazis’ be legislating for in 10 or 20 years time?

Almost everything we do has some risk attached and it’s a question of how we estimate the situation. For many people, for whatever reason, it is just not worth the inconvenience of wearing a helmet, as evidenced by the huge declines in cycling recorded after introduction of the law. Cycling without a helmet is really little different from other potentially harmful activities such as smoking and drinking. The difference is that cycling in itself is healthy, the chance of serious head injury is actually very small, whereas the loss in health and subsequent cost to the health system from those other activities (or from not exercising and becoming sedentary) is virtually guaranteed. The main effect of the helmet law has been to discourage a healthy activity.

Bicycle helmet laws remove freedom of choice. The aim may well be to preserve life but the secondary effect is to restrict freedom. In supporting the helmet laws, doctors often talk about the loss of freedom and quality of life in head injury victims as if they own the book on the subject. But without personal freedom of choice the quality of life is diminished. It is wrong for doctors to have the final say over what form an individual’s freedom should take. It would seem that Medicare has been a sinister tool for removing individual freedom, since it has made it possible for doctors to make the claim of “it being for the greater good” in protecting the investments of others, thereby bypassing the long-standing principles of common law and abrogating individual freedom.

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Civil Liberties Considerations

A. AUSTRALIA

1. Lionel Murphy, address to ALP National Conference, 1967

Every generation has to fight over and over again the battle for our fundamental rights and liberties and this generation has to do that also. We Australians tend to think that our civil rights are beyond question. In recent times, almost every one of our fundamental rights and liberties has been either trampled on, whittled away, challenged or ignored in Australia.

2. Constitutional Commission, Report of the Advisory Committee on Individual and Democratic Rights under the Constitution, Canberra, Commonwealth of Australia, 1987

Deprivation of Liberty of Property (pages 45/46)

Perhaps the most fundamental principle of English law is that embodied in Magna Carta, which states the basic rule that no persons may be arbitrarily deprived of their liberty.

The committee recommended that a new subsection 80(ii) be inserted in the Constitution in the following terms:

80. The Commonwealth or State shall not

***
(ii) deprive any person of liberty or property except in accordance with a procedure prescribed by law which complies with the principles of fairness and natural justice.

Chapter 8 Australians And Equality Rights

Stemming from Magna Carta, the notion that everyone should be treated equally before the law found its way through the English legal system into the general body of Australian law.

The committee then noted that the Aborigines and other races were not included in the concept of “equal rights to all persons”, and discriminatory Federal and State laws founded on race continued to operate in Australia until relatively recent times. … “The committee considered that a general restatement of the ancient principle of equality embodied in Magna Carta should be stated in general terms which make it clear that any unfair discrimination between Australians should be placed beyond the powers of governments.

“Of course it is clear the governments should not be prevented from making appropriate distinctions between different Australians, founded on a rational basis. Ultimately it is only those who are unfairly discriminated against who are being denied equality before the law. It is clearly appropriate for a discrimination on the basis of age to be implemented, so that governments can enact laws which require that children must attend school, or which provide for the age at which children obtain full legal capacity.”

Other examples of justifiable discrimination were cited.

The committee recommended that in substitution for the existing non- discrimination provisions of section 117, there should be proposed the following:

117. The Commonwealth or a State shall not deny equality before the law to all the citizens and to all of the permanent residents of Australia and in particular the Commonwealth or a State shall not unfairly discriminate between any of them on any grounds.

B. INTERNATIONAL AND HISTORICAL

3. J.M. Kelly, A Short History Of Western Legal Theory, Oxford University Press, 1992

Plato suggested that the dominant element in a state tends to make laws benefiting itself. He assigned to law not merely the regulation of conditions … but also the deliberate training (in the gardener’s quite as much as the teacher’s sense) of that society towards an ideal state of perfection. Thus he visualised law in an extra dimension which, although various regimes have tried to make it a reality, the West has on the whole rejected. Sparta is thought to have been his inspiration. This city enforced its manners by education and training on the young, and maintained them among them as adults. These manners had no basis in what we might recognize as a religious morality, but were geared to the production and constant renewal of a militarist and irresistible state.

Aristotle: Justice is of two kinds: `distributive’ and `corrective’. By distributive justice he meant `that which is exercised in the distribution of honour, wealth and other divisible assets of the community, which may be allotted among its members in equal or unequal shares. Allowing for the far greater range of material regulation characteristic of the modern state, we might say this definition corresponds evidently with `legislative justice’, the kind we expect to see displayed in statutes or other governmental measures which distribute benefits or impose burdens in patterns and proportions which we can accept as fair or rational having regard to the subject matter; the kind which is free of invidious discrimination. Aristotle’s meaning emerges from some general propositions, for example, that equals are to be treated equally, unequals unequally; that justice is proportion, injustice is disproportion.

Cicero the philosopher assigned to the positive laws of humans an altogether subordinate place by comparison with the law of nature. The mere fact that a measure has been enacted by a commonly accepted method does not of itself entitle it to respect as being just, or perhaps even to the title of `law’ at all if it defies higher principles.

St Thomas Aquinas insisted on the connection of law with reason, the channel through which the law of nature could be apprehended by human intelligence: `Human law has the quality of law only in so far as it proceeds according to right reason; and in this respect it is clear that it derives from the eternal law. In so far as it deviates from reason it is called an unjust law, and has the quality not of law but of violence. … Laws may be unjust … if the burdens, even though they are concerned with the common welfare, are distributed in an inequitable manner throughout the community. Laws of this sort have more in common with violence than with legality.’

Laws that are rightly enacted prove deficient where to observe them would be to offend against natural right. In such cases judgement should be delivered, not according to the letter of the law, but by recourse to equity, this being what the lawgiver aimed at.

`Now human law is enacted on behalf of the mass of men, the majority of whom are far from perfect in virtue. For this reason human law does not prohibit every vice from which virtuous men abstain; but only the graver vices from which the majority can abstain; and particularly those vices which are damaging to others.’ This emphasis on the element of `harm to others’ appears in another passage in briefer form, where St Thomas derives the law against murder from the natural- law precept, `Do harm to no man’. It will be noticed that this theoretical basis for punishment, though St Thomas did not expressly declare it the only legitimate one, will not stretch far enough to cover the punishment of acts of moral turpitude not impinging on others – a curious premonition of the views of J.S. Mill.

English lawyer Christopher St German (c.1460-1540) stated the criteria for legislative justice in terms which come straight from St Thomas: `A human law is called just, by the standard of its end, its author, and its form. Its end: when it is designed for the common good. Its author: when it does not exceed the powers of him who enacts it. Its form: when its burdens are laid upon the subjects in a due proportion, with the common good in view. And if its burdens are laid upon people in an unfair way, even if its purpose be the common good, it does not bind him in conscience.’

Locke `A man … having, in the state of Nature, … only so much [power] as the law of Nature gave him for the preservation of himself and the rest of mankind, this is all he doth, or can give up to the commonwealth, and by it to the legislative power, so that the legislative (sic) can have no more than this. Their power in the utmost bounds of it is limited to the public good of the society.’

The French Declaration of the Rights of Man and the Citizen, made by the National Convention in 1789, identified as the object of all political association the conservation of `the natural and imprescriptible rights of man: liberty, property, security and resistance to oppression’; and defined liberty as the freedom to do whatever does not injure others, who also enjoy the same freedom.

Montesquieu perceived that political liberty could not exist where any two of the three powers – legislative, executive and judicial – were in the hands of the same organ of the state.

In France, in the 1760s, a group of Enlightenment authors known as Physiocrats contended that judges, before enforcing the laws, ought to satisfy themselves that the laws they were being called on to apply actually conformed with the dictates of the `natural laws of the social order’ and of justice.
`It is clear that any judge who took it upon himself to inflict penalties on his fellows by virtue of obviously unjust laws would be guilty of fault. Judges, therefore, should measure the ordinances of positive law against the laws of essential justice which govern the rights and duties of all men … before taking it upon themselves to give judgement according to those ordinances.’

Beccaria (1764): `Every individual would choose to put into the public stock the smallest possible portion of his own liberty; as much only as was sufficient to engage others to defend it. The aggregate of these, the smallest portions possible, forms the right of punishment; all that extends beyond this is abuse, not justice.’

A core belief of the Benthamites was the sacredness of individual freedom, including freedom to contract, on the grounds that the individual must know best for himself what was most conducive to his own welfare.

J.S Mill, Utilitarianism, ed. H. Acton (London, 1972):
`All persons are deemed to have a right to equality of treatment, except when some recognised social experience requires the reverse. And hence all social inequalities which have ceased to be considered expedient, assume the character not of simple inexpediency, but of injustice, and appear so tyrannical, that people are apt to wonder how they ever could have been tolerated; forgetful that they themselves perhaps tolerate other inequalities under an equally mistaken notion of expediency, the correction of which would make that which they approve seem quite as monstrous as what they have at last learnt to condemn. The entire history of social improvement has been a series of transitions, by which one custom or institution after another, from being a supposed primary necessity of social existence, has passed into the rank of a universally stigmatised injustice and tyranny. So it has been with the distinctions of slaves and freemen, nobles and serfs, patricians and plebeians; and so it will be, and in part already is, with the aristocracies of colour, race and sex.’

Herbert Spencer: `Only one essential rule bound men, namely, that while each may do what he likes, he may not injure the equal freedom of others’ – a kind of restatement of Kant’s formula.

German jurist Gustav Radbruch: As for positivism, the doctrine that law was whatever a statute said, had rendered German justice helpless when confronted with cruelty and injustice once these wore statutory vesture. Post-war decrees invalidating Nazi laws, even though not in force, `their content was already binding before those deeds were committed; and in their content such laws correspond to a law which is above statute, however one might like to describe it: the law of God, the law of nature, the law of reason’. … Radbruch saw a revival of belief in a transcendent law by which evil positive laws may be condemned as `legal injustice’.

A much stronger recognition now exists that the rights of a majority, while they must include the determination of the state’s general policy, cannot extend to invading a range of irreducible individual and hence also minority rights. This is reflected in the European Convention on Human Rights and Fundamental Freedoms (1950).

Radbruch: When laws deliberately defy the instinct for justice, then they are void, `the people owe them no obedience, and lawyers, too, must find the courage to deny them the character of law.’ Another German jurist, Helmut Coing, (1985): `Deliberate violations [of natural law] must be met with passive resistance.’

Dworkin (1978): `Justice as fairness rests on the assumption of a natural right of all men and women to equality of concern and respect, a right they possess not by virtue of birth or characteristic or merit or excellence but simply as human beings with the capacity to make plans and give justice.’

4. Henry E. StrakoschState absolutism and the rule of law, Sydney University Press, 1967. (a history of the codification of civil law in Austria)

The author argues that codification, not only in Austria but also elsewhere, was an essential step in the creation of the modern state. In both France and Austria the new codes preserved the rule of law and (in an age when the state was arrogating to itself a monopoly of government) they safeguarded individual freedom. Indeed the author argues that codification of civil law provided the legal basis of European liberalism.

“It is necessary to make a clear distinction between civil law and public law and ‘the ordinances arising from the latter. … If administrative ordinances are being confused with laws as such the latter will soon be regarded as unstable, because dependent from the whims of the supreme power. That cannot fail to have a deleterious influence on the confidence in the administration of justice, because justice means always a fixed norm, of equal validity for all.” (author’s translation of Ofner, Vienna 1889)

“The fact that there is a nexus between the positive law of the state and universally binding norms of human behaviour, in other words, between the coercive and the normative aspect of law, has always been recognized.”

“Legal rationalism aimed at a concordance of the normative and the positive function of law, at an agreement between them which left to each its specific function. It was developed by the great scholastic masters of the thirteenth century in the doctrine of natural law. … Law was an instrument of government, directed towards a rationally conceived common good. Its purpose was rational and so was its content. Precisely for that reason the relation between law as a norm and law as a command, or between the moral and legal order, was real, without being one of identity. Each of them retained its specific character and yet they formed an indivisible whole.

Positive laws had to fit into the more universal framework of the moral order: that alone gave them their character as laws. But it was never postulated that every positive law expressed a moral norm. The content of many laws was morally neutral (traffic laws are a modern example) and such laws were morally obligatory simply because they belonged to a morally valid legal order. Any law made by public authority was valid so long as it did not offend against the more universal norm of the moral law.” [The law for compulsory wearing of helmets is not a traffic law. Traffic laws deal with competing claims and correlative rights and obligations of road users. Helmet laws regulate individual behaviour irrespective of other road users, or, indeed, any other persons, and questions of competing claims and the rights and obligations of others do not arise.]

“The French Revolution seemed to mark the final victory of an ineluctable trend towards the subjection of the law to the sovereign will of the legislating power and all attempts to preserve a rule of law alongside effective government by a centralized and absolutist state seemed doomed to failure. … Kant cut that Gordian knot … . First, he denied the existence of a direct nexus between the moral and the legal order. … But at the same time Kant preserved fully the objective nature of the law. The law, though divorced from the moral order, did not become an instrument in the hands of the state, in whatever lofty metaphysical terms the latter might be conceived”

P. 206 “The means by which the Kantian critique of natural law was applied to the codification of civil law was the creation of the concept of `strict law’ … which could be fully expressed by way of positive laws. … Strict law was also restricted law: it could not operate throughout the whole realm of social and political relations. … It was a law whose formal character confined it to the production of the autonomy of the person; it was a law of freedom. … Strict law led, by the logic of its formal character, to the division of law into a zone of private law where `any action is lawful whose maxim allows the arbitrary freedom of each to co-exist with the freedom of everyone according to the a general law’, and a zone of public law.”

P. 208 Zeiller, honoured in 1811 as `the creator of the civil code’ in Austria – still in force – stated in 1801: “The primary rule of legal obligations is therefore: Abstain from all actions which restrict the free and legal activity of others.”

P.210 “Any preface to the code on the nature of law would have to be couched in approximately the following terms: `Law is the limitation of freedom to actions compatible with the freedom of others’. … The rights due to every man, in so far as he was a rational being, had been known to him by the creator of nature through reason and through a natural feeling for right and wrong. Justice had to be the basis of the positive law of the state if government were not to degenerate into arbitrary rule.”

“The Kantian doctrine, while removing the immediate obstacles on the way of a creation of a civil law, had therefore also destroyed any possibility of limiting the positive legislative power of the state by a set of norms of greater universality and inherent strength.”

Function of law to seek a balance in the socio-political order between anarchic individualism and totalitarian collectivism. … The law which evolved in Western Christendom established a point of balance in European history. It was able to perform that function because it expressed the two basic principles of Western Christendom: a belief in the rational and organic nature of society, and a belief in the transcendent value of the human person. … It gave rise to a form of political organization which became typical of European civilization, that of `lawful government’ which means the containment of the power of public authority within the framework of the law.

“The nadir of lawlessness in internal government was reached with Hitler’s doctrine of `Law is what benefits the people.’ (See Heinrich Mitteis, Uber das Naturrecht, Deutsche Akademie der Wissenschaften zu Berlin, Berlin 1948, p. 37.) This doctrine of a `common good’, which destroyed the last vestige of a balance between the rights of the person and the rights of the community, was carried by the totalitarian powers … into international relations. … Japan, Italy, Germany … flouting of the public law of the world. … the peoples of Britain and the USA rallied to the defence of what they again understood to be the basic law of civilized life: the preservation of personal freedom in the state.”

After referring to international institutions which influence on national policies, “the very existence of a forum where an international tension … is subjected to public debate … tends towards the establishment of the universal category of the law as the standard of action. But … international law is still confined to relations between sovereign states; individuals may become increasingly the objects, but they are not yet the subjects of international law. (Within the sovereign state the positive law of its making continues to hold sway.) The struggle between the obsolescent category of the absolute sovereignty of the state and the newly emerging fact of the international community is still far from being resolved; it is, in fact, the characteristic feature of the second half of the twentieth century. And it is also the struggle for peace and for the survival of civilization.

“If we apply the findings of historical analysis … we must conclude that only a state whose sovereignty is not absolute, that is, a state recognizing the obligatory force of law as arising ultimately from principles lying beyond and above the positive legislative power of government, can be integrated through the due process of law into an international community. … The restoration of a dualism of government, the restoration of an equality of status between the law and the state, is therefore the presupposition of the solution of the most urgent problem of modern civilization, the problem of an international order based on law. But that is the same as saying that the restoration of a balance between the autonomy of the person and the rights of the community which is the gravest problem of modern government, will come to pass by way of a new impact of international law on the internal law of the state.”

5. Justice BrandeisOlmstead v United States, 1928

Experience should teach us to be more on our guard to protect liberty when the Government’s purposes are beneficent. The greatest dangers to liberty lurk in the insidious encroachments by men of zeal, well meaning but without understanding.

6. Universal Declaration of Human Rights, 1949, as proclaimed by the General Assembly of the United Nations; the following are some extracts.

Preamble

… Whereas it is essential … that human rights should be protected by the rule of law, …

Article 2

Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, … or other status”.

Article 7

All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Article 12

No one shall be subjected to arbitrary interference with his privacy … Everyone has the right to the protection of the law against such interference or attacks.

Article 29:

1. …

2. In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedom of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.

Azzopardi’s summary: Freedoms to be limited only as necessary to safeguard rights of others.

7. International Covenant on Civil and Political Rights, 1976

Article 17

1. No one shall be subjected to arbitrary or unlawful interference with his privacy, family, home … .

Article 26

All persons are equal before the law and are entitled without any distinction to the equal protection of the law. In this respect, the law shall prohibit any discrimination and guarantee to all persons equal and effective protection against discrimination on any ground such as race, colour, sex, … or other status.

On 25 September 1991, Australia acceded to the First Optional Protocol to the Covenant, making it possible for any individuals within Australia who considered that any of their human rights as set out in the Covenant had been violated to take their case to the United Nations Human Rights Committee.

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Review of Evidence of the Efficacy of Helmets for Cyclists

Introduction

That the wearing of a helmet can protect cyclists from head injury might seem obvious. Measurements in laboratories have shown that helmets have the potential to do this, but, as Davis (1993) noted, the issue is what happens when the devices promoted by such research are used and adapted by real people. Research into actual use of helmets shows that the efficacy of helmets in reducing head injury is far from clear.

Interested bodies have tended to place undue credence on research findings that appear to support their own premature conclusions that helmet wearing is efficaceous. The House of Representatives Committee on Transport Safety noted in its 1985 report, hereunder HORSCOTS 1985 report, that research in which Dorsch and others found …. , see below, “has received almost universal acceptance by bicycle groups who have been working for many years to have bicycle helmets widely accepted on the basis of their effectiveness in reducing head injuries”. Similarly, despite evidence that the evidence that the efficacy of helmets was unproved, see below, the committee itself declared early in its inquiry that, “It is this committee’s belief that all cyclists should wear a helmet to increase cycling safety both on and off roads.”

An examination is made here of the evidence of the efficacy of helmet wearing which the Federal Government relied upon for its 1989 policy of compulsory helmet wearing and of evidence from later research and experience of the policy in effect. The states relied in varying degrees on the Federal Government for evidence; the Government of the ACT relied on it entirely.

1. Evidence cited

In a letter of 24 June 1992, copy attached, the Federal Office of Road Safety cited several reports as the basis for the compulsory helmets policy. Four of them argue that wearing helmets reduces head injury. They are:

1. report of the inquiry into child pedestrian and bicycle safety, Social Development Committee of the Parliament of Victoria, 1986, 1987, (the Victoria report);

2. Staysafe 12, Parliament of New South Wales, Joint Standing Committee on Road Safety, 1988 (the NSW report);

3. FORS report CR 47, Helmets for child bicyclists, some biomedical considerations, by J.C. Lane, 1986

4. FORS report CR 36, Children and road accidents, an analysis of the problems and some suggested solutions, by Barry Elliott, 1985.

Hereunder, the original research papers upon which the four reports in turn relied are listed and commented upon.

1. The Victoria report

(a) McDermott and Klug (1982) and McDermott (1984)

From statistics for Victoria, they showed that head injuries were proportionately more frequent in injured bicyclists (few of whom wore helmets) than in motorcyclists (most of whom wore helmets) despite the more severe body injuries and presumed more severe impact sustained by motorcyclists. That the benefit of helmet wearing would transfer from motorcyclists to cyclists was merely assumed, however (McDermott et al, 1993).

Comment: The second researchers listed, Dorsch et al, said “… it is of little help to compare the nature and frequency of head injuries between helmeted motorcyclists and unhelmeted bicyclists, as was done in a recent Australian study. In such a study, a host of differences between pre-crash, within-crash and post-crash factors in the two groups could contribute to erroneous conclusions about the potential protective effects of bicycle helmets.”

The submission by the Government of Victoria to the HORSCOT 1985 inquiry commented on the Dorsch study, but did not even mention McDermott or Klug.

(b) Dorsch et al (1984, 1987)

The Victoria report cited the unpublished 1984 paper. The authors introduced their published paper of 1987 with the words, “In the past, evaluation of helmet efficacy has been based on laboratory tests of limited relevance to real crashes. … Helmets for bicyclists could do much to reduce deaths and injuries among crash-involved riders. While few people would doubt this assertion, there are currently no quantitative data demonstrating the efficacy of bicycle helmets in real crashes.”

The authors sent 1321 questionnaires to members of bicycling clubs in South Australia, seeking information about their most recent crash. Out of 866 usable responses, “197 bicyclists reported a crash within the last five years in which they had struck their head or helmet. … it was estimated that the risk of death from head injury was considerably reduced for helmeted relative to unhelmeted bicyclists. … Further research is needed to confirm and refine our findings.”

Comments:

1. The authors note the popular assumption that helmets are efficaceous … “While few people would doubt this assertion“.

2. The authors themselves acknowledged limitations of their findings and the need for further research to confirm them.

3. The sample was mainly drawn from members of bicycle racing clubs, and therefore was not representative of the mostly younger and slower- moving general population of cyclists. Indeed, Dr Dorsch said in evidence to the House of Representatives Standing Committee on Road Transport Safety (HORSCOTS) inquiry (1985) on page 901(a) of evidence “One has to be very careful in making estimates of how effective universal bicycle helmet usage would be in reducing deaths and serious injuries. … people who are wearing what we regarded as the good, hard helmet … had 19 times less risk of suffering a fatal head injury. That was a hypothetical procedure. … it was based largely on an adult group of cyclists and because we went through a rather hypothetical statistical procedure to arrive at those numbers, I think one would have to be very careful in generalising those findings perhaps to very young bicyclists. … one has to be very careful in making estimates of how effective universal bicycle helmet usage would be in reducing deaths and serious injuries. In our paper we did, sure, put estimates on it but as a very hypothetical procedure. I was a bit distressed by some of the reports I had seen that suggested that 75 per cent of deaths could be prevented by everyone wearing very good, hard helmets.” She later added: “When you read those [coroners’] reports … you start to have some doubt that even the best helmets available would be as effective as we might think.”

4. In its submission to the HORSCOTS 1985 inquiry, the Government of Victoria said:

“The incidence of bicycle helmet use has not yet reached a sufficiently high level anywhere in the world for a scientific examination of helmet effectiveness in injury reduction to be undertaken. One study has examined the effectiveness of helmets on a self-reported accident basis for a small sample of users and concluded that the better hard shell helmets give greater levels of protection than inferior hard shell helmets, soft helmets or no helmet (Dorsch et al 1983) (NHMRC Road Accident Research Unit, University of Adelaide, Adelaide, 1984).” McDermott and Klug, 1982 was not even cited.

A new Australian standard, AS2063.2 adopted in 19??, after the Dorsch study, “allowed for the introduction of light-weight, well-ventilated, soft-shell helmets” (Connolly, 1991). The findings of Dorsch would not be applicable to such helmets.

5. The later researchers, Thompson et al (1989), noted the findings of Dorsch et al and added, “Because of methodologic limitations, none of the available studies have produced compelling evidence of the effectiveness of bicycle helmets.” Hillman (1993) – see below – made comments to similar effect. Wood and Milne (1986) noted that the findings of McDermott and Klug and Dorsch et al had indicated significant gains from helmet use, but pointed out that “the benefits of bicycle helmet wearing have not been proven yet using mass accident data.”

The Victoria report also says, “In an extensive analysis of children and road accidents, Elliott (1985) states that `The value and importance of pedal cyclists wearing helmets appears beyond question at this point in time'”, but Elliott relies on McDermott and Dorsch et al.

Ms C. Boughton of FORS cited Dorsch: “helmets meeting the current standard of AS2063 decrease the chance of death by a factor of 19 when compared to a person who is not wearing a helmet at all.” … “need promotion and public education campaigns to get the usage rates up to any acceptable level.”

[Following paragraph added by Peter van Schaik]
6. Another interesting point about the Dorsch study is that it found 62 per cent of cyclists who reported hitting their heads were wearing helmets at the time, but the percentage of helmet wearers would have been low. This suggests that helmeted cyclists are more likely to have an accident and/or strike their head.

2. The NSW report

The discussion of helmets in the NSW report began with the statement, “The Committee received compelling information about the need for helmets to be worn by bicyclists”, but the only evidence it cited was a finding by Healy (1985) of a 21 per cent drop in head injuries following increases in helmet wearing in Victoria.

Healy (1985): Healy merely used data from Wood and Milne. The data comprise statistics for head and other injuries to cyclists and rates of helmet wearing in Victoria in 1981-85. The numbers are small and show much year-to-year variation, and Wood and Milne denied that these data constitute proof of the benefits of helmet wearing – see their comment above.

3. FORS report CR 47

The main concern of this report, by Lane (1986), was the technical characteristics of helmets. It relied for its evaluation of efficacy on Dorsch et al and a study by Wood (1986) of bicyclist casualties in Victoria over the period 1983-86, when the use of helmets was increasing. Lane cited Wood’s data showing bicyclist casualties with head injuries declined, but there was little change in the number of other injuries. Lane concluded this was very suggestive that the observed reduction in casualties with head injuries is a consequence of increased helmet wearing. He noted, however, that it did not constitute a formal evaluation.

4. FORS report CR 36

As noted above under the Victoria report, this report by Elliott (1985) relies on McDermott and Dorsch et al.

Hillman (1993) in his report Cycle helmets, the case for and against makes a comprehensive review, in chapter 3, of research on helmet wearing and head injuries. He draws attention to difficulties and causes of uncertainty in estimating the efficacy of helmets, and shows that findings of research have varied widely. In chapter 4, Hillman questions the benefits of helmet wearing. He describes the benefits attributed to helmets as at best highly exaggerated, and says that wearing a helmet only marginally reduces the extent of head injuries following collision with a motor vehicle. (In Australia, a moving motor vehicle was involved in 92 per cent of fatal bicycle crashes in 1988 (Attewell and Dowse, 1992)).

Summary of evidence cited in support of Federal policy

Clearly, the evidence that supported the Federal Government adopting its compulsory helmets policy was flimsy. Far from being adequate to justify governments overriding individual decisions, it is hardly strong enough to support governments promoting the wearing of helmets.

2. Evidence from other studies pre-law

Wasserman et al (1986): These researchers noted that several authorities had suggested that bicyclists wear helmets but added: “few data are available to either support or refute this recommendation.” They interviewed 516 bicyclists in the USA regarding helmet use and head injuries. They expressed their findings in very cautious terms: “The findings suggest that helmets may be effective in preventing head injuries”, adding qualifications that “unmeasured variables might account for the apparent association between helmet use and protection from head injury … the results were somewhat fragile statistically … relied entirely on the interview.”

Thompson et al (1989): Their conclusions that cyclists with helmets had an 85 per cent reduction in their risk of head injury and an 88 per cent reduction in their risk of brain injury are often cited. Their case-control study, at Seattle in the USA, comprised the following, with percentages wearing helmets in brackets: 235 “case patients” with head injuries received while bicycling (7%), a control group of 433 persons with bicycling injuries not involving the head (24%) and a second control group of 558 people who had had bicycling accidents during the previous year (23%).

The authors acknowledged two sources of uncertainty: statistical error due to the fairly small sample, and bias in the sample: “We cannot completely rule out the possibility that more cautious cyclists may have chosen to wear helmets and also had less severe accidents.” Also, for the case patients a much higher proportion of crashes (22.6 per cent) was caused by contact with a moving motor vehicle than for the control groups (12.5 and 3.9 per cent respectively). Such crashes typically result in more serious injuries than crashes where no moving motor vehicle is involved.

[Following paragraph added by Peter van Schaik]
Dr. R.S.Thompson et al wrote in 1989 that bike helmets are highly effective, 85% for their group, in preventing head injuries, added that “Safety helmets are widely recommended for cyclists, but convincing evidence of their effectiveness is lacking.”

[Following paragraph added by Peter van Schaik]
McDermott et al in a Journal of Trauma report noted that Thompson’s 85% result reduces to 61% by excluding facial head injuries that a helmet would not prevent. It further notes that Thompson’s study had ten cyclists wearing helmets in the adjusted counts, a number too small to draw such a statistical conclusion. McDermott found that about 40% of bicyclist’s head injuries were reduced when using approved helmets, though injury rates increased for the neck, extremities and the pelvic region.

[Following paragraph added by Peter van Schaik]
Robinson (Head Injuries and Bicycle Helmet Laws, in press) says: “The 85% reduction in head injuries from helmet wearing in Seattle was derived mainly from a comparison of a 21.1% helmet wearing rate in a control group of children from families in a healthcare cooperative who had cycling accidents and a wearing rate of 2.1% in head injured child cyclists. However, in Seattle in May and September 1987, the same time as the investigation into helmet effectiveness at the five major teaching hospitals, the observational study (DiGuisseppi et al., 1989) found helmet wearing rates of only 3.1 and 3.3% in samples of 1957 and 2544 child cyclists. If cyclists riding around Seattle had been considered the control population, rather than those who had accidents, a rather different conclusion might have been reached about the effectiveness of helmets.”

[Following paragraph added by Peter van Schaik]
Thompson found that helmets reduce the risk of head injury by 85%, but by using the same methodology on other data in the study, it can be concluded that helmet use also reduces the risk of injury to other parts of the body by 72%.

Rodgers (1988): To examine claims that growth in the use of hard shell bicycle helmets had been successful in reducing bicycle- related head injuries and deaths, Rodgers studied over 8 million cases of injury and death to cyclists over 15 years in the USA. He concluded as follows: “There is no evidence that hard shell helmets have reduced the head injury and fatality rates. The most surprising finding is that the bicycle-related fatality rate is positively and significantly correlated with increased helmet use.” To our knowledge, Rodgers’s findings have never been challenged.

Travers Morgan (1987): Data from a questionnaire survey of bicycle crashes in Western Australia 1985-86 did “not include enough helmet wearers to assess with certainty whether head injuries are less common or less serious when a helmet is worn. … there is an indication that severe overall injuries are actually slightly more common among helmet wearers. Whilst this may not be significant, it does suggest that further research could be worthwhile” – page 35. Despite this finding, the authors recommended, on page 55, “greater initiatives should be taken to promote use of safety helmets.”

Corner et al (1987): This study of technical requirements for helmets noted that “the most life-threatening crash situation is collision with another vehicle. Other crash situations, e.g. falling from the bicycle and the like, are usually significantly less severe and require only minimal head protection.” The study recommended that helmets should be extended to protect the temporal area of the head.

Williams (1991): Helmets made to the Australian standard may fail to provide protection from 63 per cent of impacts to the head, those occurring to the temples and elsewhere below the test line for helmets. Also, where impact occurred on the ear pieces of the retention system or the rim of the helmet near the ear, wearers have suffered lacerations from the sharp edges of the ear pieces and rims.

Comment by the British Medical Association: The British Medical Association (1993) reviewed the studies of Dorsch et al, and Thompson, Rivara and Thompson and a survey in the UK by Mills (1989). The BMA’s comment was: “Although these studies provide useful preliminary data, further research is required in order that more authoritative recommendations can be made.”

[Following paragraph added by Peter van Schaik]
North et al (1993): noted in South Australia that “We have recently observed an apparent fall in the number of patients suffering from head injury due to road trauma. … The largest drop in patient numbers was observed in motor cyclists, falling from an average of 24 per year previously, to only five in 1992.” This shows that whilst head injuries to bicyclists declined dramatically after the helmets law, so did those to other road users.

[Following paragraph added by Peter van Schaik]
Pitt et al. (1994): Commented “the reason for the decrease in bicycle related head injuries is more complex than just increased wearing of helmets”.

[Following paragraph added by Peter van Schaik]
Cameron et al (1994): Interpreted the decline in percentage of head injuries in Victorian accident claims for cyclists to be purely as a consequence of increased helmet wearing. Robinson (Head Injuries and Bicycle Helmet Laws, in press) observed a similar trend for child pedestrians and cyclists in data from 1980-85, when few cyclists wore helmets. The correlation between the head injury percentages was 0.94, with P < 0.02. It is suggested that the common trend may be related to impact speed of motor vehicles. Janssen amd Wismans (1985) found that reductions in impact speeds result in greater reductions in head accelerations than for other parts of the body. The introduction of the helmets law in Victoria coincided with the introduction of major initiatives directed at drink-driving and speeding in December 1989 and March 1990, as noted by Cameron. From this it could be expected that average impact speeds in bicycle accidents would be less, and thus the percentage of head injuries would also be reduced.

Conclusion

The Federal Government’s policy on compulsory helmets was decided without sufficient knowledge of the efficacy of helmets in reducing injury to cyclists.

References

Attewell, R.G. and Dowse, M.J., Fatal crash types. Analysis of 1988 fatality file, Federal Office of Road Safety report no. CR 105, Canberra 1992

British Medical Association, Cycling towards health and safety, Oxford University Press, Oxford, New York, 1993

Corner, J.P., Whitney, C.W., O’Rourke, N. and Morgan, D.E., Motorcycle and bicycle protective helmets: requirements resulting from a post crash study and experimental research, Federal Office of Road Safety report no. CR 55, Canberra 1987

Davis, R, Death on the streets, Leading Edge Press and Publishing Ltd, Hawes, North Yorkshire, 1992

Elliott, B., Children and road accidents, FORS report CR 36, Federal Office of Road Safety, Canberra, 1985

Dorsch, M.M., evidence given to the House of Representatives Standing Committee on Transport Safety inquiry on motorcycle and bicycle helmet safety, 1985, at pages 901A and 902A

Dorsch, M.M., Wodward, A.J. and Somers, R.L., Do bicycle helmets reduce severity of head injury in real crashes?, Acc. Anal. & Prev. 19, 3, pp. 183-190, 1987

Government of Victoria: submission to the House of Representatives Standing Committee on Transport Safety inquiry on motorcycle and bicycle helmet safety, 1985, at page 1031

Healy, D., Trends in helmet usage rates and bicyclist numbers sustaining head injury – Victoria, Road Traffic Authority report 86/6, Melbourne, 1985

Hillman, M., Cycle helmets, the case for and against, Blackmore Press, Longmead, Shaftesbury, Dorset, 1993

Lane, J.C, Helmets for child bicyclists, some biomedical considerations, FORS report CR 47, Federal Office of Road Safety, Canberra, 1986

McDermott, F.T., Why pedal cyclists should wear safety helmets, Australian Family Physician, 13, 4, pp. 284-285, 1984

McDermott, F.T. and Klug, G.L., Differences in head injuries of pedal cyclists and motorcyclist casualties in Victoria, Med. J. Aust. 2:30, 1982

McDermott, F.T., Lane, J.C., Brazenor, G.A. and Debney, E.A., The effectiveness of bicyclist helmets: a study of 1710 casualties, The Journal of Trauma, 34, 6, pp. 834-845, 1993

Rodgers, G.B., Reducing bicycle accidents: a reevaluation of the impacts of the CPSC bicycle standard and helmet use, Journal of Products Liability, 11, pp. 307-317, 1988

Thompson, R.S., Rivara, F.P. and Thompson, D.C., A case-control study of the effectiveness of bicycle safety helmets, The New England Journal of Medicine, 320: 21, 1989

Travers Morgan Pty Ltd, Bicycle crashes in Western Australia 1985- 86, Federal Office of Road Safety, Canberra, 1987

Wasserman, R.C., Waller, J.A., Monty, M.J., Emery, A.B. and Robinson, D.R., Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness, American Journal of Public Health, 78, 9, pp. 1220-1221, 1988

Wood, T., Bicycle safety in Victoria, Proceedings Bikesafe 86 conference, Federal Office of Road Safety, Canberra, 1986

Wood, T. and Milne, P., Head injuries to pedal cyclists and the promotion of helmet use in Victoria, Australia, Acc. Anal. & Prev. 20, 3, pp. 177-185, 1988

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Discouragement Of Cycling, And Effects On Welfare

Written in 1994

1. Introduction

This paper examines the rationale for compulsory wearing of helmets as stated by the then Federal Minister for Land Transport: that head injury to cyclists will be reduced, resulting in savings to the community in health care and other costs – in effect, an increase in public welfare.

Laboratory tests have shown that a helmet has the potential to mitigate injury to the head, but this is limited to impacts at low speed. It is a long way from the controlled conditions of the laboratory to the variable behaviour of people in the circumstances of accidents. Consequently, evidence of the efficacy of helmets in reducing injury to cyclists in practice is conflicting. Further, compulsion has other effects with potential to add to the costs of public health care.

It is true that rates of death and serious injury to cyclists in road accidents in Australia have declined. From 98 in 1989, the last full year before helmets became compulsory for cyclists in Victoria, fatalities declined by 58 per cent to 41 in 1992. There were 43 fatalities in the year ended October 1993. Data showing declines in serious injuries in New South Wales, Victoria and Western Australia are discussed below. The declines can be largely explained by factors other than the compulsory helmet laws. Improvements in roads and motorists’ behaviour have reduced rates of death and injury of all road users. More importantly, many people have responded to the compulsory helmet laws by giving up cycling, or, its statistical equivalent, cycling less. Substantial declines in numbers of cyclists have been measured by surveys in New South Wales, Victoria, Queensland, Western Australia, the Australian Capital Territory and the Northern Territory. The findings of these surveys are used here to estimate the total effect of the helmet laws in discouraging cycling.

Taking account of these other factors, the contribution of compulsory helmet laws to reducing rates of death and serious injury of cyclists is discussed below, together with the adverse consequences for public welfare.

2. Effect of improvements in roads and motorists’ behaviour

As a motor vehicle was involved in 92 per cent of fatal accidents to cyclists in Australia in 1988 (Attewell and Dowse, 1992), the behaviour of motorists is a critical factor in death and serious injury of cyclists. Following intensified random checks of speed and blood alcohol, and improvements in roads, total road fatalities declined by 30 per cent from 1989 to 1992, from 2804 to 1974. The decline has continued, to 1903 in the twelve months ended October 1993 (FORS, 1993).

The general decline of 30 per cent is reflected in deaths of pedestrians. It would therefore explain half or more of the 58 per cent decline in deaths of cyclists.

3. Decline in number of cyclists

3.1 Findings of surveys

3.11 Victoria

Before compulsory helmets were introduced in Victoria on 1 July 1990, some students at schools which compelled them to wear helmets chose to give up cycling instead (Ref?).

According to Vic Roads report IR 90-15 (1991), the first survey after helmets became compulsory in Victoria showed that the number of cyclists described as adult commuters declined from 5162 to 2098, or nearly 60 per cent, between March and July 1990. The author attributed this to the usual reduction of cycling in winter months, but the July survey was taken in fine weather. It would appear that the helmet law contributed to the decline.

Morgan and others (1991), reporting on surveys directed primarily to measure the use of helmets, made comparisons of matched samples of recreational and commuter cyclists in March 1990 and March 1991, at sites in Melbourne, Ballarat and Shepparton. These showed, in their Tables 17 and 18, declines of 30 per cent in recreational cycling and 32 per cent in commuter cycling from 1990 to 1991.

Monash University Accident Research Centre (MUARC) has conducted four surveys of bicycle use and helmet wearing rates in Melbourne, in November to January 1987/88 and successively in essentially the same 2-week periods in May/June of 1990 (pre-law), 1991 and 1992 (post-law) (Finch and others, 1993a). The 2-week periods were chosen to minimise the effect of different weather conditions. The 1991 survey found that total bicycle use by children had decreased by 36 per cent compared to 1990, with the largest decrease (44 per cent) being by the 12-17 year- old group (Cameron and others, 1992). This age group is included in the higher risk categories for fatalities to cyclists (FORS, 1991).

Finch and others provide, on page 36, data showing the following decreases in numbers of bicyclists observed during the first year of the law: adults 29 per cent, teenagers 46 per cent and children 24 per cent. They go on to say that the numbers increased from 1991 to 1992 as follows: teenagers 6 per cent, children 20 per cent and adults 34 per cent. “As a result of these increases, the number of adult and child bicyclists was not much smaller than the pre-law numbers (a 9 per cent drop in children, 5 per cent in adults).” Later, on pages 43 and 44, they note that different weather may have been a factor in the change in numbers from 1991 to 1992, half of all weekend observation sessions coinciding with rain in 1991 but only 14 per cent in 1992. Another explanation they offer for the increase in numbers in 1992 is a bicycle rally passing through observation site 80. Information obtained from the authors is that the numbers of cyclists observed there were as follows: 1987/88, 129; 1990, 347; 1991, 72; 1992, 451. The 451 amounts to 18.2 per cent of the total number of 2477 cyclists observed in 1992 and site 80 alone accounts for 19 points of the 23 per cent increase in total numbers of cyclists 1991 to 1992.

More comment on the findings of Finch and others is contained in an associated submission from Dorothy Robinson.

3.12 New South Wales

In New South Wales, helmets have been compulsory since 1 January 1991 for adult cyclists, defined as 16 years and older, and since 1 July 1991 for those under 16. A survey of helmet wearing by cyclists was conducted for the Roads and Traffic Authority (RTA) in September 1990 and a second survey in March and April 1991 (Walker, 1991) to allow evaluation of the impact of the helmet law on adult cyclists and to provide a baseline measurement of helmet wearing by cyclists under 16 before helmets became compulsory for them.

The surveys showed a 6 per cent increase in the number of adult cyclists between September 1990 and April 1991. Walker concluded that “it appears clear that the new regulation has not deterred cyclists”, but this is far from clear. As well as the surveys being taken at different times of the year, the first “was conducted in overcast conditions in Sydney and, in some areas, was interrupted by rain whereas the second survey was conducted in sunny conditions.” A greater increase could have been expected.

Walker (1992) conducted a third survey in April 1992 for the main purpose of providing an assessment of the use of helmets by children under 16 before and after the law. It showed that the number of adult cyclists had decreased by 14 per cent and child cyclists by 38 per cent since April 1991. (The RTA’s summary of 14 August 1992 stated the latter figure as 36 per cent, by reason of including school children of 16 and 17.)

As the helmet law was in force for adult cyclists in both April 1991 and April 1992, the 14 per cent decrease in their numbers is not a measure of its discouraging effect on them. It may measure a delayed effect however, perhaps as people became more averse to wearing a helmet or the law was enforced against them.

A fourth survey in April 1993, essentially a replication of the previous surveys, showed a further decline of 11 per cent in numbers of child cyclists, to 45 per cent below 1991 (Smith and Millthorpe, 1993). The greatest decline was in the number of female students cycling to secondary schools – to less than a quarter of 1991.

3.13 Queensland

In 1990 and 1991, branches of the Royal Automobile Club of Queensland conducted surveys to measure the proportions of cyclists wearing helmets (Wikman and Sims, 1990, 1991). The surveys were mainly based on students riding to school and included Brisbane and centres ranging from Gold Coast to Cairns. Data were gathered for 1990 from 29 October to 24 November and for 1991 from 29 September to 24 November, the earlier start being chosen to improve the coverage of all age groups of students.

The wearing of helmets became compulsory on 1 July 1991, between the surveys. It could therefore be expected that the numbers of cyclists recorded, incidental to the purpose of measuring helmet wearing, would indicate the discouraging effect of the law. In fact, the 1991 report says, “Most surveyors commented that ridership was lower than previous years”, but adds, “To compensate for this it was requested that where possible more schools be surveyed”. Consequently, the decline in numbers of riders would have been greater than the 22 per cent shown for schools in total. Indeed, for most centres, where apparently it was not possible to survey more schools, declines of around 30 to 50 per cent were typical.

3.14 Western Australia

Compulsory helmet wearing was introduced on 1 January 1992, but not enforced until 1 July.

As in other states, in Western Australia the primary concern of surveys has been to measure rates of wearing of helmets. Such was the survey of Healy and Maisey (1992). They also commented that the numbers of children cycling to primary schools and numbers of recreational cyclists declined from 1991 to February 1992.

Heathcote (1993) did a wider-ranging survey, including data on numbers of cyclists in 1991 and 1992. The limited data he presents show some decline in numbers of children cycling to school. He suggested that the data do not show any change in the rate of decline, implying it is merely a continuation of a trend of previous years, but this is mere assumption, as he offered no explanation for the previous decline. His conclusion that the helmet legislation was not a significant factor in the decline is similarly no more than an assumption.

Heathcote’s limited observations of “commuter” cyclists indicate an increase in numbers after the helmet law, but his observations, also based on limited data, of cyclists classed as recreational show a decline of over 50 per cent. Therefore, data from automatic counter surveys conducted by Main Roads at the Narrows and Causeway bridges were used. These showed that the number of cyclists crossing on Sundays declined by 38 per cent from October-December 1991 to October- December 1992. Loath to attribute the cause of the decline to the law, Heathcote attempted to explain it by changes in leisure patterns, economic factors, population movements and the weather. These explanations are spurious; the first three could not change significantly in one year and, by his own statement on page 4, observations for all groups were taken only when the weather was fine and suitable for cycling.

Main Roads also counted numbers of cyclists crossing the Narrows and Causeway bridges on weekdays. These data for the period October 1991 to October 1993 are shown in graphical form in Figure 1 and 2, attached. The mean number of cyclists declined between October- December 1991 and October-December 1992 by 9 per cent at the Narrows bridge and 26 per cent at the Causeway bridge. Information from Western Australia Police shows that enforcement of the helmets law intensified in 1993, the rate of issue of infringement notices being 50 per cent higher than in the second half of 1992. Figures 1 and 2 show that this was matched by a further decline in cycling; for example, 10 per cent at the Narrows and 4 per cent at Causeway October-November 1993 compared to 1992. Sharper declines are evident in other months – 43 per cent from April 1992 to April 1993 and 52 per cent May 1992 to May 1993 for both bridges combined. Other factors may have contributed, but this evidence does support the hypothesis that the helmet law has resulted in a substantial reduction in cycling by “commuters” and schoolchildren.

3.15 Northern Territory

Incidental to surveys of bicycle helmet wearing by the Road Safety Council of the Northern Territory (1992, 1993), the following numbers of cyclists were recorded. The horizontal lines indicate the start of the helmet law, 1 January 1992 for cyclists 17 and over and 1 July 1992 for others.

Numbers of cyclists

Date of survey     prim. school     sec. school      "commuter"

1990, August                                            252

1991, April                                             222

1991, August                                            350
                                                  ---------------
1992, April            987              931      |      142
                  --------------------------------
1992, August           995              595             122

1993, May              823              570             131

There was little change pre-law to post-law in the numbers of children cycling to primary school, but a 36 per cent decline in cycling to high school. The decline in numbers of “commuter” cyclists was of the order of 50 per cent.

3.16 Australian Capital Territory

Members of the Cyclists’ Rights Action Group carried out a survey of 325 cyclists in May 1992, shortly before helmets became compulsory in July 1992. When asked, “Would you cycle less if helmets were compulsory?”, 90 or 28 per cent of respondents answered “yes”. Ratcliffe (1993) reported on surveys of bicycle traffic in the ACT before and after that, as follows:

For data over one week in November 1991 and December 1992 respectively: “Based on automatic counts of cycles for one week at 23 cycle path locations, mean weekday cycle path daily volumes were recorded in 1992 to be about one third lower than the similar period in 1991, with mean weekend daily volumes declining by about half.”

“Based on a survey conducted over a single morning … the number of morning peak period cyclists commuting to city and the other three town centres was measured to reduce by an average 21 per cent between November 1991 and November 1992.”

Such declines occurred despite very little enforcement of the law, only 50 traffic infringement notices having been issued from July 1992 to April 1993.

Claiming that it is “not possible with the existing data to draw firm conclusions about the effect of helmet legislation on cycle activity in the ACT”, Ratcliffe attempted to explain away the declines from 1991 to 1992 as not significant or due to the weather. Some preliminary analyses of variance were conducted on data from three of the 23 count stations. The results show that “only in a few cases was a significant difference estimated … . These results derive from the very high daily flow variability”. But Ratcliffe did not explain why tests for significance were not carried out on the much larger numbers for all stations in aggregate. The aggregate declines were from 7290 to 5176 on weekdays and from 5496 to 2876 at weekends. It is inconceivable that these large numbers would not test as significant.

As for the weather as a factor, all bicycle data were collected on rainless days, and detailed records show little variation of weather from 1991 to 1992 on collection days.

Finally, Ratcliffe’s summary of findings of surveys elsewhere is misleading. He said “Reports of bicycle activity in Victoria and New South Wales show that, for the periods before and after introduction of helmet legislation, there was no overall change to cycling in Victoria, and an average reduction of 26 per cent in NSW.” For Victoria, the “period before” is November 1987 to January 1988, 2« years before helmets became compulsory. The “period after” is May/June 1991. The authors of the survey that Ratcliffe cited, Cameron and others (1992), cautioned that the “comparison was made at different times of the year and nearly 3« years apart, and hence should be considered tenuous”, but Ratcliffe did not mention that. The only finding reported by Cameron and others which qualifies as a valid comparison of pre-law and post-law was a decline in cycling by children of 36 per cent between May/June 1990, just before the law came into effect, and May/June 1991. Ratcliffe did not mention it. (The survey of May/June 1990 did not include adults.)

In respect of NSW, Ratcliffe’s summary misrepresented certain of the survey findings. The data he cited (Walker, 1992, Table 9) are from surveys carried out in April 1991 and March/April 1992. In April 1991, the helmet law applied only to adults, and data from the survey then are pre-law only for children. Ratcliffe wrongly designated all 1991 data cited as belonging to the period before introduction of helmet legislation. Then he claimed there was an average reduction in cycling in NSW of 26 per cent. The average is of 14 per cent reduced cycling by adults and 37 per cent by children, but only the latter is a measurement of the decline in cycling from pre-law to post-law. On these figures, Walker had suggested “the new regulation has had the impact on numbers of bicycle riders under sixteen rather than any incidental changes … “, but Ratcliffe disregarded this, saying, “these results hide significant differences in cycling groups, with both reports being cautious in attributing all the changes to cycle activity to the helmet legislation”.

3.2 Analysis of findings of surveys

The surveys which show best the comparisons of numbers of cyclists pre-law and post-law are those of New South Wales and Victoria, and the best data are for child cyclists. But the measured decreases in numbers of child cyclists, 38 and 45 per cent below the base period in NSW in 1992 and 1993 respectively, and 36 per cent in Victoria in 1991, still under-estimate the discouraging effect of helmet laws.

First, some such effect would have occurred in anticipation of the law coming into force. Before and during the base periods for the relevant surveys, May/June 1990 in Victoria and April 1991 in NSW, publicity campaigns encouraged the wearing of helmets, and in April 1991 in NSW it was compulsory for adult cyclists. Many parents would in effect have anticipated the law by applying it to their own children. Tables 19 and 20 of Walker (1992) show helmet wearing by children increased from 12.7 per cent in September 1990 to 25 per cent in April 1991, but some children would have responded by giving up cycling or cycling less. The slight decrease in the number of child cyclists from September 1990 to April 1991 (Tables 19 and 20) where an increase could be expected provides evidence of this. As a result, the number of child cyclists recorded in the April 1991 base period of the third survey in NSW would have been lower because of the law. The declines in cycling measured subsequently would therefore under-estimate its full effect. Instead of the 36 and 38 per cent measured, the actual decline in the number of child cyclists pre-law to post-law is estimated at 40 per cent.

Second, the discouraging effect has been shown to continue post-law. For cyclists under 16 in NSW, Smith and Milthorpe (1993) measured a decline of 10 per cent in the second year – see their Table 3.2. For adult cyclists, Walker (1992) measured post-law declines of 14 per cent in the first year and a further 10 per cent in the second year – see his Table 3.10. Data from cycle counters operated by Main Roads in Western Australia also show post-law declines.

Third, any true measure of the effect of the law must be on the basis that it is enforced. The 45 per cent decrease in the number of child cyclists in NSW from 1991 to 1993 occurred without full enforcement – as 26 per cent of them were still not wearing helmets in April 1993. Table 3.2 of Smith and Milthorpe (1993) shows the numbers 6270 in April 1991, 3887 in 1992 and 3478 in April 1993 (after adjusting for cyclists at recreation areas in Albury not included before). Calculating from the table, those not wearing a helmet decreased from 4295 to 933 to 889. If the law were fully enforced, to ensure a wearing rate of virtually 100 per cent, some of the 889 persistent non-wearers would choose to cease cycling, or would cycle less. The number can be estimated from Table 3.2. Of the 4264 cycling without a helmet in 1991, 563 chose to don a helmet and keep on cycling until 1993, but 2792 – five times as many – had given up cycling by 1993. On the basis that five out of six, i.e. 740, of the 889 persistent non- wearers would choose similarly, only 2738 would still be cycling, a decline of 56 per cent from 1991.

The 56 per cent includes the decline of one year post-law. Some further decline seems likely. Adding the effect of anticipation, it is estimated that the long term effect of the law will be to discourage 60 per cent of children from cycling. As there are 3 million children aged 5-16 in Australia, perhaps a million aged say 10 or more would be discouraged, with consequent detriment to national welfare – see below. For Western Australia, the corresponding number would be over 100000.

4. Effect of compulsory helmet laws on death and injury

Deaths of cyclists in road accidents in Australia decreased from 98 in 1989 to 41 in 1992. Of these, deaths of children up to 16 were 44 and 17 respectively. How much of these decreases can be attributed to compulsory helmet laws?

With small numbers, random variations are relatively large; pre-law, the total of 98 fatalities in 1989 compares with 87 in 1988, and for cyclists aged up to 16 the difference is proportionately greater: 44 in 1989 and 33 in 1988 (FORS, 1989, 1990). Fatalities might well have been high by chance in 1989. Setting that point aside, the 30 per cent general decline in road fatalities from 1989 to 1992 would explain a decrease from 98 to 68 in deaths of cyclists in total, and from 44 to 31 in deaths of child cyclists. As the helmet law was not in force everywhere in Australia throughout 1992, its discouraging effect on cycling by children would be somewhat less than the 56 per cent estimated above. Putting it at 50 per cent would explain a further decrease in deaths to 16. The actual number was 17. It is therefore not evident that the helmet laws made any positive contribution to reducing deaths of child cyclists.

Have the helmet laws contributed to reducing serious injury to cyclists? Data are available for Victoria, New South Wales and Western Australia.

Victoria

In a study entitled “Head injury reductions in Victoria two years after introduction of mandatory helmet use”, Finch and others (1993b) of MUARC used data based on claims to the Transport Accident Commission for bicyclist casualties who were involved in collisions with a motor vehicle. The decrease in the number of bicyclists killed or admitted to hospital after sustaining head injuries was 48 per cent in the first post-law year (year ended June 1991) and it reached 70 per cent in the second year. The corresponding decreases for those killed or admitted to hospital who did not sustain head injuries were 23 per cent and 28 per cent.

Finch and others concluded that the introduction of the law had been accompanied by an immediate large reduction in the number of bicyclists with head injuries. “Apparently this has been achieved through a reduction in the number of bicyclists involved in crashes (at least partly through a decrease in bicycle use by children and teenagers) and a reduction in the risk of head injury of bicyclists involved in crashes”. They were understandably reluctant to conclude that the reduction in head injuries was an effect of the helmet law; the numbers are fairly small; considerable fluctuations have occurred in the past; and these reductions occurred at a time of improved behaviour of motorists due to initiatives directed at drink/driving and speeding, and of publicity about cyclists.

Vulcan and others of MUARC reported these and similar findings in Morbidity and Mortality Weekly Report 42, 18, 14 May 1993 of the US Department of Health and Human Services. The editors of the report commented: “The reduction in number of bicyclists with head injuries following implementation of the law in Victoria may reflect a combination of several factors, including the decline in bicycle use by children … the effect of educational efforts and publicity … initiatives to reduce motorists’ speeding and drinking and driving. Further assessment is needed to identify the most important components … and to measure the effectiveness of the program in reducing head injuries.”

Factors other than those suggested by Finch and others apparently were operating to reduce the proportion of head injuries in the total of injuries. Data for claims to the Transport Accident Commission by both cyclists and pedestrians in the years 1987-92 are attached as A. For cyclists, from the pre-law years 1988 and 1989 to the post-law years 1991 and 1992 claims for head injuries declined by 56 per cent and other injuries by 33 per cent – similar to the findings of Finch and others. But the data for pedestrians show this occurred for pedestrians too, the corresponding declines being 31 per cent and 14 per cent. The numbers appear to be large enough for this difference to be significant.

Reduced speed of motor vehicles and other changes in how they are driven may be an explanation for the difference. Discussion of the effect of changing speed on the seriousness of accidents in Corner and others (1987) shows that such effects are not simple. Research reported by Janssen and Wismans (1985) showed similarities in the impact of pedestrians’ and cyclists’ heads with vehicles, but that impact of a cyclist’s head with the windshield or even with the roof is much more likely than for a pedestrian.

The Victorian Injury Surveillance System (VISS), which monitors injuries to children under 15 years old, has published statistics for admissions of cyclists aged 5 to 14 years to five hospitals in Melbourne in the years 1989-92. Admissions for head injury declined by 32 per cent between 1989 and 1992, but this is unremarkable as greater rates of decline were shown by total road fatalities in Victoria, 49 per cent (FORS, 1989, 1990), and admissions of cyclists for other injuries, 35 per cent. From these data, it is not evident that the helmet laws made any contribution.

McDermott and others (1993) undertook an evaluation of the efficacy of helmet use by comparison of crashes and injuries in 366 helmeted and 1344 unhelmeted casualties treated from 1987-89 at Melbourne and Geelong hospitals. They noted that the relative risk of head injury in helmeted cyclists compared with unhelmeted involved in crashes cannot be estimated directly from this study. They concluded that approved helmets reduced the risk of head injury by at least 39 per cent, and the severity of injury to the head. There were several anomalies, however. First, they concluded that helmets reduced injuries to the face – not covered by a helmet. When questioned, McDermott was unable to offer a satisfactory explanation.

Second, they found that the frequency of neck injury was increased in helmeted casualties, and offered no explanation. Third, helmeted casualties had a greater proportion and more severe non-head injuries than unhelmeted. They offered a partial explanation for the greater proportion, but admitted to being unable to explain why the severity was greater.

All in all, the data adduced here underline how little is known about head injuries to cyclists and the effects of helmets. As data are accumulating, more unexplained effects are becoming evident and the value of helmets in reducing injury coming more into question. Further, indications are emerging (Robinson, 1993) consistent with the finding of Rodgers – see our Appendix 1 – of a positive correlation between use of helmets and casualties to cyclists.

A matter for concern is the reliance that can be placed on studies made in the various states and territories. Shortcomings of Ratcliffe’s study in the ACT have been pointed out above. The TAC data for pedestrians puts the findings Finch and others in a different light, but they made no mention of pedestrians in their report.

New South Wales

Governments have cited sharply reduced deaths of cyclists in New South Wales in 1991 and 1992 following the introduction of the helmets law as evidence of its efficacy. Robinson (1993) has analysed statistics from the Road Traffic Authority’s annual publication Road Traffic Accidents in NSW. The average number of deaths in 1991 and 1992, 8, was 59 per cent lower than the (pre-law) average of 1989 and 1990, 19.5, but the decline can be explained by other factors. First, with these small numbers, relatively large variations can occur by chance. Pre-law, there were 34 deaths in 1988 followed by 19 in 1989 and 20 in 1990. Second, at least 25 points of the decline can be explained by fewer cyclists being on the road. Third, the hazard to cyclists due to motor vehicles was lower, owing to breath testing and other factors. The decline of 32 per cent in deaths of pedestrians is a measure of the reduction in this hazard. It is noted that 12 of the 16 cyclists killed in 1991 and 1992 were wearing helmets.

The statistics for serious injuries tell a similar story. Total deaths and serious injuries declined at much the same rate from 1989/90 to 1991/92 for all road users; deaths and injuries to cyclists as a percentage of these have therefore remained fairly constant, as follows:

  Year                            87    88    89    90    91    92
  Killed or seriously injured    3.9   3.8   3.7   4.4   4.0   3.8

This result has occurred despite the decline in numbers of cyclists on the road and increased wearing of helmets.

Robinson also used the NSW statistics for death and serious injury and for helmet wearing in 1992 to assess the protective effect of helmets. In that year, when 171 adult and 97 child cyclists were killed or seriously injured, Walker (1992) recorded 85 per cent of adult cyclists and 76 per cent of children in April as wearing helmets. Robinson reasoned that, if wearing a helmet had no protective effect, the proportions of dead and injured wearing a helmet would be the same, which she calculated as 81.7 per cent for adult and child cyclists combined. The actual proportion of 82.4 per cent is in close agreement and even slightly higher. There are minor uncertainties in the data, but it is clear that they do not demonstrate any reduction in the probability of death or serious injury from wearing a helmet.

Western Australia

For Western Australia, Healy and Maisey (1992) claimed that the growing rate of helmet wearing was reflected in reduced admissions to hospitals for intracranial injuries. On the basis of that, they evaluated costs and benefits of mandatory helmet wearing.

Healy and Maisey said on page 21 that the 5-12 age group indicates best the possible association between bicycle helmet wearing and admissions to hospital for intracranial injuries. In their figure 13, the plot of intracranial injuries to that group shows a steady decline from 113 in 1981 to 62 in 1990 against a rising trend in helmet wearing. But the data for helmet wearing are only for 1986 onward. Also, the plotting of injuries as 3-year averages masks substantial year-to-year fluctuations; as shown in their Table 8, injuries in 1988 were not appreciably lower than 1986. More important, they take no account of the declining rate of cycling; Table 7 of Heathcote (1993) shows that for the 5-12 age group cycling declined rather faster from 1988 to 1990 than admissions for intracranial injuries. Finally, the attempt to correlate declining intracranial injuries with increasing wearing of helmets is discredited by the data for the 13-17 age group. Despite little decline in their rate of cycling and a low wearing rate, intracranial injuries to them declined at least as much as the 5-12 year-olds. The basis of Healy and Maisey’s evaluation of costs and benefits is therefore unsound.

Heathcote (1993) presented, in Table 13, numbers of fatalities to cyclists in the years 1986-92, and in Table 14 and Appendix 10, numbers of cyclists suffering head injury in 1981-92. These show that fatalities declined from 8 in 1991 to 1 in 1992, and head injuries from 196 to 110. He concluded that the helmet law “reduced the number of head injuries and fatalities suffered by cyclists”. This conclusion is not sound. The decline in fatalities could well be due to chance: 1986 to 1987 showed a greater decline, from 14 to 4, and 5 fatalities occurred in the first 10 months of 1993 (advice from Western Australia Police).

The decline in head injuries from 1991 to 1992 would be statistically significant, but is not proved to be a “close approximation of head injuries that may be reduced due to helmet wearing”, as Heathcote suggested. In any case, the reduction occurred partly through the mechanism of discouraging cycling. Fewer cyclists were on the road, with reported crashes declining by 21 per cent and total injuries by 16 per cent. Head injuries declined even more, it is true, from 23 per cent to 15.4 per cent of total injuries, but the proportion of head injuries in the total has fluctuated greatly before, 1991 being the highest for 5 years and 1989 at 16.7 per cent being little higher than 1992.

The conclusion is that it is not possible to measure from these data what contribution the wearing of helmets made to reducing head injuries.

5. Negative effects of compulsory helmets on national welfare

No significant positive effects of helmet laws in reducing death or serious injury being evident, their negative effects on national welfare become relatively more important.

5.1 Distraction from other measures

First, the emphasis that governments place on the wearing of helmets distracts attention from measures for preventing accidents. Helmets of course can merely mitigate the effects of an impact and do not prevent accidents at all. Hillman (1993) discusses the suggestion that wearing a helmet may give cyclists, especially children, the false confidence to take more risks.

More attention should be given to education and training of child cyclists, and action should be taken to counter commercial promotion of cycling by children too young for it, and to dispel the impression created by advertising that bicycles are toys for doing tricks. Mathieson (1986) cited studies in America that showed that trained and experienced cyclists are 4 times less likely to be involved in an injury accident than untrained adults, and 7 times less likely than children.

As 92 per cent of fatal accidents to cyclists in 1988 involved a moving motor vehicle, it is imperative that action should be taken to protect cyclists from motorists, including more education to induce young motorists in particular to have greater care for cyclists, but governments have done little.

In Britain, the British Medical Association (1992) said that “resources are almost certainly better directed towards the prevention of accidents rather than the limitation of the damage cause by them. The introduction of mandatory wearing of cyclist helmets shifts responsibility for the safety of cyclists to the cyclists themselves … It seems more appropriate that responsibility should be borne by those causing the injuries, namely drivers of motor vehicles”. The BMA added: “The wearing of helmets must be placed in the context of other means of protecting cyclists, such as motor-vehicle speed reduction, improving the conduct of drivers, and developing cycle networks and enhancing road design for the benefit of cyclists.”

5.2 Change to mode of travel

Many children who reduce their rate of cycling will travel by car instead, or walk – and have accidents. As noted above, 42 child passengers in cars and 39 child pedestrians died of head injury in 1988 compared to 11 cyclists. The 1987 report of the Parliamentary Inquiry in Victoria which recommended compulsory helmets showed, for the years 1980-85, that the rate of death and injury per 100 000 children of 0-16 years was lower for cyclists than for pedestrians, in total and in all age groups except 12-16 years. Moreover, there was a consistently lower rate of head injury to cyclists than pedestrians. Deaths and injuries to children – and to adults – who change to another mode of travel rather than wear a helmet therefore should be debited to the helmets laws. Measuring them of course would be difficult.

5.3 Loss of skills in cycling

Children who opt out of cycling rather than wear a helmet will fail to learn the skills of cycling. Instead of beginning to develop road sense at an early age with a slow vehicle unlikely to cause injury to others, they will begin with a motor vehicle. Also, not being familiar with cycling themselves, they will be less aware of cyclists and less likely to be considerate of them. Increased danger for the remaining cyclists will result.

People who opt out of cycling in their youth will be unlikely to take it up in their adult life, and, not having developed skills in cycling at an early age, are likely to be prone to accidents. The outcome will be a society more dependent on motor transport.

5.4 Effects on health

Less cycling will mean loss of beneficial exercise. In its book the British Medical Association (1993) described health benefits gained through the exercise of cycling. It cited several studies to measure benefits in terms of life years. One study concluded that those who cycled 60 miles a week from the age of 35 could add 2« years to their life expectancy. The BMA concluded (p. 121) that “the benefits gained from regular cycling are likely to outweigh the loss of life through cycling accidents for the current population of regular cyclists”. The BMA went on “The net benefits of cycling as an effective and accessible form of exercise should therefore be promoted vigorously by government agencies, policy-makers, health authorities … cycling can make a very real contribution to improving the health of the nation.”

As estimated above, the helmet laws could result in a million children aged 10 or more in Australia and more than 100000 in Western Australia opting out of cycling and losing its benefits for their health. Cycling combines transport and exercise. The benefits of the exercise are therefore gained at little or no cost in time where people cycle to work, school, shops or other places they need to get to. Extra costs in terms of time will be incurred where travel, by motor vehicle, and exercise are separate activities. Is it not recognised that one of the most effective forms of preventive medicine is for teenage children, especially girls, to take more exercise? Cycling to school may be the best way, but, ironically, the discouraging effect of compulsory helmets is greatest for this group.

Some cyclists say that wearing a helmet aggravates migraine and other ailments. Skin cancer is of increasing concern in Australia, but helmets provide little protection against the sun. Transport authorities argue that peaks can be fitted to helmets or supplementary caps worn, but these do not protect the sides of the face. According to The Canberra Times of 28 August 1992, researchers at Dryburn Hospital in Durham, England, found that hats with brims at least 7.5 cm wide are needed “to provide reasonable protection around the nose and cheeks, where non-melanoma skin cancers commonly occur”. The Federal Minister for the Environment, Ros Kelly, in November 1993 advised Australians to adopt a sun-smart lifestyle to reduce the incidence of skin cancers. She pointed out that the thinning of the ozone layer increases the risk of skin cancer and cataracts. Compulsory helmet laws counteract her advice and their long-term effect is likely to be more skin cancer. In time, some of those affected may litigate to obtain compensation from governments.

6. Findings

A critical factor in death and serious injury to cyclists is the behaviour of motorists.

The general decline in road deaths and injuries following introduction of random checks of speed of motor vehicles and blood alcohol of drivers is a factor in a decline in deaths and injuries of cyclists in recent years.

Surveys carried out before and after introduction of compulsory helmet laws in New South Wales, Victoria, Queensland, Western Australia, the Northern Territory and the Australian Capital Territory have all shown increases in rates of helmet wearing, but also sharp declines in numbers of cyclists.

The earliest and among the best data of decline in numbers of cyclists are of child cyclists in Victoria, where total bicycle use by children decreased by 36 per cent in a year following introduction of the helmet law.

In New South Wales, surveys have shown a decline of 38 per cent in child cyclists in the first year and a further decline of 11 per cent in the second year of the helmet law – a total decline of 45 per cent.

For every child cyclist induced by the law in New South Wales to wear a helmet, five chose to give up cycling instead.

Many of those gave up cycling would perforce have adopted another mode of travel and have had accidents while travelling by that mode; any deaths or injuries thus incurred – number unknown – should be debited against the helmet law.

Based on data from New South Wales, it is estimated that the full effect of the helmet law with rigorous enforcement is a 60 per cent reduction in cycling by children, and the effect is likely to increase.

Some reductions in head injury may have occurred as a result of increased wearing of helmets, although the data are not conclusive and the number who may have benefited is very small compared to those giving up cycling in response to the law.

Indications are emerging of a positive correlation between use of helmets and casualties to cyclists.

A matter for concern is the reliance that can be placed on studies made in the various states and territories.

The helmets law has distracted from other measures to protect cyclists and will result in loss of skills and health benefits of those who give up cycling rather than wear a helmet, the loss of health benefits alone being likely to outweigh any benefits in mitigation of head injury.

References

Attewell, R.G. and Dowse, M.J., Fatal crash types. Analysis of 1988 fatality file, Federal Office of Road Safety report no. CR 105, Canberra 1992

British Medical Association, Cycling towards health and safety, Oxford University Press, Oxford, New York, 1992

Cameron, M., Heiman, L. and Neiger, D., Evaluation of the bicycle helmet wearing law in Victoria during its first 12 months, Report No. 32, Monash University Accident Research Centre, Melbourne, July 1992

Corner, J.P., Whitney, C.W., O’Rourke, N. and Morgan, D.E., Motorcycle and bicycle protective helmets: requirements resulting from a post crash study and experimental research, Federal Office of Road Safety report no. CR 55, Canberra, 1987

Finch, C.F., Heiman, L. and Neiger, D., Bicycle use and helmet wearing rates in Melbourne, 1987 to 1992: the influence of the helmet wearing law, Monash University Accident Research Centre report no. 45, February 1993

Finch, C.F., Newstead, S.V., Cameron, M.H. and Vulcan, A.P., Head injury reductions in Victoria two years after introduction of mandatory bicycle helmet use, Monash University Accident Research Centre report no. 51, 1993

FORS, Road fatality statistics Australia, , Canberra, 1991.

FORS, Road Crash Statistics Australia, November 1989 and June 1990, Federal Office of Road Safety, Canberra

FORS, Day-to-Day Travel in Australia 1985-86, Federal Office of Road Safety, Canberra, 1989

Federal Office of Road Safety, Road Fatality Statistics Australia, monthly report, April 1993, Canberra

Healy, M. and Maisey, G., The impact of helmet wearing legislation and promotion on bicyclists in Western Australia, Traffic Board of Western Australia, Perth, 1992

Heathcote, B., Bicyclist helmet wearing in Western Australia: a 1993 review, Traffic Board of Western Australia, Perth, 1993

Hillman, M., Cycle helmets the case for and against, Policy Studies Institute, 100 Park Village East, London, 1993

Janssen, E.G. and Wismans, J.S.H.M., Experimental and mathematical simulation of pedestrian-vehicle and cyclist-vehicle accidents

Lambert, J., Number of cyclists, bicyclist trips and bicyclist accident reports in Victoria, 1986-1989, VICROADS internal report, May 1990, reference 18 cited in Victorian Bicycle Strategy, VICROADS, November 1991.

Mathieson, J.G., Gaps in current knowledge and effects on counter measures, Bikesafe 86 conference, Newcastle

McDermott, F.T., Lane, J.C., Brazenor, G.A. and Debney, E.A., The effectiveness of bicyclist helmets: a study of 1710 casualties, The Journal of Trauma, 34, 6, pp. 834-845, 1993

O’ Rourke, N.A., Costello, F., Yelland, J.D.N. and Stuart, G.G., Head injuries to children riding bicycles, Medical Journal of Australia, Vol. 146, 15th. June 1987

Parliament of Victoria, Social Development Committee, Safe Roads for Children, inquiry into child pedestrian and bicycle safety, second report, 1987, Tables 5, 6, 11 and 12

Ratcliffe, P., Bicycling in the ACT – a survey of bicycle riding and helmet wearing in 1992, ACT Department of Urban Services, Canberra, 1993

Road Safety Council of the Northern Territory, Bicycle helmet wearing in the Northern Territory, GPO Box 1176, Darwin, 1992

Road Safety Council of the Northern Territory, 1993 bicycle helmet survey report, GPO Box 1176, Darwin, 1993

Robinson, D., submission to Select Committee on Road Safety, Parliament of Western Australia, 1993

Smith, N.C. and Milthorpe, F.W., An observational survey of law compliance and helmet wearing by bicyclists in New South Wales – 1993, for the New South Wales Roads and Traffic Authority, Sydney, 1993

Victorian Injury Surveillance System, Hazard No. 6, Page 6., 1990

Vic Roads, Initial Effects of Mandatory Bicycle Helmet Wearing Legislation”, July 1990, report IR 90-15, Melbourne, 1990

Walker, M.B., Law compliance and helmet use among cyclists in New South Wales, April 1991, for the New South Wales Roads and Traffic Authority, Road Safety Bureau consultant report CR 1/91 Sydney, 1991

Walker, M.B., Law compliance among cyclists in New South Wales, April 1992, a third survey, for the New South Wales Roads and Traffic Authority, Network Efficiency Branch, Sydney, 1991

Wikman, J. and Sims, C., Bicycle helmet wearing survey 1990, Royal Automobile Club of Queensland, Brisbane

Wikman, J. and Sims, C., Bicycle helmet wearing survey 1991, Royal Automobile Club of Queensland, Brisbane

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A Review of the South Australian Office of Road Safety Report 8/94

1. Introduction

This is a review of the South Australian Office of Road Safety report 8/94 subtitled “Evaluation of the Compulsory Helmet Wearing Legislation for Bicyclists in South Australia”. This report (herein referred to as SAORS 8/94) shows that authorities in South Australia have been committed to the policy of helmet wearing for cyclists since 1984, if not earlier. At that time, indeed even now, the efficacy of helmet wearing as a means of reducing injury to cyclists was far from established by scientific studies. The authorities in South Australia relied on a study by Dorsch and others, but its findings were preliminary only. The commitment to the policy was therefore premature. Clearly, if a study were now to reveal that fact, and that the helmets legislation has not worked, or even been counter- productive, persons who were party to the decision to introduce it would be severely embarrassed at the least. The South Australian Office of Road Safety is such a person, being an arm of the Department of Transport. SAORS 8/94 is therefore not a disinterested assessment, as becomes evident from scrutiny of it.

That the authorities in South Australia, and elsewhere in Australia, had no serious doubts about the efficacy of helmet wearing is evident from their failure to establish systems to monitor the effects of helmets legislation, in particular the effect of discouraging cycling.

SAORS 8/94 is based on fairly limited data from which the authors concluded that the helmets legislation has been successful in reducing head injuries and recommended that it be continued. This recommendation appears to have been based as much on the author’s unquestioning faith in helmets as on any findings in their report. Legislators in other Australian States and Territories have since cited the SAORS 8/94 study in support of their own helmets legislation, but its findings need to be seriously questioned. Comment is first made on the study by Dorsch and others, then on the three measures by which SAORS 8/94 evaluates the effect of the helmets law, namely the number of cyclists (exposure), helmet wearing rates and the number of hospital admissions for cyclist casualties.


2. The Dorsch Study

Page 1 of SAORS 8/94 notes a study (Dorsch, 1984) which had shown “the chance of death in a cycling accident decreased by a factor of 19” when wearing a hard-shell helmet as opposed to no helmet. However, data from NSW from 1992-94 show that 80% of cyclists killed on the roads in NSW (RTA, 1992-94) were wearing helmets (excluding cases where helmet wearing status was unknown), which is similar to the proportion of cyclists observed wearing helmets (76% for children and 85% for adults). This is hardly even close to a factor of 19 – more like a factor of one.

The House of Representatives Standing Committee on Transport Safety noted in its 1985 report that the 1984 paper on research by Dorsch and others “has received almost universal acceptance by bicycle groups who have been working for many years to have bicycle helmets widely accepted on the basis of their effectiveness in reducing head injuries”. Like the Committee itself, bicycle groups assumed in advance of evidence the efficacy of helmets in protecting against injury and welcomed any findings, however tentative, that favoured their assumption. Certainly, the Dorsch paper has contributed to knowledge, but has been largely discounted by subsequent researchers.

Dr. Dorsch gave evidence to the House of Representatives Standing Committee on Transport Safety 1985. On page 901(a) of evidence she said: “One has to be very careful in making estimates of how effective universal bicycle helmet usage would be in reducing deaths and serious injuries … People who are wearing what we regarded as the good hard helmet … had 19 times less risk of suffering a fatal head injury. That was a hypothetical procedure. … It was based largely on an adult group of cyclists and because we went through a rather hypothetical statistical procedure to arrive at those numbers, I think one would have to be very careful in generalising those findings to very young bicyclists. … One has to be very careful in making estimates of how effective universal bicycle helmet usage would be in reducing deaths and serious injuries … In our paper we did, sure, put estimates on it but as a very hypothetical procedure. I was a bit distressed by some of the reports I had seen that suggested that 75% of deaths could be prevented by everyone wearing very good hard helmets. “. Here we point out that the Australian Standard for bicycle helmets was amended in 1990 to allow helmets with a soft shell. This amendment was made to make helmet wearing more acceptable, but was contrary to the recommendations of commissioned research.

The authors (Dorsch and others) introduced their published paper of 1987 with the words, “In the past, evaluation of helmet efficacy has been based on laboratory tests of limited relevance to real crashes. … Helmets for bicyclists could do much to reduce deaths and injuries among crash-involved riders. While few people would doubt this assertion, there are currently no quantitative data demonstrating the efficacy of bicycle helmets in real crashes.”

The authors sent 1321 questionnaires to members of bicycling clubs in South Australia, seeking information about their most recent crash. Out of 866 usable responses, “197 bicyclists reported a crash within the last five years in which they had struck their head or helmet. … it was estimated that the risk of death from head injury was considerably reduced for helmeted relative to unhelmeted bicyclists. … Further research is needed to confirm and refine our findings.”

The authors themselves acknowledged limitations of their study. Their sample was mainly drawn from members of bicycle racing clubs, and therefore would be far from representative of the generally younger and slower-travelling general population of cyclists. Thompson and others (1989), noted their findings and added, “Because of methodologic limitations, none of the available studies have produced compelling evidence of the effectiveness of bicycle helmets.” Hillman (1993) made comments to similar effect.

The Dorsch study also found 62% of cyclists who reported hitting their heads were wearing helmets at the time, but the percentage of helmet wearers would have been extremely low; by 1990, after 4 years of promotion, it had reached only 15% for cyclists over 15. This suggests that helmeted cyclists are more likely to have an accident and/or strike their heads. This could also be related to an observation that helmeted cyclists are often very keen to recount the incident of how their helmet “saved their life”, and may therefore have been over- represented in the questionnaire because they were more likely to respond. Any over-representation of helmeted cyclists in the data may have distorted the results.


3. Exposure (i.e. Reduction in number of cyclists)

South Australian authorities did no systematic monitoring of numbers of cyclists – as they say, “due to the disparate nature of the results from different sources, it is not possible to be conclusive about the effect of the requirement to wear bicycle helmets on the number of cyclists”. They guessed, on page 32, that the decrease in the number of cyclists was the same as the decrease in the “non preventable injuries”, but it was substantially greater in NSW where non-head injuries to children declined by 13 per cent (RTA), but cyclist numbers declined by 39 per cent (Walker). As their guess is also a factor in their calculations of “helmet effect”, those too are only guesses.

SAORS 8/94 cited cycling surveys and hospital data to determine the effects of reduced exposure to cycling on a change in the occurrence of head injuries. The authors admitted that due to the inadequacy of the various sources it is not possible to be conclusive about the effect of helmet legislation on number of cyclists. In other words, the South Australian Government was negligent. They should have ensured proper and comprehensive surveys were in place before and after the law was introduced. Indeed the second recommendation of the report was that “regular and more representative surveys be conducted”, but it’s a bit too late for that now!

In a letter dated 2 February 1996, SA ORS advised that they proposed to conduct future bicycle counts at suburban checkpoints, in addition to those already conducted at schools and around the city of Adelaide. It is no longer possible to determine accurately the extent of any decline in number of cyclists due to helmet legislation. The proposed surveys could be expected to show an increase in cycling from year to year, but this should not be used to claim that cycling has recovered from any loss due to compulsory helmets, as cycling around Australia was reported to have been increasing rapidly before any helmet laws were enacted. The Government should still be encouraged to conduct these surveys however, as they may prove highly useful for monitoring trends should the helmets law be repealed.

Comments on survey methodology: Self-reporting surveys are at best unreliable. The only reliable measure of numbers of cyclists is to count them as they pass given checkpoints. The exact same checkpoints should be used for both before and after surveys, and where possible even the same people employed at the same checkpoints. The checkpoints should be strategically placed so as to get a true representation of all cyclists (for example, some surveys in the past have counted only commuters, or only children entering schools). The surveys should be conducted at exactly the same time of the year since there have been shown to be great variations from month to month, and as much as possible in the same weather conditions. This was done in NSW for children (although, as is typical in these surveys, the real purpose was to record the helmet wearing rate) and, compared to the survey in April 1991, just pre-law, revealed a reduction in cyclists of 36 per cent by April 1992 and 43 per cent by April 1993.

3.1. Health Omnibus Surveys – Frequency of Cycling

These surveys showed no significant decline in cycling. The findings are questionable for a number of reasons which the authors of SAORS 8/94 failed to identify.

1) The before and after surveys were conducted in 1990 and 1993. 1991 was when the law came in, but what happened with 1992? Thus we have a three year gap between the before and after periods during which any number of factors other than a helmets law may have influenced cycling.

2) The data were all self-reported. Reliability is therefore extremely questionable.

3) The questions asked fail to quantify cycling sufficiently. Suppose that a person cycled every weekday before the law, but afterwards only once per week? They would still be in the “once per week” category and no decline would have been recorded for them, but their decline in cycling would actually have been 80 per cent. The questions were totally inadequate to record any decline in cycling due to compulsory helmets.

4) Tables 6a and 6b record that about half of bicycle trips and the greatest increases for bicycle trips for children under 15 years were on their own property, where they don’t have to wear a helmet!

In a letter dated 2 February 1996, SA ORS advised that they would redevelop relevant questions for inclusion in the annual Health Omnibus Survey.

3.2. City of Adelaide Bicycle Cordon Count

These surveys recorded very similar results for the years 1985 till 1992 (except for 1988 which was attributed to changed survey conditions for that particular year). The authors noted that 1991 (immediately after the law was introduced) actually recorded a slight increase. No mention was made of weather conditions though. The authors also failed to do a test for significance. The 2.9% increase in 1991 could well be within the bounds of normal variance as there appears to be some degree of variation in the data from year to year.

In Table 7, the survey for 1993 showed a 15 per cent drop in cycling, though the authors took great pains to try and explain this away to the weather and the impending Grand Prix. The surveys were delayed by the weather and the authors reasoned that fewer people may have cycled due to uncertainty about the weather. They failed to reason that (bearing in mind the surveys were eventually conducted in fine weather), cyclists may have been keen to get out and cycle having been kept indoors by the previously bad weather and further, because of the delays in the survey, it was getting closer to the summer months when the weather gets warmer and more people ride their bicycles.

Since the Grand Prix was close to the time of the surveys the authors reasoned that fewer people may have cycled due to uncertainty about road closures or detours. They failed to reason that people may have wanted to cycle near the Grand Prix circuit out of curiosity, and that bicycles are less susceptible to road closures and traffic jams than cars. Those people who do not wear helmets may also have cycled less because of the presence of police officers accompanying the road closures and detours.

Another observation which could be made is about the lack of a decline immediately after the law, followed by a 15 per cent decline two years after the law. This could perhaps be related to the characteristics of the commuter cyclist. The authors pointed out that this survey tended to record mainly commuter cyclists in city traffic. Commuter cyclists in city traffic are probably more likely than the average cyclist to wear a helmet in the first place and more likely to start wearing a helmet because of a law, and less likely than recreational cyclists to reduce or stop cycling. Immediately after the law the non-helmet wearing commuter cyclist may have continued to ride as before either with or without a helmet. Two years later, some of those wearing helmets against their will may have become discouraged with the reality of wearing a helmet which they find uncomfortable, and most of those not wearing helmets have by now felt the wrath of the law, or even the wrath of people who make it their business to yell at people for not wearing a helmet. The net effect could be a delayed decline in cycling. People who have given up cycling under these circumstances are unlikely to take it up again so long as there is still a requirement to wear a helmet.

It would seem that almost anything can be read into these surveys. The reasoning which the authors applied (in contrast to ours) to the results of the cordon count would seem to indicate that they had a bias which was to dismiss the possibility that the law has reduced cycling.

3.3. Observational Studies of Helmet Wearing Among South Australian School Children

The authors note that Harrison’s (1994) study of school children showed a 38 per cent decline in cycling from September 1988 to March 1994. Due to seasonal factors, however, cycling is more popular in March than September in southern Australia; at checkpoints in Western Australia in 1993 and the Australian Capital Territory in 1993/94, less than half the numbers of cyclists were counted in September as in March. Given also the general increasing trend of cycling shown in other states in the period before compulsory helmets were introduced and that there is a six year before/after period, the decline due to the helmets law could well have been much greater than 38 per cent.

These facts are in contrast to the arguments of the SAORS 8/94 authors, who on page 31 attempt to pass this decline off as a result of a decrease in popularity of bicycles, and increasing concern of parents about the safety of children travelling to school alone. One very likely reason for bicycles becoming less popular, would be the fear put into people as a result of Government helmet propaganda (for example, television commercials showing eggs being hit by hammers). As for the other point, surely children would be at much less risk from “the Bogey man” with the increased speed and mobility of a bicycle compared with walking to school or even walking to a bus stop, so are the authors saying that 38 per cent of parents have decided to drive their children to school rather than let them ride their bike? This would mean an increase in motor traffic, in particular around schools. It can be argued that cars stopping to drop children off create a dangerous safety environment for children. Further, a one person- bicycle trip would have been replaced by three person-motor vehicle trips since the parent must drop their child off and then return home. Also, some children who walk instead of ride will suffer injury.

3.4. Other Cycling Surveys

Given the data available, the authors have rightly pointed out that “it is not possible to be conclusive about the effect of the requirement to wear bicycle helmets on the number of cyclists”. However there are some pre and post law cyclist counts from other states which provide data with considerable reliability, and they all indicate rather large declines. It may be unreasonable to assume that South Australians are significantly different in their “acceptance” of the helmets law than other Australians.

Here is a brief summary of surveys that we are aware of:

1) Pre-law in Victoria, some students at schools which compelled them to wear helmets chose to give up cycling instead (evidence given to House of Representatives Standing Committee on Transport Safety, 1985, page 1078).

2) According to Vic Roads report IR 90-15 (1991), the number of cyclists described as adult commuters declined by nearly 60 per cent between March and July 1990. This figure is invalid because of the different times of the year involved (the decline is probably attributed to the usual reduction of cycling in winter months), although the July survey was taken in fine sunny weather.

3) Morgan and others (1991), in surveys in March 1990 and March 1991, showed declines of 30 per cent in recreational cycling and 32 per cent in commuter cycling in Victoria.

4) Surveys in Melbourne by Monash University Accident Research Centre (MUARC) showed total bicycle use by children had decreased by 36 per cent. Finch and others provide data showing the following decreases in numbers of bicyclists observed during the first year of the law: adults 29 per cent, teenagers 46 per cent and children 24 per cent.

5) A baseline survey by Walker for the RTA of NSW showed an average post-law decline for cyclists under 16 of 39 per cent (see above).

6) Surveys by Walker for the RTA of NSW were inconclusive for adult cyclists. A decline was shown since April 1991, but this was post-law.

7) In 1990 and 1991, branches of the Royal Automobile Club of Queensland conducted surveys, which showed a reduction of 22 per cent for schools in total, but because of changes in survey conditions the decline was probably more in the order of 30 to 50 per cent. Further, this decline occurred before the law was enforced.

8) In their survey, Healy and Maisey (1992) commented that the numbers of children cycling to primary schools and numbers of recreational cyclists (in WA) declined from 1991 to February 1992.

9) Heathcote (1993) presents limited data which show some decline in numbers of WA children cycling to school. Heathcote’s limited observations of “commuter” cyclists indicate an increase in numbers after the helmet law, but his observations of cyclists classed as recreational show a decline of over 50 per cent. Data from automatic counter surveys conducted by Main Roads showed a decline of 38 per cent from October-December 1991 to October-December 1992.

10) WA Main Roads also counted numbers of cyclists crossing the Narrows and Causeway bridges on weekdays, which show sharp declines in cycling.

11) Surveys by the Road Safety Council of the Northern Territory showed there was little change pre-law to post-law in the numbers of children cycling to primary school, but a 36 per cent decline in cycling to high school. The decline in numbers of “commuter” cyclists was of the order of 50 per cent.

12) Members of the Cyclists’ Rights Action Group carried out a survey of 325 cyclists in the ACT in May 1992, pre-law, and found that 28 per cent (or 90 respondents) would cycle less if helmets were compulsory.

13) Ratcliffe (1993) reported that mean weekday cycle path daily volumes in the ACT were recorded in 1992 to be about one third lower than the similar period in 1991, with mean weekend daily volumes declining by about half.

14) ACTUS followed up with another survey in 1993/94 which found a 34 per cent increase from 1992, almost back to pre-law figures. However, the 1993/94 surveys were conducted mainly in February, whereas the 1992 surveys were in December. Comparisons of those few sites with figures available for the same months, show a total count of 7763 for 1992/93 versus 7810 for 1993/94, an increase of 0.6 per cent.


4. Helmet Wearing Rates

Tables 8 through 13 of SAORS 8/94 are all self reported. If asked after the law if they wore a helmet, how many people would have lied, not wanting to admit to a lawbreaking activity, and said “yes” when the answer is in fact “no”, or even “yes (but only when I think I can’t get away with not wearing one)”. In any case it is only an indication of helmet wearing, and nothing to do with helmet law acceptance.


5. Hospital Admission Data

A number of points arise from the hospital admission data, and subsequent analysis of the effect of the helmets law.

5.1. Hospital Admissions for Under 15’s

The number of admissions for under 15’s was much the same in the first year of the law as for the first three pre-law years of the data. This is in spite of increased helmet wearing rates and reduction in number of cyclists. The number of admissions in the second year of the law actually increased. So with fewer cyclists wearing more helmets, hospital admissions were the same or more. Helmet laws were largely meant to protect the children, yet it appears that they have done children more harm than good.

5.2. Hospital Admissions for Over 15’s

The number of admissions for over 15’s showed a solid decrease after the law. This is inconclusive however in light of the absence of an accurate measure of the decline in cyclists. It is also established that older children and adults are more likely to have accidents involving motor vehicles than are young children (Hillman, 1993) so the fact that hospital admissions for over 15’s declined but under 15’s did not is likely to be related to improved traffic conditions and less motor vehicle involvement.

5.3. Improved Traffic Conditions

There is no account taken by the authors of the effect of improved traffic conditions, as indicated in Figure 19 of their report by the general decreasing trend of all road crash casualties. It is noted on page 31 that casualties remained high until around June 1991 at which point they showed a substantial decrease. This was at the same time that the helmets law was introduced. The authors rightly suggest that the decrease was possibly due to a combination of factors, including speed cameras and 0.05 BAC limit. This may be coincidental, but the requirement for compulsory bicycle helmets and the 0.05 BAC limit were both part of the Federal Government’s 10-point black spots road funding package in 1989.

Commenting on the decline as shown in Figure 19 of their report, the authors say on page 31 that “It would appear from this that the reduction in number of bicycle casualties admitted to hospital may not be attributed to any indirect effect of helmet legislation”. This statement is rather tentative and open to misinterpretation, but it seems they are claiming that the reduction in all bicycle casualties (not just head injuries) might have nothing to do with any reduction in cycling, i.e. that cycling did not in fact decline at all and the real reason there were fewer (non-head) injuries was because of the safer roads!

5.4. Involvement of Motor Vehicles

From Table 21 (Bicycle Accidents Resulting in Hospital Admission Involving A Motor Vehicle) the authors note that the majority (75-80%) of accidents resulting in hospital admissions do not involve a motor vehicle. This is correct, but, as noted by Hillman (1993): “The great majority of accidents are minor. They characteristically involve cyclists losing control of their cycles and falling off. Other vehicles are not involved. Injuries are rarely serious; admission to hospital usually reveals only short-term concussion. But when accidents are serious, they generally involve damage to the head following collision with a motor vehicle. This is true for the large majority of fatalities and about one half of the serious injuries. Adult cyclists are most frequently involved.” In Australia in 1988, a moving motor vehicle was involved in 92 per cent of fatalities to cyclists.

The SAORS 8/94 authors noted the decreasing trend of percentages for motor vehicle involvement in Table 21, but failed to realise that this is likely to be a direct result of the roads being made safer for cyclists. As a result of less motor vehicle involvement, it can be expected that the percentage of non-head injuries will increase in proportion to injuries involving the head. In South Australia, North et al. (1993) noted “We have recently observed an apparent fall in the number of patients suffering from head injury due to road trauma …. The largest drop in patient numbers was observed in motor cyclists, falling from an average of 24 per year previously, to only five in 1992.” This is unlikely to be related to helmet wearing since compulsory helmets for motor cyclists has been in effect for two decades. It appears to be well established that there was a decreasing trend in head injuries for all road users in South Australia, not just cyclists. To determine this effect on cyclists, a comparison between cyclists and pedestrians would be appropriate.

For Victoria, Robinson (1996) found that the percentage of head injuries in claims to the Motor Accidents Board for pedestrians and cyclists aged 0-16 from 1980-85 shows a correlation of 0.94, statistically significant with P < 0.02. Major initiatives directed at drink-driving and speeding were introduced in Victoria in December 1989 and March 1990 (Cameron et al. 1994), and pedestrian fatalities fell by 42 per cent from 159 in 1989 to 92 the following year. It is likely these initiatives also reduced impact speeds and hence head accelerations and the proportion of victims with head injuries. It would seem that any reduction in head injuries would have had more to do with RBT and anti-speeding campaigns than with the use of helmets.

As Robinson (1996) pointed out, “the cause of any common trends in percentage head injured for pedestrians and cyclists may relate to impact speed of motor vehicles”. Janssen and Wismans (1985) observed a 40 per cent reduction in maximum head acceleration of dummy pedestrians hit by vehicle fronts, compared with reductions of 30%, 22% and 10% for chest, pelvis and feet, when vehicle impact speed was reduced from 40 to 30 kph. The effect for dummies on bicycles was similar. Maximum head acceleration reduced by 50 per cent, compared with 30%, 16% and 36% for chest, pelvis and feet.

It is well established that a reduction in motor vehicle involvement and/or speed will reduce the incidence of head injuries significantly more than non-head injuries.

As mentioned earlier, Table 21 shows that about 80 per cent of cycling accidents resulting in hospitalisation do not involve a motor vehicle and further that motor vehicle involvement had declined. However, it is also well documented that over 90 per cent of serious head injuries to cyclists do involve a motor vehicle (Hillman, 1993). Therefore, even without helmets, we can reasonably expect the number of serious head injuries to decrease in proportion to other injuries for cyclists. In fact, from a mere 2 percentage-point change in motor vehicle involvement (say from 20% to 18%) we could expect about a 10 per cent reduction in serious head injuries compared to other injuries! It should also be pointed out that, in addition to a lower frequency of motor vehicle involvement, the average speed of the motor vehicle in those accidents might also have been reduced thanks to speed cameras and other measures which were in force, therefore further contributing to the reduction in head injuries.

From Table 21 of SAORS 8/94, motor vehicle involvement declined from 21.3 per cent in 1989/90 to 18.9 per cent in 1992/93, or by 11.3 per cent (2.4 percentage points) over the same period as the two year before/after period used to obtain the 24.7 per cent reduction in PPI (Potentially Preventable Injuries, ie injuries which a helmet might have prevented – see page 30 of SAORS 8/94). For the one year before/after period, with only a 12.1 per cent reduction in PPI (see page 29), the decline in motor vehicle involvement was from 19.7 per cent to 18.3 per cent, or by 7.1 per cent (1.4 percentage points). These figures of 24.7 versus 2.4, and 12.1 versus 1.4, are roughly proportional and provide an alternative explanation for the reduction in head injuries than simply the use of helmets.

The authors of SAORS 8/94 did not consider any of the above when they calculated their figures of a 12.1 per cent and 24.7 per cent reduction in potentially preventable head injuries, which they attributed entirely to helmets. They also failed to explain why there was such a great disparity between the one- and two-year figures, one of which was twice as large as the other! It is unlikely that the efficacy of helmets would have changed by so much in the space of just one or two years.

5.5. Cyclist Risk Taking

Another possible explanation for the data is that cyclists may be taking more risks now that they are wearing helmets. Risk compensation is fairly well documented. Hillman (1993) cites research on risk compensation and notes that “discussion of this subject of behavioural adaptation no longer centres on whether it occurs but on how complete it is”. By comparing head with non-head injuries and attributing the difference to the benefits of helmet wearing, the SAORS 8/94 authors have ignored the possibility that cyclists may be taking more risks and therefore having more accidents and/or more severe accidents. The net effect of this may be more non-head injuries with head injuries remaining the same due to the increased risk taking cancelling out the (limited) benefit of bicycle helmets. This is clearly not a beneficial or desirable outcome of the helmets legislation.

There is certainly no shortage of data to support the hypothesis that cyclists are taking more risks due to helmet wearing. Here are a few examples :

1) Rodgers (1988) studied over 8 million cases of injury and death to cyclists over 15 years in the USA. He concluded as follows: “There is no evidence that hard shell helmets have reduced the head injury and fatality rates. The most surprising finding is that the bicycle- related fatality rate is positively and significantly correlated with increased helmet use.”

2) The South Australian under 15 hospital admissions data showed no decline and even an increase in head injuries, in spite of any declines in cyclist numbers.

3) As previously stated, non-head injuries to children in NSW declined by substantially less than the decline in number of cyclists. This result happened despite declines in injuries to pedestrians and motorists: an indication of safer roads.

5.6. No Tests of Significance

There were no tests of significance done on the important data in Tables 24 and 25, from which conclusions of helmet effect were drawn. This would be unacceptable for any respectable scientific journal.

5.7. Classification of Injuries

The injuries listed in Appendix 1 as being potentially preventable by a helmet are biased. How could a helmet protect nasal bones, upper facial bones, eye, eyeball, nose and forehead? Research commissioned by the Federal Office of Road Safety recommended that the standard for bicycle helmets, AS2063, should be amended to extend protection to the temporal area, but it was not done in 1990, when other amendments to the standard were made. Another study (Acton, 1996) found that bicycle helmets were not preventing facial injuries in children.

It should also be pointed out that many of the injuries listed as being preventable by helmets are of a superficial nature (e.g. “open wound of scalp, nose”) and that helmet wearing is likely to result in an increase in the more serious diffuse brain injury (National Health and Medical Research Council, 1994).


6. Conclusions

1) There are no data from South Australia which adequately measures the true change in number of cyclists. Proper studies should have been set up but were not. It is no longer possible to determine with any certainty the effect legislation has had on the number of cyclists in South Australia.

2) High helmet wearing rates are seen as evidence of the effectiveness of the law, which seems to imply that the purpose of the law is simply to force cyclists to wear helmets at all costs, as opposed to saving lives and reducing injury.

3) When placed under scrutiny, the conclusions reached that the helmets law has reduced head injuries by 12.1 per cent to 24.7 per cent are without proper foundation. Further, these figures were derived without proper statistical tests of significance. It is not even established that rates of head injury to those still cycling after the helmets law declined; indeed, interstate experience indicates that the reverse is more likely. In any case, reduced head injury rates are more likely to be a result of improved road conditions due to factors including anti- speeding and RBT measures, than due to helmets.

4) Bicycle helmet legislation should be repealed in South Australia and elsewhere. There has been much harm done (loss of cycling benefits, infringement of civil liberties) for little or no gain. It is about time Governments were honest and admitted that the helmets legislation has been a failure. Recommending that legislation be continued whilst having (at best) flimsy evidence of its effectiveness is a case of reverse-onus – it is the Government that should have conclusive proof to support legislation.

5) The South Australian Office of Road Safety Report 8/94 is very limited in its value for the purposes of evaluating the effect of compulsory bicycle helmet legislation. Its conclusions were evidently motivated by the political desire to justify the current compulsory helmets policy of the Government.

6) The Dorsch study has been disregarded by most researchers.


7. Acknowledgements

Special thanks to:
D.L. Robinson, UNE
The South Australian Office of Road Safety


8. References

ACT Bicycle Volumes; Trends, Variations, Survey Results, Helmet Wearing And Cyclist’s Characteristics, 1991 – 1993/94; Report prepared by the Traffic Monitoring Unit, ACT City Services, Department of Urban Services, PO Box 158 Canberra ACT 2601, Australia.

Acton, Caroline H C, Nixon, James W, Clark, Ronald C ; Bicycle riding and oral/ maxillofacial trauma in young children, MJA 1996; 165: 249.

Cameron, M.;Vulcan, A.P.; Finch, C.F.; Newstead, S.V. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia – an evaluation. Accident Analysis and Prevention, Vol 26, No 3, 1994a.

Dorsch, M.M., Wodward, A.J. and Somers, R.L., Do bicycle helmets reduce severity of head injury in real crashes?, Acc. Anal. & Prev. 19, 3, pp. 183-190, 1987

Finch, C.F., Heiman, L. and Neiger, D., Bicycle use and helmet wearing rates in Melbourne, 1987 to 1992: the influence of the helmet wearing law, Monash University Accident Research Centre report no. 45, February 1993

Harrison, R., Observational Study of Bicycle Helmet Wearing Amongst South Australian Schoolchildren, for the Office of Road Safety, Department of Transport, South Australia, April 1994.

Healy, M. and Maisey, G., The impact of helmet wearing legislation and promotion on bicyclists in Western Australia, Traffic Board of Western Australia, Perth, 1992

Heathcote, B., Bicyclist helmet wearing in Western Australia: a 1993 review, Traffic Board of Western Australia, Perth, 1993

Hillman, M., Cycle helmets, the case for and against, Blackmore Press, Longmead, Shaftesbury, Dorset, 1993

Janssen, E.G.; Wismans, J.S.H.M. Experimental and mathematical simulation of pedestrian-vehicle and cyclist-vehicle accidents. Proceedings of the 10th International Technical Conference on Experimental Safety Vehicles, Oxford, July 1985.

Marshall, J.; White, M.; Evaluation of the Compulsory Helmet Wearing Legislation for Bicyclists in South Australia, South Australian Department of Transport, Office of Road Safety Report Series 8/94, November 1994.

North, B.; Oatey, P.; Jones, N.; Simpson, D.; McLean, J.; Head injuries from road accidents – a diminishing problem? Medical Journal of Australia, 158:433; 1993

Ratcliffe, P., Bicycling in the ACT – a survey of bicycle riding and helmet wearing in 1992, ACT Department of Urban Services, Canberra, 1993.

Road Safety Council of the Northern Territory, Bicycle helmet wearing in the Northern Territory, GPO Box 1176, Darwin, 1992

Road Safety Council of the Northern Territory, 1993 bicycle helmet survey report, GPO Box 1176, Darwin, 1993

Robinson, D.L.; Head Injuries and Bicycle Helmet Laws, Accident Analysis and Prevention, volume 28, number 4, pages 463-75 (1996).

Rodgers, G.B., Reducing bicycle accidents: a reevaluation of the impacts of the CPSC bicycle standard and helmet use, Journal of Products Liability, 11, pp. 307-317, 1988

Smith, N.C. and Milthorpe, F.W., An observational survey of law compliance and helmet wearing by bicyclists in New South Wales – 1993, for the New South Wales Roads and Traffic Authority, Sydney, 1993

Thompson, R.S., Rivara, F.P. and Thompson, D.C., A case-control study of the effectiveness of bicycle safety helmets, The New England Journal of Medicine, 320: 21, 1989

Vic Roads, Initial Effects of Mandatory Bicycle Helmet Wearing Legislation”, July 1990, report IR 90-15, Melbourne, 1990

Walker, M.B., Law compliance and helmet use among cyclists in New South Wales, April 1991, for the New South Wales Roads and Traffic Authority, Road Safety Bureau consultant report CR 1/91 Sydney, 1991

Walker, M.B., Law compliance among cyclists in New South Wales, April 1992, a third survey, for the New South Wales Roads and Traffic Authority, Network Efficiency Branch, Sydney, 1991

Wikman, J. and Sims, C., Bicycle helmet wearing survey 1990, Royal Automobile Club of Queensland, Brisbane

Wikman, J. and Sims, C., Bicycle helmet wearing survey 1991, Royal Automobile Club of Queensland, Brisbane

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