Ah, those crazy public health people and their crazy recommendations. “Vaccinate,” they say, but you still have outbreaks where vaccinated people are hit with the disease they were supposedly immunized against. “Wash your hands,” they argued, but people who wash their hands still get gastrointestinal disease. “Wear your seatbelt,” they proposed, but people die from seatbelt-related injuries all the time. “Wear a helmet while riding a bicycle,” but there seems to be no appreciable reduction in the number of head injuries when mandatory bike helmet laws are proposed.
What gives? What’s with all of these recommendations that seem to be useless?
Well, they’re not useless. They are given the perception of being useless by those who seek to be contrarians. After all, if you really want to argue against something, you will find some sort of evidence against it. Or, rather, you will find a way to misinterpret the evidence to suit your needs.
So should you wear a bicycle helmet?
The answer, as always, is that “it depends.” At the very least, bicycle helmets are proven to protect your head from severe outcomes when you get hit or hit something. The Cleveland Clinic states:
“All bike riders should wear bicycle helmets. Each year in the United States, about 800 bicyclists are killed and another 500,000 end up in hospital emergency rooms. About two-thirds of the deaths and one-third of the injuries involve the head and face. Wearing a helmet can reduce the risk of head injury to bicyclists by as much as 85 percent.”
There’s a caveat in that statement, however. Just wearing a helmet alone will not save you from injury if the accident is bad enough. So it’s a little deceptive to think that you are safe from injury if you just wear a helmet. You’re safER than you would be without a helmet, but you’re not safe at all if everyone around you is driving like a crazy person.
There also seems to be a bit of a paradox in mandating bicycle helmets. The more you mandate helmets, the less people ride, the more drivers think cyclists are safe (and thus relax around cyclists to the point where collisions are increased), and the more cyclists feel safe and engage in unsafe riding. This explains the paradox a little better:
“Proponents of legislating mandatory helmet use cite strong evidence that helmets can prevent many fatalities and up to 88% of potential brain injuries in bad falls. Opponents focus on the potential chilling effect of bike helmet laws on cycling itself. According to this argument, since cycling is already a discretionary activity, anything that makes cycling less convenient — and indeed the simplicity and convenience of bicycling is one of its main attractions — will discourage cycling.
In effect, mandatory helmet-use creates an additional expense for the cyclist, another piece of equipment to carry around and one more preparatory step before climbing aboard and pedaling away. And indeed, cycling has declined in several Australian states that passed mandatory adult helmet laws in 1990. Ironically, helmet laws that discourage cycling may indirectly harm those so discouraged, in view of research indicating that cycling promotes health through the cardio-vascular benefits of vigorous exercise.
Moreover, since many helmet-law proponents are medical professionals with little familiarity with cycling, some cyclists feel singled out among the various groups in society, many of whom — motorists, for instance — engage in arguably more dangerous and antisocial practices. While helmets drastically lessen the severity of head injury to cyclists, helmet-law advocates rarely promote helmet use as part of a comprehensive set of safety, education and facility-development measures aimed at cyclists and motorists alike. The European Cyclists’ Federation estimates that the expenditures required to equip all bicyclists with helmets in a country or state would prevent more accidents and injuries if spent instead for safety education and on improving the cycling infrastructure.”
And that’s the crux of the problem. Without comprehensive plans to eliminate all bicycle injuries, simply mandating everyone to wear helmets will not show a demonstrable decrease in the number of injuries. I mean, if a car hits you at 60 miles per hour, no helmet is going to save you from a severe injury. However, if cars are aware of cyclists and not exceeding reasonable speeds and avoid cyclists through their driving habits or physical barriers, then wearing a helmet will help in the event of that rare, low speed collision or fall…
So let’s put it this way:
5: Risk of injury if traffic laws are loose and cyclists are in close proximity to high-speed cars, bad drivers, and not wearing any helmets.
4: Risk of injury if all the conditions above are the same, but the cyclists wear helmets.
3: Risk of injury if all the conditions above are the same, but there are cycling awareness campaigns aimed at drivers to make them safe around cyclists.
2: Risk of injury if all the conditions above are the same, but there are additional programs to make cyclists aware of how best to ride safe.
1: Risk of injury if all the conditions above are the same, but there are also physical barriers to prevent contact between cars and cyclists.
0: Risk of injury in a perfect world. (Spoiler alert: We don’t live in a perfect world.)
Yeah, we don’t live in a perfect world, and the choice of wearing a helmet is very much up to you. If you choose not to wear a helmet because you deny all the evidence that it helps, well, that’s up to you. If you choose not to wear a helmet because you want things to be perfect and won’t do so until they are… Well… You’re going to be waiting a while.
That, and you’ll be the equivalent of the screaming parent who doesn’t want to vaccinate because vaccines are neither 100% safe nor 100% effective.
ps: Spare me the argument about “big helmet.”
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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