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Philip Preville: The case for making bike helmets mandatory

Driving without a seat belt is considered absurdly reckless. Why isn’t cycling without a helmet?

Heads Will Roll

Any cyclist who’s ever been in an accident knows the feeling of being thrown upon the mercy of the grid. There is no way of predicting how the vectors will play out, nor any providence that can harness them, even for the most trifling mishap. All you can do is gird yourself.

Back in August, 47-year-old Joseph Mavec was cycling along quiet west end Wychwood Avenue when his bike’s front wheel got snagged in an old, unused streetcar track. My wife did the same thing eight years ago in the very same location and walked away with a scrape. Mavec struck his head on the pavement and quickly died. He was not wearing a helmet.

Fate was both crueler and kinder to Wendy Trusler. On July 19, 2000, Trusler was cycling north on Spadina toward College Street, back in the days when metal posts, not concrete curbs, separated the tracks from other traffic. She made a snap decision to cut across the tracks mid-block—and unwittingly into the path of a northbound 510 silently approaching at 50 kilometres an hour. “It was maybe 10 feet away from me when I saw it,” she says. “I only had time to turn my back to it.” The streetcar hit Trusler, and she bounced back and forth between it and the bollards for roughly five metres, the red rocket cracking the ribs on her left side, the posts snapping her right femur. By the time all moving bodies came to rest she had 17 broken bones, including her clavicle, shoulder blade, cheekbone and jaw. But she was wearing a helmet, and she suffered no cranial or brain trauma.

Even some cyclists who routinely wear a helmet are of the opinion that it would be of no help in major collisions involving trucks or buses, but you never can tell. Trusler has held on to that cracked helmet like some kind of grotesque keepsake, and even shows it off sometimes. Yet many people still react imperviously to her story. “I know a lot of cyclists who don’t wear helmets,” she says. “I speak up, but if the discussion isn’t going anywhere I just drop it.”

It’s a familiar one-way conversation: making pointless exhortations to cyclists who refuse to wear a helmet as a matter of principle. I’ve certainly done it. So has the province’s deputy chief coroner, Dan Cass. Just this summer, Cass released a report recommending that helmets be made mandatory for all cyclists in Ontario, not just those under 18 years of age. He reviewed every cycling fatality on Ontario roads from 2006 to 2010, and his findings were stark: 94 of the 129 cyclists who died were not wearing a helmet.

Cass’s work merely adds to the body of research on the benefits of bike helmets. Back in 2000, a review of 16 studies calculated that helmets reduce the risk of fatal injury by 29 per cent, and subsequent studies have concluded that helmets reduce the risk of head and brain injury by up to 88 per cent.

Despite this data, and his own, Cass’s call for a compulsory helmet law was not unanimously applauded. His report dedicated lengthy passages to the dissenting opinions of some of the cycling advocates on his expert panel. Their main objection was based upon research from Australia dating back to the early 1990s, which showed that mandatory helmet laws resulted in a decline in cycling activity. By extension, their argument goes, the overall health of the population will suffer due to increased idleness. In a nutshell: mandatory bike helmets will worsen the obesity epidemic.

The same argument is advanced by cycling advocates around the world to resist the implementation of mandatory helmet laws. One organization, the Bicycle Helmet Research Foundation, is committed to debunking studies that support helmet use, including the ones cited above. To judge from CycleHelmets.org, the foundation’s members are cycling’s truthers: they’ve never read a study that wasn’t rife with flawed methodology or hidden bias.

In the 1970s, opponents of mandatory seat belt laws also invoked revisionist science to back up their argument. Today, anyone who insisted upon their right to drive without buckling up would be branded a fool. Likewise, it’s hard to divine how any cyclist, when confronted with the coroner’s findings, could ignore them in favour of some 20-year-old bicycle research from New South Wales. But that’s essentially what some of the bike advocates on the coroner’s expert panel did. Their argument tries to change the subject, turning a traffic safety issue into a public health issue. This is not ParticipAction; it’s about making cycling trips as safe as possible.

An awful lot has changed in the last 20 years—in Ontario and New South Wales and everywhere else in the world. Urban grids are crowded like never before, and Toronto is the perfect example. We’ve had a condo boom—not just downtown, but across the amalgamated city. The transit system is overflowing, and pedestrians flood the streets. And even though there’s no more road space downtown today than there was 20 years ago, vehicular traffic has gone up dramatically. The city’s own figures show that traffic in the core during the morning rush hour has risen by more than 20 per cent, from roughly 150,000 vehicles in 1991 to more than 183,000 in 2006.

This is a lot to contend with no matter how you travel, but it’s hardest on cyclists, who suffer a dreadful lack of dedicated cycling infrastructure. (The coroner, to the applause of his expert panel, also recommended more and better cycling networks.) You’d think that the perception of crowded, unsafe, road-ragey streets would deter people from cycling. Yet through all of these changes, an increasing number of Torontonians are hopping on two wheels.

The 2006 census showed a record 24,000 Torontonians commuting to work by bike. (The 2011 census hasn’t yet been crunched for cycling data, but it will almost certainly show another record rise.) Those numbers are increasing not in spite of a crowded grid, but because of it. Slim, quick and nimble, bikes have become the best and cheapest way to beat congestion. It’s nice to know that cycling makes people healthier and reduces their carbon footprint—but those are merely fringe benefits. The main reason for riding to work is to save time and money.

I’m convinced that if Ontario enacted a helmet law it would not result in a decline in cycling activity. More and more people are making the choice: they’d rather bike to work in 10 minutes than simmer in gridlock for half an hour, and they’re not about to get back behind the wheel just because they have to wear a lid. I would love to put this hypothesis to the test. So would the coroner’s office, which recommended that any mandatory helmet law be followed up with a comprehensive study.

In the end, however, the case for mandatory helmets is best made not through aggregate data, but trip by trip. If you ask yourself, before every ride, whether or not you’d be better off wearing a helmet, the answer is inevitably yes. Wendy Trusler was two months away from her wedding day when she was hit by that streetcar. Before she left the house, her fiancé, Cam Taylor, reminded her to wear her helmet. When she awoke in hospital that evening her first words to Taylor were, “I’m so sorry.” His reply: “We’ve got nothing but time.” Eight weeks later they were wed, and she danced the night away.

  • jkwon

    yes, basic accountability (eg. licensing, mandatory education on traffic laws, enforcement of traffic laws, safety standards, vehicle insurance etc) would be a huge boost to the credibility of the biking movement. It’s a two-way street (no pun intended) & if bikers want to be taken seriously they need to abide by at least some of the same laws that apply to motorists. I think that would level the playing field amongst the two groups & change alot of driver’s attitudes of a
    us vs them” mentality to more of a shared space knowing that everyone has the same level of accountability…

  • no

    The safety of a bicycle is not the problem. The problem is the environment the cyclists are placed it.

    Look to Europe (Netherlands/Belgium, etc) and then look at the number of head related injuries and deaths.

    If the infrastructure was there, we wouldn’t even be having this discussion.

    As for licensing, please. A bike is not a car, despite what the HTA says.

  • Brad

    There are 2 problems with this opinion. 1) that the citations claiming effectiveness are taken as gospel when there are other studies that show the opposite effect and 2) that cycling results in more injuries than what the general population faces on a day by day basis when this is not true.

    One thing that is not disputed is that regular cycling increases both the quality and length of life of the rider, even when no helmets are worn.

    Lay off the rights of cyclists to ride bare headed or people will start to look to any bad habit anyone may have. And we all have some.

  • W. K. Lis

    Licensing for bicycles? What about skateboards? Roller-blades? Joggers? Motorized wheelchairs? Tricycles? Wagons? Baby carriages? Shopping carts? The list will just go on.

  • Doug Rand

    Cass is no statistician.

    His methods have been criticized by academics in the Canadian Medical Association Journal:
    http://www.cmaj.ca/content/early/2012/10/15/cmaj.120988/reply#content-block

    … and for focussing on helmets rather than accident prevention:
    http://cycle.ottawacitizen.com/news/guest-posting-cyclists-must-take-responsibility-for-their-own-safety

    Apparently, anyone who can make it to the end of their driveway on a bike is an expert.

  • Harvey

    This article takes for granted that mandatory bicycle helmets can only. Improve safety.

    This is wrong. In places where a helmet law has been enacted, the risk of death & serious injury for cyclists went UP. That is because the risk of accidents increased. Those additional accidents could not be mitigated by a piece of polystyrene.

    More info at http://www.crag.asn.au

  • Peter Krantz

    If the statement of wearing helmets saves lives is so relevant, then why not insist that car drivers wear helmets. The number of head injuries prevented would be far greater than cyclists.(for racing cars, helmets are mandatory)

    In Europe cyclists do not wear helmets, and there are far less accidents with cars due to safer cycling infrastructures and car drivers which avoids an accident and protects your head\brain better. Logical….,but cyclist should abide by the same rules as car drivers and have to use a #@+! helmet to protect themselves against car drivers…Where is this going…

  • margarets

    This whole argument is so old and dumb. A study of ALL fatalities on Ontario roads would show that more drivers, passengers and pedestrians than cyclists are killed from head injuries that *might* have been mitigated (not prevented in the first place) if the driver, passenger or pedestrian had been wearing a helmet.

    Yet no one ever suggests that drivers, passengers and pedestrians should wear helmets. Just cyclists. That alone makes the whole discussion stink of anti-cycling sentiment.

    So what is the real agenda here? It’s not preventing deaths from head injuries sustained in traffic accidents. I think it’s about blaming the victim, to get the focus off the issue of safe cycling environments, because safe cycling environments might mean a bit of inconvenience or change in behaviour for motorists, and WE CAN’T HAVE THAT NOW CAN WE?

    Harrumph.

  • CaresAboutHealth

    A UK study showed that drivers take more risks and leave less room when overtaking a helmeted cyclist. The researcher was hit twice in that study – by a car and a truck – both times when wearing a helmet. So the answer is that you are not necessarily safer when wearing a helmet.

    Helmets can generate noise and affect hearing and peripheral vision. Cyclists used to wearing helmets were found to ride faster on the same route when wearing a helmet than without. You cite the example of a snap decision to cut in front of a ‘silent’ streetcar. Maybe without the helmet, Wendy might have heard something that might have prevented her from riding into the path of the streetcar. Or maybe she would have felt more vulnerable if not wearing a helmet and stopped and looked?

    The case for helmet laws can only be made through aggregate data. If, as in Australia, you pass helmet laws that force millions of cyclists to wear helmets, but there is no corresponding decrease in the risk of death and serious injury per cyclist (and if anything the risk appears to increase compared to other road users), what well-informed person would want to repeat this?

  • Peter

    Its absolutely true that helmet law reduces bike use.
    There is a school in my area that experienced a 93% reduction of kids riding to school after helmet law. That means there was 7% of school cyclists still on the road.
    One has to wonder what is going on when we are told we experienced a 29% reduction of cyclist deaths over the period of the introduction.

  • Robert X

    This article indicates, more than anything else, the sad state of journalism. The author rests his case almost entirely on anecdote and innuendo, while he disparages an organization (at http://www.cyclehelmets.org) that analyzes research on this topic, both pro and con, using disciplined mathematics, science and statistics. Apparently, science means nothing in his mind; anecdotes trump data. (Does he not realize that claims “up to” a certain percentage effectiveness should be taken as propaganda? “Up to” logically includes numbers down to zero!)

    As to Preville’s opening salvo, in his subtitle: Bike helmets are in no way equivalent to auto seatbelts. Seatbelts are tested in extremely realistic crashes, with actual cars destroyed in 50 kph collisions; the belts must protect a realistic model of a human. By contrast, bike helmets are tested on a decapitated model of a head (no body attached) in a perfectly straight drop onto a polished surface at a mere 20 kph, the speed at which a walker’s head would hit if he stumbled. Few consumers or helmet advocates understand the ludicrously low certification standard, but that standard adequately explains why time and again, helmet laws have shown no per-rider benefit.

    Bicyclists are just 1% of the nation’s head injury victims, far fewer than even walkers. In fact, for every cyclist anecdote, one could find roughly ten pedestrian and roughly 50 motorist anecdotes, plus countless people walking in their homes. What will Preville write about saving the other 99%?

  • Peter Clinch

    “Does he not realize that claims “up to” a certain percentage effectiveness should be taken as propaganda? “Up to” logically includes numbers down to zero!”, wonders Robert X…

    Well, actually it includes numbers to down below zero, with credible (not conclusive, but credible) research suggesting an increase in certain serious injuries amongst helmet wearers. So it would be just as honest to claim something like “up to 14% increase in neck injuries”, but thankfully nobody’s dishonest enough to try that on.

    But what we get back to is the best way of seeing the effectiveness of mandatory helmets is look at the examples we have from where they have them, and see that where they are analysed dispassionately with science they show no clear track record of making cyclists safer, and a clear track record of making cycling less popular. In short, we have track records that mandatory cycle helmets are a public health own-goal, but in spite of that it is still widely assumed that if we wring our hands, mean well and concentrate on statistically meaningless anecdotes we’ll somehow make the world a safer place. But we won’t.

  • John J.

    The writer means well but has been misled.

    In these days of falling car sales, the auto industry is likely looking around to reduce any competition and has decided to frame things to make their most effective competitor, cycling, appear dangerous. Studies showing that compulsory helmet laws reduce cycling is important information for them that they can use to try to coerce people back to the old mono-modal days. (It won’t work by the way, we’re on to them.)

    Cycling is inherently safe, naturally attractive and just happens to fit perfectly in these times of expensive oil, crowded transit, desires for good city life and automobile gridlock with where people are at now. For the last twenty years or so, people have been discovering it as a good way to get to where they want to go. This threatens the profits of the auto makers and related industries and they want to stop that.

    Bike helmets are NOT the equivalent of car seat belts. They are the equivalent of car helmets. Useful only when doing something risky like racing or playing around on muddy recreation trails.

    The two anecdotes in this article reveal what should be done to Toronto’s streetcar tracks not what the people cycling across them should wear. There are rubber flangeway fillers that can be added at the crossings. Why haven’t they been put in?

  • Bob H

    “Their argument tries to change the subject, turning a traffic safety issue into a public health issue. This is not ParticipAction; it’s about making cycling trips as safe as possible.”

    This is just nonsense. Implementing a helmet law is a public policy decision. It is idiotic to set policy by declaring that this policy is only about safety, and therefore ignoring all the other implications of the policy. “Safety” does not exist in some sort of a vacuum, apart from other factors.

    It is perfectly valid to consider whether a helmet law will just trade head injuries for obesity. I’m not accepting this as a fact, but simply saying that the public health angle is relevant and not “changing the subject”. A policy decision should balance all the pros and cons to determine whether there is a net benefit.

    Further, policy decisions should be based on outcomes for the population. Sure, I personally am probably better off getting hit by a car while wearing a helmet versus not wearing one. But I’d be even better off not being hit by the car. What is known to make cyclists truly safe is having more cyclists on the roads, as drivers become more accustomed to them. If a helmet law deters cyclists, there may actually be more injury overall, not less.

  • Arno S

    Research shows that the benefits of cycling outwheigh the risks by over 20:1 – even without wearing a helmet. This cannot be said for driving, which only has risks associated with it. If saftey were the issue, then driving should be restricted and and cycling encouraged. Helmet laws instill a fear of cycling and have been shown to reduce uptake of cycling, thereby reducing the incredible benefits that cycling offers society – improved health, less pollution, reduced traffic congestion, reduced ghg emissions, lower infrastructure costs etc. If mandatory helmet laws are so great, then why are there only a handful of jurisdictions in the world which have helmet laws and why are even those with helmet laws (Mexico City, Israel, and recently a city in Washington State) repealing them? Helmet laws do not prevent crashes. We would be way further ahead by seeking ways to prevent crashes – better infrastructure, improved driver training, cycling education for all children, improved legal framework. Mandatory helmet laws are bad for society.

  • rusl

    Aside from theoretical safety goals, any helmet laws must be effective at stated goal: to make cyclists wear helmets.

    As often noted, cycling is not driving a car. It is not licensed. It is often outside of the law: in many jurisdictions ridiculous and out-dated laws are on the books governing cycling. In many jurisdictions licensing is theoretically required but not present. Or laws put the requirement of having a bell on a bicycle up there with lights and a helmet – on par.

    Cycling with a bell is a good idea. Cycling with a helmet on your head is a good idea. A mandatory cycling law is unlikely to achieve that end. Many others have pointed out public safety drawbacks to mandatory laws. At the very least helmet law zealots must address the basic issue of effectiveness: Do mandatory helmet laws increase the number of people wearing helmets when cycling? Or do they instead, add another unenforceable double standard to the books? Do we need more laws such as “no loitering” that are only ever enforced in a prejudicial manner?

    One can and should argue as well against the safety utility of seat belts in cars. This protects drivers only, not the general public. The net result has been more people driving dangerous cars in public which leads to more fatalities overall. (not just “accidents”, include lung cancer) Making something dangerous more sustainable is not a positive outcome.

    There is no war on cars but there should be. They are a public burden. Folks should be free to drive cars on private property. Otherwise we should not be providing public street access to car use when it is destructive to our society. Yes, this is considered an extreme position. Yet it is correct, the use of cars cannot continue.

    Cars are not people, nor something people need.

  • havingalook2

    Once again we wish to legislate “common sense” and then of course don’t put the resources in place to enforce it. So typical. Wear one or don’t – just don’t expect the health care system to care for your head or brain injury because you elected to not wear a device that could have prevented some of your injuries.
    It won’t matter what we do as a city. I live on Sherbourne Street (a war zone right now) the street that is getting what, three different prototype experimental bike lanes at an untold expense. I will not enjoy watching the cyclists still opting to ride on the sidewalks endangering pedestrians regardless of what type of bike lanes are provided, or the number of cars and trucks and even police cars that will pull over – block the bike lane so they can go into the Tim Horton’s to get coffee. So you can legislate all you wish, if there are nothing in place to deal with these infractions – what is the point. The debate between cyclists and motorists in this city will never end, it is all about entitlement and stop quoting Europe, they are a civilized area of the planet and we seem to never take their lead on any social issues so give that argument a rest.

  • Pedant

    Wow! Toronto Life commenters at their entitled, loony left best. From conspiracy theory about big auto to “reducing greenhouse gases,” as if this takes a single car off the road as downtown TO’s population booms. Preville has certainly picked a thought-provoking topic with more practical application to everyday life than debates about climate change or recycling. He does ignore the enforcement problem. Would this be one for police or a traffic warden-style enforcement force? Do we have the appetite for constant confrontations while the law is being enforced? I give cycling about five more years before there is some kind of major backlash either on health and safety or public order grounds. And yes, I cycle about 2/3 of the time, a short commute to work and across town for leisure on weekends. It has become a far less pleasant experience over the last five years, solely due to the inconsiderateness of other cyclists! Either the Delta Force Commando types who want to impose their extreme exercise regimes on us in the public realm, or the new cyclists with poor spatial awareness. I’ve seen three cyclists get killed outside our office over the past three years…

 

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