Legislation for the compulsory wearing of cycle helmets

Board of Science and Education
November 2004

Introduction
The BMA has strongly supported the advice that all cyclists should wear properly fitted helmets but has not supported the proposal that this be made compulsory. This was not Annual Representative Meeting (ARM) policy but followed a recommendation made in the Cycle helmets (1999) report.

In the past year we have received correspondence from a number of BMA members, in particular those treating injured victims of cycle related accidents on a daily basis, requesting that the BMA reconsider its existing policy on this issue [Go to note 1]. In our 1999 report significant emphasis was placed on the BMA’s wish not to discourage cycling by making helmets compulsory.

This advice was based on evidence from Australia indicating that cycling levels decreased following the introduction of legislation. This evidence is now outdated and contains distortions from variables including a reduction in the legal age of driving that meant more teenagers travelled in motor vehicles. A study from Ontario, Canada has demonstrated that introduction of helmet legislation did not reduce numbers of children cycling [Go to note 2].

Research published in June 2003 for the Department for Transport revealed a growing trend for wearing cycle helmets in the UK. Wearing rates for the population as a whole rose from 16% in 1994 to 25% in 2002 [Go to notes 3 and 4].

The evidence
Cycle helmets are now compulsory in Australia [Go to note 5], New Zealand [Go to note 6], Spain, Iceland (aged under 16), the Czech Republic (aged under 16), Canada (aged under 18) [Go to note 7] and twenty states in the USA. Studies in a number of these countries have shown that high usage rates of helmets as a result of legislation is associated with a reduction in cycle related deaths and head injuries. Evidence supporting the wearing of cycle helmets continues to mount:

It is estimated that 90,000 road-related and 100,000 off-road related cycling accidents occur every year in the UK, of which 53% (100,000) involve children under sixteen [Go to note 8].
In 2002, 594 children and 1,801 adults were killed or seriously injured as a result of road-related cycling accidents [Go to note 10].

Significantly, with child cyclists, 85 per cent of accidents occur off road where primary prevention measures such as cycle lanes, vehicle speed reduction and driver education are ineffective [Go to note 9].

Several recent studies and discussions [Go to note 14] have provided scientific evidence that bicycle helmets protect against head, brain, severe brain and facial injuries, as well as death, as a result of cycling accidents:

  • In the USA, a 30-month study of 3,854 cyclists showed that helmet usage decreased the overall risk of brain injury by 65 per cent and severe brain injury by 74 per cent in all age groups [Go to note 9].
  • An Australian study showed that wearing cycle helmets reduces both the incidence of facial injuries by 28 per cent and their severity [Go to note 11].
  • A Cochrane review considering five case-control studies from the UK, Australia and the USA illustrates a large and consistent protective effect from cycle helmets, reducing the risk of head and brain injury by 65 to 88 per cent and injury to the upper and mid face by 65 per cent [Go to note 12].
  • A study of primary school, secondary school and adult cyclists in New Zealand demonstrated a 19 per cent reduction in head injuries to cyclists in the three years after the introduction of legislation [Go to note 13].
  • In Victoria, Australia, an increase in helmet use from 31 per cent prior to legislation to 75 per cent one year after was accompanied by a decrease in head injuries by 40 per cent in the following four years [Go to note 12].
Enforcement
As with any other legislation enforcement is as important as the law itself. Without compliance the law is at best ineffective. To achieve maximum compliance, the legislation should be complemented by mass educational and promotional campaigns. Evidence from Australia and New Zealand showed that educational campaigns prior to the introduction of legislation resulted in an increase in helmet wearing from two per cent to up to 95 per cent [Go to note 8].

An education programme in Reading that promoted cycle helmet use among children and teenagers resulted in a local increase in usage from 18 per cent to 60 per cent and a concurrent decrease in cycle-related injuries [Go to note 9]. The most difficult group in which to increase helmet use was teenagers, who are often the category most at risk. One approach is to target educational programmes at adults, as evidence from a Seattle-based study suggests that helmet usage is greatest in children riding with helmeted adults [Go to note 12].

At a practical level, enforcing the legislation can be achieved through on-the-spot fines or tickets issued by police and traffic wardens, while schools can ensure all children wear helmets on journeys to and from school. Cycle helmet legislation and other safe cycling promotions are not mutually exclusive, and there is a clear role for the simultaneous introduction of more primary prevention measures including cycle lanes, driver education and vehicle speed reduction initiatives.

Further measures to improve cyclists' safety
The BMA believes that cycling has many advantages to the individual in terms of improved health and mobility, as well as to society via, for example, reduced air pollution and traffic congestion. Even in the current hostile traffic environment, the benefits gained from regular cycling are likely to outweigh the loss of life through accidents for regular cyclists.

We need to reinforce the points made in our 1999 report, that action to reduce the high rate of fatal and serious accidents suffered by cyclists must include:
  • the creation of a safer cycling environment
  • reductions in vehicle speeds and traffic volume in urban areas
  • the provision of cycling training for all children
  • recognising road safety, including cycling proficiency education, as part of the curriculum for all school children. This should include basic cycle maintenance, and safety precautions (eg lights, reflective clothing), information on the health benefits of cycling, as well as encouraging cycle helmet use.
  • Information on current cycle helmet standards and the level of protection they provide should be more easily accessible to consumers.
  • Advertising Standards officials should ensure that the public are protected against misleading safety claims from manufacturers.
  • Cycle manufacturers and retailers should consider supplying a free cycle helmet (or helmet voucher) with every bike sold.
  • Helmet costs should be reduced substantially, eg through Government subsidy schemes and the reassessment of VAT on safety products on a European wide basis.
Summary of evidence
  • The evidence from those countries where compulsory cycle helmet use has already been introduced is that such legislation has a beneficial effect on cycle-related deaths and head injuries. This strongly supports the case for introducing legislation in the UK. Such legislation should result in a reduction in the morbidity and mortality associated with cycling accidents.
  • Recent evidence has indicated that the introduction of compulsory legislation does not have a significant negative effect on cycling levels. Such legislation in the UK should not discourage cyclists and lead to a more sedentary lifestyle with consequent health risks.
Recommendations
In light of this evidence on 20 October 2004, the Board of the Directorate of Professional Activities of the BMA agreed that the BMA support the introduction of legislation making the wearing of cycle helmets compulsory for both children and adults.

Further, as stated in the 1999 report we strongly recommend that all cyclists wear proper fitting helmets which as a minimum should be certified to the EN 1078 standard, but preferably certified to the Snell B95 standard. It is also important that helmets are replaced after an accident.

References and footnotes
[1] For example, John Black. Emergency Medicine Consultant and Emergency Department Clinical Director. John Radcliffe Hospital, Oxford

[2] Macpherson AK et al. Mandatory helmet legislation and children’s exposure to cycling. Inj Prev 2001;7(3):228-230

[3,4] K Gregory, C Inwood and B Sexton, Cycle helmet wearing in 2002, Prepared for Road Safety Division, Department for Transport, Teenage boys appeared to be the only exception to the rule with rates dropping from 16% to 12%. Alongside data showing that deaths and serious injuries for boy cyclists were about 5 times the rate for girls. This research endorsed the need to encourage teenage boys to wear cycle helmets. The Government is already targeting teenage boys with the THINK! Campaign under Road safety banner, launched in May 2003.

[5] Compulsory legislation introduced in 1990.

[6] Compulsory legislation introduced in 1994.

[7] Compulsory legislation introduced in 1995.

[8] Chapman HR, Curran ALM. Bicycle Helmets 1- Does the dental profession have a role in promoting their use? British Dental Journal 2004;196(9):555-560

[9] Lee AJ, Mann NP. Cycle Helmets. Arch Dis Child 2003;88: 465-466

[10] Statistics from the Department of Transport: Road accident casualties by road user type and severity: 1992-2002

[11] Chapman HR, Curran ALM. Bicycle Helmets 1- Does the dental profession have a role in promoting their use? British Dental Journal 2004;196(9):555-560.

[12] Thompson et al. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev. 2000;2:CD001855

[13] Scuffham P et al. Head injuries to bicyclists and the New Zealand bicycle helmet law. Acci Anal Prev 2000;32(4):565-573

[14] Making cycle helmets compulsory: ethical arguments for legislation Aziz Sheikh MD MRCGP, Adrian Cook BSc MSc, Richard Ashcroft BA PhD

© British Medical Association 2007

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