11.15.19

Mandatory Helmet Laws: A Public Health Intervention?

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I ride my bicycle at least once a day. Whether I’m casually pedalling to work on the Capital BikeShare or I’m speeding down MacArthur Boulevard on my road bike alongside my teammates, cycling is one of my favourite activities. On my bike, I get to roll by traffic during rush hour, I get to enjoy the fresh air after a long day at the office, and I get a daily a dose of physical activity. Cycling is an important component of my physical and mental health, and I cannot imagine my life without it. Still, despite the joy that cycling brings me, I am aware that each time I get on my bicycle, I am placing myself in a vulnerable position.

Three years ago, I got into an accident while cycling home from work. It was the motorist’s fault, but I was left with a severely broken foot and ankle. Even though I will have pain in my foot for the rest of my life, I was lucky that all I had was a broken limb. Many bicycle/motor vehicle accidents end in fatalities or injuries that can have serious, life-long consequences on individuals and their families.

Road injuries kill around 1.4 million people every year, putting them in the top 10 causes of death around the world. The WHO Global Status Report on Road Safety 2018 revealed that road traffic injury is the leading cause of death for people between 5 and 29 years, with more than half of global traffic deaths involve pedestrians, cyclists, and motorcyclists. In the United States, approximately 800 bicyclists are killed every year, and almost 50,000 individuals experience bicycle-related injuries. Although overall traffic fatalities around the United States dropped by 1% in 2018, cyclist fatalist increased by 10%.

In an attempt to respond to this increase in bicycle fatalities, the federal National Transportation Safety Board (NTSB) released recommendations on November 5, 2019 targeting ‘cycling infrastructure’ and ‘cyclist conspicuity’. While the primary focus was on crash avoidance, the investigators also examined instances where crashes did occur in order to produce recommendations for reducing fatalities and serious injuries. In particular, NTSB recommended “that all 50 states, the District of Columbia and Puerto Rico, require that all persons wear a helmet while riding a bicycle.”

As someone who always wears a helmet, my first reaction is that mandatory helmet legislation is a simple, logical public health intervention to reduce preventable deaths and injuries. A recent article assessing the impacts of helmet legislation on cycling fatalities in Australia found that cycling fatalities in the country dropped 46% immediately following the introduction of such legislation. Mandatory helmet legislation has been used around the world since 1990 when the Australian state of Victoria became the first jurisdiction to introduce such legislation for all ages. Today, 28 countries around the world have implemented bicycle helmet legislation of some degree. Legislation requiring helmets for individuals of all age groups has been implemented in nine countries (Argentina, Australia, Finland, Malta, Namibia, New Zealand, Nigeria, South Africa, and United Arab Emirates), five Canadian provinces, and a number of cities across the United States.

However, not all cyclists agree with this intervention. Some argue that these laws deter people from riding bicycles, make bike sharing programs unsustainable, discourage exercise, and weaken the demand for other resources, such as safe bicycle lanes, that would help cyclists.

Do mandatory laws lead to a reduction in the number of bicycles on the road? A 2008 Cochrane Systematic Review found that bicycle helmet legislation increased uptake of helmet use, decreased bicycle-related head injuries, without finding a reduction in the number of cyclists. Discouraging individuals from cycling should not be an outcome of any legislation seeking save lives and prevent injuries, so more research should be conducted to ensure that individuals continue to ride their bicycles even when faced with helmet laws.

In addition to building the research base to support legislation, mandatory helmet laws must be part of a larger strategy: cities must address systemic problems associated with lack of safe cycling environments. While the evidence currently shows that helmet use is effective, these mandates should be only one component for protecting cyclist from death and injury. Laws and regulations can be used to ensure that streets are made safer for cyclist through, for example, separated bicycle lanes and requirements for traffic calming measures such as speed bumps and speed reduction for motorized vehicles.

As cities around the world try to promote walking and cycling to decongest roads or to promote more physical activity, urban landscapes cannot continue to favour cars, leaving individuals seeking other modes of transportation in dangerous situations. While helmets are important for protecting individuals, systemic changes must be made to our roads to protect vulnerable commuters.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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