Transport and Health Study Group

The Transport and Health Study Group is the principal public health organisation in the transport field, certainly in the UK and probably in Europe.

We were deeply concerned at the Advertising Standards Association ruling banning a cycling advertisement in which the rider was not wearing a cycle helmet. In our view it is far from clear that cycle helmets ought to be promoted as actively as such a ruling would imply. There is significant professional and scientific controversy on this subject, so much so that the Journal of Transport and Health (a scientific journal which we sponsor for publication by Elsevier) will be devoting an entire issue to the debate in the near future.

Cycle HelmetsThe first problem is that epidemiological evidence has never succeeded in demonstrating at a population level the benefits that might be expected. This raises in our minds the real possibility that there is some factor which counters the benefits that might be expected from the helmet, possibly a physical factor (such as increased risk of neck damage), possibly a behavioural factor in the cyclist (such as risk compensation) or possibly a behavioural factor in others (there is one study which shows that drivers drive closer to cyclists who are wearing a cycle helmet). There are also good reasons to accept that research on cycle helmet effectiveness was strongly affected by confounding factors, related to social class differences between those who do, or do not, choose to wear a helmet. Whilst this issue remains unresolved there is a basis on which a scientifically well-informed rider could legitimately decide that it was safer not to wear a helmet.

The second problem is one of proportionality. If the above doubts can be resolved there is indeed a case for wearing a helmet whilst cycling. It is however no stronger than the case for wearing a helmet whilst walking in icy weather, whilst walking when over the age at which balance starts to decline, whilst walking when tired, inebriated or unwell, or whilst driving. Serious head injuries occur in all of these settings. Some might query the equivalence of wearing a helmet whilst cycling or whilst driving by asserting that the cyclist is more vulnerable. However, properly analysed, the statistical risks are indeed equivalent. The cyclist may be less protected but the forces involved in car collisions are greater (indeed rise with the square of the speed). Indeed, driving helmets have been compulsory in motorsport since the 1950’s, yet there have been no moves to promote their use in daily driving. The case for wearing a helmet when playing football is much stronger than the case for wearing a helmet whilst cycling.

The third problem is the impact that the disproportionate advocacy of cycle helmets has on cycling rates and hence on the diseases of physical inactivity such as heart disease, obesity and diabetes. To advocate helmet-wearing when walking, driving, cycling and playing football would be harmless and would represent one legitimate point of view in the debate about risk-aversion. To pick cycling out of that list is to make it abnormal – to put it in the same category as motorcycling or being on a construction site. Cycling is safe. Urban cycling in England is safer than driving in France. Comparing like journeys cycling is very similar in risk to driving. It is safer than walking. For young male road users it is considerably safer than driving. If there is a very small difference in risk between cycling and driving it is of the same order as choices which people make unthinkingly such as to take a car rather than a train or to drive on an all-purpose road rather than a motorway. And that very small risk is more than offset for the individual by the health benefits (cycling increases life expectancy rather than reducing it) and for society by reduced third party risks (if third party risks are taken into account cycling is considerably safer than driving). Yet the false idea has arisen that cycling is unsafe. And that idea causes serious harm to many people by dissuading them from cycling.

Of course the fact that something is safe does not mean that it ought not to be made safer. It is indeed perhaps an exaggeration to describe something as safe when it is simply no more dangerous than driving, an activity which has killed more people than both world wars. But to select cycling from a list of activities which would equally benefit from helmet-wearing, and to deploy regulatory activity to cycling uniquely from that list, is to present a harmful false impression of its danger. This harmful false impression will kill people – they will be put off cycling and as a direct consequence will be twice as likely to die of heart disease and much more likely to suffer diabetes.

The ASA could correct this disproportionate message in either of two ways. It could stop banning advertisements which show cyclists without helmets or it could extend the ban to cover adverts which show people driving or walking without helmets. It should do one or other of these two things.

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  1. George Nieman says:

    Having worked in A&E when cycles have been brought in with severe head injuries simply because they did not wear a helmet. The choice often is shown to be, live,by wearing a helmet of die without wearing one.

    1. Tom williams says:

      Problem is helmets change perceptions, encourage risk taking, encourage bad driving, exacerbate rotational neck injuries, and don’t protect cyclists from HGV’s (the single biggest killer of cyclists).
      The choice is complicated and we don’t have all the evidence to guarantee a factual understanding.

  2. Richard grimes says:

    Wearing a cycle helmet should always be a personal choice. When I was knocked off my bike by a car I hit my head on the road and I had concussion. I wasn’t wearing a helmet, but this was in the 80s and no one wore helmets then. I now wear a helmet and I have fallen off my bike a couple times, particularly when I cycle along bridle paths. My weight combined with the speed I cycle means that I’ve had hard thumps on my head, but the helmet has protected me. (Though my bike, and the rest of my body fared worse.) It’s a personal choice.

    I don’t think young people are dissuaded from cycling because it is expected that they wear a helmet. I live opposite a school and I see lots of students cycling and none of them wear a helmet: young people are very good at deciding for themselves and ignoring conventions, even “compulsory” ones like wearing a helmet. What’s dissuading them are congested, dangerous roads, and that they can get a lift from a parent or, increasingly, drive to school themselves (both of which increases the road congestion).

    Suggestions that cycle helmets cause type 2 diabetes (type 1 is genetic and not connected with obesity) is pushing the argument so far as to concede defeat. Sugared drinks, sweets, changing diets (more processed foods), selling off school playing fields and parents insisting on driving their kids to school (caused by tabloid paedophile scaremongering?) are much more likely causes of obesity.

    Your point about icy weather is interesting, but when I’ve fallen due to slipping on ice, it is my wrists (which hit the ground first) that take the knock, not my head. Perhaps I should wear some wrist support when walking in icy weather. However, the time when I don’t wear a helmet when cycling is when the temperature is cold because I want to wear a warm hat rather than a cold helmet. Arguably, my bike is more likely to slip in icy weather and more chance of me falling off. Hence why I am more likely to walk (and perhaps need the wrist supports…)

    Rather than disputing the effectiveness of helmets (my personal experience convinces me that my helmet is effective, but hey, my head is just one in any epidemiological study, but an important one to me) you should stress that it is a personal choice. If you do not wear a helmet and you hit your head when you fall off your bike, the damage you receive (whether greater or lesser) is due to your personal choice, just as the damage I receive is due to mine.

  3. Tom williams says:

    When I was a cycling instructor I would often see kids falling off their bikes and putting the head out to stop them – after all they were wearing a helmet and thus wouldn’t hurt themselves! Always thought it would be better to spend the money on brake pads, other bicycle maintenance and cycling gloves. The helmet debate is a red herring and points towards cycling being dangerous when we all know the health benefits to riders (fitness) and others (reduced pollution and encouragement to cycle) greatly outweigh any dangers from collisions.
    I would like to see a report into the damage done in their manufacture (normally Chinese badly regulated factory’s) to the environment and workers, as well as shipping, packaging, etc
    Frankly I’m a bit shocked that anybody in the health profession still argues for their compulsory usage – or are they being blinded by the helmet manufacturers and automobile industry lobbyists and well meaning (but scientifically illiterate) charities.

    1. Tony jewell says:

      It would be good to encourage more sound research in this contested area eg Post Office cyclists study? My understanding is that helmets benefit the individual by protecting against head injuries but at a population level remains uncertain due to the risk of discouraging a wider acceptability to cycle. I think it’s good for professional cyclists to be seen wearing helmets to encourage fashion conscious younger people. Good environmental transport policies are needed to make cycling a safer and easier choice of travel.

  4. Tom williams says:

    £60 on a cycle helmet, or a days professional cycle training and bespoke design of your commuter route. It’s clear which is likely to reduce collisions and make for safer cycling.
    We should be showing how easy cycling is, not discussing helmets and high vis gear.

  5. Deanne says:

    I am appalled that the government can’t take this more seriously. Every now and again we read about someone being brain damaged or fatally injured for not wearing a helmet! Why isn’t something being done for God’s sake. This is 2014. It should definitely be illegal for a child to ride a bike or scooter without wearing a helmet. Thankfully most parents have the common sense to insist their children wear one, but sadly , many still don’t

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