Mandatory bike helmet laws:
April 2021 : A peer-reviewed study led by a Swiss neurosurgeon and titled Severity and predictors of head injury due to bicycle accidents in Western Australia (paywalled) investigates traumatic brain injury among cyclists in WA over seven years :
Background: Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature.
Methods: Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed.
Results: Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated.
Conclusions: Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.
Study table extracts
The Rotterdam Score is a measure of traumatic brain injury wherein a completely normal appearing scan has a Rotterdam score of 1 and the worse possible score is 6. GOS is the Glasgow Outcome Scale wherein 1 is death, 2 is persistent vegetative state, 3 is severe disability, 4 is moderate disability and 5 is low disability.
The study found 60.4% of TBI patients were wearing helmets (113/187), which is similar to anecdotal estimates of the percentage of cyclists who wear helmets on Western Australia roads - with media stories highlighting the state’s low level of helmet law observance. From 2010 to 2019, just 19.4% of cyclist admissions to WA’s State Trauma Unit weren’t wearing helmets at the time of their accident.
From the study sample of 1,019 patients admitted to hospital over seven years, 113 of the traumatic brain injury victims were wearing helmets and 74 were not. Helmet wearers = 11.1%, bare heads = 7.3%.
As per its conclusions, the study found bike helmets in WA have reduced epidural hematomas and open head injuries but for most other forms of brain injury there is little difference between helmet wearers and bare head cyclists, with the latter having a lower risk of occurence or severity of several diagnoses.
April 2021 : Road injury in Australia published by the Australian Institute of Health and Welfare itemises all road fatalities and injuries in 1990, and makes two points worthy of further investigation:
p4 : Cyclists, who account for 16% of hospital separations, make up only 4% of fatalities.
p5 : Pedal cyclists are the road users with the lowest proportion of head injuries in the serious to critical range (ie. 15%).
AIHW reports published in 1990, 1991, 1992 and 2015-16 (in 2021 the most recent data), along with the Bureau of Infrastructure and Transport Research Economics in 2018, allow a comparison of hospitalised road injuries, injury severity and age brackets for different road users in 2015-2016 and 1990-1992 (the years when mandatory helmet laws were enforced in different Australian states) :
The data illustrates that since being forced to wear helmets, Australian cyclists have suffered a 25.6% increase in hospitalised injuries, compared to 57.5% for motorcyclists, 18.2% for vehicle occupants and a 32.8% reduction for pedestrians who are the most comparable road users vulnerable to injury.
Unlike 16% in 1990, cyclists comprised 18.9% of all Australian road injuries in 2015-2016.
Bike helmets should reduce the proportion of serious, severe, critical and life-threatening injuries, yet since 1992 the number of cyclists suffering such injuries has increased 183%, compared to 77% for motorcyclists, 16.1% for vehicle occupants and a 13.5% reduction for pedestrians.
Serious, severe and critical injuries were 14.3% of all cyclist hospital admissions in 1990, 13.4% in 1991, 14.3% in 1992 when the last Australian state enforced mandatory bike helmets, and 22.7% in 2015-2016. The proportion of life-threatening injuries reduced significantly for motorcyclists and MV occupants but increased slightly for pedestrians, although by 2015-2016 pedestrians had 146 fewer overall hospital admissions than in 1992, while cyclists had 1,001 more.
Reflecting Australia's decrease in youth cycling and increase in adult cycling, the 0-25yo demographic had 2,432 fewer hospitalised injuries in 2015-2016 compared to 1992, while the 25yo+ demographic suffered 3,850 more hospitalised injuries, which is why the overall numbers increased from 5,526 in 1992 to 6,943 in 2015-2016.
The table below compares Australian cyclist injury locations, ages and fatalities from 1990 (the first year of helmet law enforcement) with 2015-2016, using extracts from Road injury in Australia and Pedal cyclist deaths and hospitalisations 1999–00 to 2015–16, both published by the Australian Institute of Health and Welfare.
The data show that upper limb injuries disproportionally increased from 1990 to 2015-2016. It should be noted that lower limb injuries cannot be prevented or influenced by wearing a helmet and are a reflection of crash frequency and/or cycling participation.
It should be noted that all data above relate to road traffic injuries only. Total on-road and off-road cyclist hospitalised injuries in 1990 were 7,520 and in 2015-2016 were 12,027 - a 59.9% increase. The 1990 split was on-road 6,266/off-road 7,520, a difference of 1,254 or 83.3% of all cyclist injuries being on-road. The 2015-2016 split was on-road 6,943/off-road 12,027, a difference of 5,084 or 57.7% of all cyclist injuries being on-road.
Available participation survey data suggest fewer Australians cycling daily in 2017 than prior to 1990-92 helmet law enforcement. BITRE data also show that from 2010 to 2018, 23.0% of cyclist fatalities (252/58) in Australia were not wearing a helmet at the time of their crash - a lower proportion than the proportion of cyclists estimated to ride without a helmet on Australian roads.
April 2021 : Australian Institute of Health and Welfare transport injury data allow a comparison with National Cycling Participation survey results from 2011 to 2019 in different age brackets (see NCP 2019 here) :
Details for the charts above plus other participation survey results and Australian annual population since pre-law 1985/86 can be viewed here. AIHW data suggest cyclists represented 15.8% of all Australian road user hospital separations (including drivers, passengers, motorcyclists and pedestrians) in 1990, the first year of bicycle helmet law enforcement, and 21.4% in 2017-18. Pedestrians, another vulnerable road user, decreased from 12.0% in 1990 to 7.2% in 2017-18.
April 2021 : A new study published in the British Medical Journal titled Sex-based differences in helmet performance in bicycle trauma finds that bicycle helmets offer less head protection to females than males, perhaps offering a positive perspective to the fact that mandatory helmet laws discourage cycling among females in particular :
Results : In total, 18,604 patients of average age 48.1 were identified, and 18% were female. Helmet use was greater in females than males (48.0% vs 34.2%, p<0.001). Compared with helmeted males, helmeted females had greater rates of serious head injury (37.7% vs 29.9%, p<0.001) despite less injury overall. In sex-disaggregated models, helmet use reduced odds of intracranial haemorrhage and death in males (p<0.001) but not females. In sex-combined models, helmets conferred to females significantly less odds reduction for severe head injury (p=0.002), intracranial bleeding (p<0.001), skull fractures (p=0.001), cranial surgery (p=0.006) and death (p=0.017). There was no difference for cervical spine fracture.
Conclusions : Bicycle helmets may offer less protection to females compared with males. The cause of this sex or gender-based difference is uncertain, but there may be intrinsic incompatibility between available helmets and female anatomy and/or sex disparity in helmet testing standards.
January 2021 : Click here for an analysis of West Australian cycling participation and hospital injury figures from 2011 to 2017.
January 2021 : 2016 bike helmet penalty increase in NSW a failure
In 2016, the NSW Government introduced new fines and regulations that will discourage cycling, damage public health, increase injuries per cyclist and worsen traffic congestion with a consequent impact on total road casualties. From March 2016, new fines and regulations have applied to NSW cyclists:
- the penalty for not wearing a helmet increased from $71 to $319 (350% increase)
- the penalty for running a red light increased from $71 to $425 (500% increase)
- the penalty for riding dangerously increased from $71 to $425 (500% increase)
- the penalty for not stopping at a pedestrian crossing increased from $71 to $425 (500% increase)
- adult cyclists must carry photo identification at all times from March 2017
- uncertainty over the legality of bike riding by NSW, interstate or foreign cyclists without either a driver's license or $51 NSW Photo Card
The NSW helmet fine increased from 1 July 2019 in line with inflation from $319 to $344.
Analysis of data shows that NSW cycling participation declined from 2016 to 2019 but total cyclist injuries and head injuries increased.
Road Safety Annual Report 2018 published by the OECD's International Transport Forum presents data for 25 member countries re cyclist fatalities since 1990, which was the year that Australia first enforced all age mandatory bicycle helmet laws.
Albeit only annual snapshots, this data allows the cyclist fatality rate in Australia and in other all-age or child helmet mandated countries (total 12 out of the 25) to be compared with 13 OECD countries that don't have adult or child bicycle helmet laws:
The OECD International Transport Forum data show that countries with all-age or child helmet laws have had a 46.5% reduction in cyclist fatalities from 1990 to 2016, while those without mandatory helmet laws have enjoyed a 55.0% reduction.
For a broader averaged perspective, countries with all-age or child helmet laws have had a 43.3% reduction in cyclist fatalities from 1990 to 2000-2016, while those without mandatory helmet laws have enjoyed a 50.2% reduction.
The four most prominent countries with mandatory all age, youth or voluntary helmet wearing - Australia, Canada, New Zealand, USA - had a 22.5% cyclist fatality reduction from 1990 to 2000-2016, albeit heavily influenced by America's large volumes and poor results.
It should be noted that in Finland an all age law was introduced in January 2003 but there is no penalty and it is not enforced. Finland’s cyclist fatality numbers had already fallen from 101 in 1990 to 53 in 2000, a 47.5% reduction before the helmet law.
It should also be noted with New Zealand’s 64.6% reduction from 1990 to 2000-2016 that the NZ Transport Ministry’s Household Travel Surveys show a 59.32% reduction in hours cycled per person per year from 1989/90 to 2015/17. The national all-age bicycle helmet law was introduced in 1994 (more detail).
Road Safety in Australia (PDF 122kb) shows the average annual cyclist road fatality rate in Australia from 1980 to 1990 was 88 and from 1991 to 2001 it was 47 - a reduction of 47%.
Cyclist injury figures in Australia show an approximate 30% increase in hospital admissions per road cyclist during the 1990s but the decline in fatalities has been claimed as evidence that mandatory helmets save lives.
These statistics can be compared with Safety and mobility of vulnerable road users: Pedestrians, bicyclists and motorcyclists published in 2012 with OECD figures from 1970 to 2008:
Australia, New Zealand, Canada, US - average overall 45.7% vulnerable road user fatality reduction and average 43.7% cyclist fatality reduction.
All non-helmet law countries - average overall 62.8% vulnerable road user fatality reduction and average 75.3% cyclist fatality reduction.
Where is the evidence that Australia's all-age mandatory bicycle helmet laws enforced from 1990 have resulted in less cyclist deaths than in non-helmet law countries?
February 2019: The OECD data above should be compared with a paper published in 2019 by Australia's pro-helmet law academics claiming that Australia's rate of bicycle fatalities per one million population fell by 46% immediately after bike helmet legislation was introduced in 1990-92 and the law has saved 1,332 lives from 1990 to 2016.
Below is extracted from the Road Trauma Australia 2017 Statistical Summary which can be downloaded from the Bureau of Infrastructure, Transport and Regional Economics (BITRE).
The fatality data above can be averaged and compared in different ways:
1988 - Vehicle occupants 1,920 / Pedestrians 548 / Cyclists 87
(1988 population 16,532,164 - vehicle occupants fatalities 116.14 per million / pedestrian fatalities 33.15 per million / cyclist fatalities 5.26 per million)
2017 - Vehicle occupants 810 / Pedestrians 160 / Cyclists 38
(2017 population 24,600,777 - vehicle occupants fatalities 32.93 per million / pedestrian fatalities 6.50 per million / cyclist fatalities 1.54 per million)
Percentage reductions - Vehicle occupants -57.8% / Pedestrians -70.8% / Cyclists -56.3%
(per million population - vehicle occupants -71.65% / pedestrians -80.39% / cyclists -70.72%)
1988-1989 - Vehicle occupants pa average 1,911 / Pedestrians pa average 524.5 / Cyclists pa average 92.5
(1988-89 averaged population 16,673,290 - vehicle occupants fatalities 114.61 per million / pedestrian fatalities 31.46 per million / cyclist fatalities 5.55 per million)
2016-2017 - Vehicle occupants pa average 820.5 / Pedestrians 171 / Cyclists 33.5
(2016-2017 averaged population 24,395,842 - vehicle occupants fatalities 33.63 per million / pedestrian fatalities 7.01 per million / cyclist fatalities 1.37 per million)
Percentage reductions - Vehicle occupants -57.1% / Pedestrians -67.4% / Cyclists -63.8%
(per million population - vehicle occupants -70.66% / pedestrians -77.72% / cyclists -75.32%)
1993 - Vehicle occupants 1,372 / Pedestrians 331 / Cyclists 45
(1993 population 17,634,808 - vehicle occupants fatalities 77.80 per million / pedestrian fatalities 18.77 per million / cyclist fatalities 2.55 per million)
2017 - Vehicle occupants 810 / Pedestrians 160 / Cyclists 38
(2017 population 24,600,777 - vehicle occupants fatalities 32.93 per million / pedestrian fatalities 6.50 per million / cyclist fatalities 1.54 per million)
Percentage reductions - Vehicle occupants -41.0% / Pedestrians -48.6% / Cyclists -15.6%
(per million population - vehicle occupants -57.67% / pedestrians -65.37% / cyclists -39.61%)
1993-2002 - Vehicle occupants pa average 1,277.1 / Pedestrians pa average 321.8 / Cyclists pa average 45.6
(1993-2002 averaged population 18,531,152 - vehicle occupants fatalities 68.91 per million / pedestrian fatalities 17.37 per million / cyclist fatalities 2.46 per million)
2008-2017 - Car occupants pa average 862.6 / Pedestrians 172.4 / Cyclists 35.7
(2008-2017 averaged population 22,925,758 - vehicle occupants fatalities 37.63 per million / pedestrian fatalities 7.52 per million / cyclist fatalities 1.56 per million)
Percentage reductions - Car occupants -32.5% / Pedestrians -46.4% / Cyclists -21.7%
(per million population - vehicle occupants -45.39% / pedestrians -56.71% / cyclists -36.59%)
Note that all road user deaths totalled 5,687 in 1988-1989 and 2,519 in 2016-2017, a reduction of 55.7%. This compares to the cyclist fatality reduction of 63.8% when comparing these time periods.
It is also noteworthy that Australian Institute of Health and Welfare data show Australia had 7,520 cyclist hospital admissions in 1990 and 11,430 in 2015, an increase of 52.0%. Almost all survey data and anecdotal evidence show a reduction in Australia's cycling participation since 1990, and there is no valid evidence that it has increased 52.0%.
The averaged annual cyclist fatality numbers in 1988-1999 were 93 and the averaged annual cyclist fatality numbers from 1990 to 2016 were 42, suggesting an average 51 fewer deaths per year. Over 27 years this would be 1,377 (similar to the study's estimate of 1,332 cyclist lives saved by helmet laws since 1990).
The averaged annual vehicle occupant fatality numbers in 1988-1989 were 1,911 and the averaged annual vehicle occupant fatality numbers from 1990 to 2016 were 1,134, suggesting an average 777 fewer deaths per year. Over 27 years this would be 20,979 fewer deaths of vehicle occupants who don't have mandatory helmet laws.
The averaged annual pedestrian fatality numbers in 1988-1989 were 525 and the averaged annual pedestrian fatality numbers from 1990 to 2016 were 259, suggesting an average 266 fewer deaths per year. Over 27 years this would be 7,182 fewer deaths of pedestrians who don't have mandatory helmet laws.
The study authors have maintained their insistence that helmet laws didn't discourage cycling participation immediately after helmets were mandated in 1990-92 or since, and have ignored similar fatality reductions among other road users due to reduced urban speed limits, drink driving laws and tougher road penalties, as well as life-saving advances in medical technology/trauma care and a significant expansion of Australia's off-road cycleways that reduce the traffic exposure of cyclists. Different road user fatality comparisons since pre-law and over the past 20 years can be viewed here.
It should also be noted that Pedal cyclist deaths and hospitalisations, 1999-00 to 2015-16 published by the Australian Institute of Health and Welfare in May 2019 shows that from 2013–14 to 2015–16, head and neck was the main area injured in 48% of all cyclist deaths. This can be compared to the United States, where helmets are mandatory for children in about half the states and adults across the country have no helmet law. Surveillance for Traumatic Brain Injury Related Deaths - United States, 1997-2007 shows an average 325 cyclist deaths per year from traumatic brain injury, which compares to an average 730 total fatalities in the US from 1997 to 2007 (source). This is 44.5% of cyclist fatalities caused by TBI in the US compared to 48% caused by head and neck injuries in Australia, suggesting little fatality benefit from Australian mandatory helmet laws.
November 2019: Research published in The Lancet journal shows Australia is ranked 140 out of 146 countries studied to determine what percentages of adolescent school children are meeting the World Health Organisation's recommendations for a minimum of one hour of moderate to vigorous physical activity each day.
August 2019: Wearing a bike helmet leads to less cognitive control, revealed by lower frontal midline theta power and risk indifference confirms earlier studies, albeit for different reasons, showing that risk compensation causes helmet wearers (up to 49%) to choose risker options in their decision-making, helping to explain why statistical and anecdotal observation of cycling participation in Australian shows significant declines since helmet law enforcement but an increased number of hospitalised injury per cyclist.
Abstract: A recent study claims that participants wearing a bike helmet behave riskier in a computer‐based risk task compared to control participants without a bike helmet. We hypothesized that wearing a bike helmet reduces cognitive control over risky behavior. To test our hypothesis, we recorded participants' EEG brain responses while they played a risk game developed in our laboratory. Previously, we found that, in this risk game, anxious participants showed greater levels of cognitive control as revealed by greater frontal midline theta power, which was associated with less risky decisions. Here, we predicted that cognitive control would be reduced in the helmet group, indicated by reduced frontal midline theta power, and that this group would prefer riskier options in the risk game. In line with our hypothesis, we found that participants in the helmet group showed significantly lower frontal midline theta power than participants in the control group, indicating less cognitive control. We did not replicate the finding of generally riskier behavior in the helmet group. Instead, we found that participants chose the riskier option in about half of trials, no matter how risky the other option was. Our results suggest that wearing a bike helmet reduces cognitive control, as revealed by reduced frontal midline theta power, leading to risk indifference when evaluating potential behaviors.
May 2019: A study published by the Australian Institute of Health and Welfare in May 2019 confirms that hospitalised cyclist injury numbers soared between 1999 and 2016, the exception being children and teenagers as fewer and fewer Australian youngsters enjoy healthy recreational exercise by riding a bike. This study avoids any use of the word "helmet" but effectively validates all the points made on this website.
Click here for a comparison of Australian daily cycling participation with hospital admission injuries and population growth since 1985/86.
Neo-Political Action and a New Public Policy Paradigm – A case study of mandatory bicycle helmet laws by Ian Ker et al considers political resistance to reviewing Western Australia's mandatory bicycle helmet law and analyses the participation, head injury and risk compensation results: "The inescapable conclusion is that the Western Australian community as a whole is substantially worse off as a result of mandatory helmet laws."
March 2019: The peer review journal Transportation Research has published a pilot study by Australian researchers that found 31% of survey participants regarded cyclists as less than human, with 49% of non-cyclists having that opinion (read more).
Within the study's discussion the authors speculate:
Ultimately, the goal of this research would be to test interventions to reduce dehumanization. If at least some forms of dehumanization are predictive of anti-cyclist aggression, over and above negative attitudes, this suggests that one way to reduce aggression might involve humanizing cyclists rather than just encouraging positive attitudes. How that might be done is not obvious, but it raises a number of possibilities. Mandatory helmet laws in Australia mean that hair and faces are more obscured; this may be contributing to dehumanizing beliefs. Furthermore, the perception that cycling requires a ‘uniform’ of Lycra and fitness gear may be contributing to this feeling of cyclists as ‘others’, as well as increasing barriers to participation (Daley & Rissel, 2011). Future research might test the effectiveness of promoting the idea that cyclists are diverse and similar to other road users or maybe even find creative ways to show their faces to drivers so they are seen as persons, not darting mechanical obstacles.
The study, although not comprehensive because it only surveyed 442 responses, adds to evidence that motorists drive closer and less safely near helmeted cyclists because they believe they are better protected than cyclists without a helmet. The increased ratio of accidents and injuries per cyclist in mandatory jurisdictions may be due to increased head diameter, risk compensation, wind shear, muffled hearing, sweat and now evidence that many motorists consider cyclists to be less than human.
February 2019: A US paper has been released, titled The Prevalence of Bicycle Injuries in a Large Urban Hospital, which reviews a trauma registry at the Los Angeles County and USC Medical Center in California (where bike helmets are mandatory for all cyclists aged less than 18yo) over three years. Abstract results:
During the study period, 1454 patients were admitted following bicycle injuries. The most common mechanism of injury was collision with a motor vehicle without being thrown off (44%) followed by collision with a motor vehicle and subsequently being thrown off (26%). The overall use of helmet was 14%. In the age group <18 years, the helmet use was 9%, and in the 50 group >18 years, helmet use was 16%. 8% of patients tested positive for ethanol use and 4% had tested positive for amphetamine use. Overall, 292 patients had severe trauma (AIS>2). Significant head trauma (head AIS>2) was diagnosed in 142 patients (10%). The prevalence of significant head trauma was 35% in the group of patients with helmet and 34% in the group without helmets (p-value=0.84). It should also be noted that the prevalence of all significant trauma was 26% in the group of patients with helmet and 20% in the group without helmets (p-value=0.048). The overall mortality was 1%. There was no difference in mortality between helmeted and non-helmeted patients.
The study results have similarities with Western Australia where total hospital admissions increased from an average 665pa in pre-law 1988-1991 to an average 1,209pa in 2013-2016, and the head injury proportion increased from an average 177pa or 26.6% in 1988-1991 to an average 353pa or 29.2% in 2013-2016 (see below for more detail).
The US study’s lack of difference in mortality between helmeted and non-hemeted patients is at odds with the Australian academics' claim above that 1,332 lives have been saved by helmet laws, as are most surveys of cycling participation compared to cyclists fatality trends in Australia.
December 2018: Peer reviewed paper authored by Colin Clarke and published by World Transport Policy and Practice: "Available data comparing the ratio of cyclist to pedestrian deaths from most countries considered does not show a benefit from helmet laws and increased helmet wearing rates. The number of cyclist’s deaths due to situations not involving motor vehicles appears to increase with helmet use and needs further investigation."
November 2018: Peer reviewed paper published by the prestigious Accident Analysis and Prevention journal validating studies in 2007 that found vehicles more closely overtake cyclists wearing helmets than those without, helping explain why hospitalised injuries per cyclist have increased substantially since Australia enforced mandatory all age helmet laws in 1990-92 (read Forbes magazine analysis or the study itself).
April 2018: Peer reviewed paper published by the Journal of Transport and Health - Changes in participation, demographics and hazard associated with mandatory bicycle helmets in New South Wales, Australia by Jim Lemon from the Transport and Road Safety Research Centre at the University of New South Wales.
Four factors that reduced the hazard of fatality for bicyclists at about the time of the introduction of mandatory helmet laws are apparent. These factors explain the gradual, rather than abrupt, decline in cycling fatalities, the selective reduction in fatalities among teenage riders and the lack of subsequent increase despite rising population.
That bicycle helmets have prevented some fatalities and reduced some injuries is not disputed. However, the factors mentioned above are able to explain most or all of the observed reductions in fatalities and provide a better explanation of the pattern of those reductions than mandatory helmet legislation.
January 2018: Peer reviewed paper by US and Australian academics again confirming that risk compensation increases the numbers of accidents among helmeted cyclists - The Unintended Impact of Helmet Use on Bicyclists’ Risk-taking Behaviors.
Our findings suggest, on average, helmet users are 15.6% more likely to overtake, and the effect is statistically significant using the non-parametric bootstrap sampling evaluation. This study serves as a cautionary warning that road safety programs may need to consider strategies in which unintended impact of bicycle helmet use can be mitigated.
Australia's public health and road safety disaster continues ... Travel to Work data from the 2016 Census was released in October 2017 and the chart below shows cyclist work commuting has declined from 1.68% in 1986 to 1.24% in 2016. That .44% difference is 38,140 of the total 8,668,182 commuters in the 2016 Census, which in turn is 35.4% of the 107,756 cyclist commuters in 2016.
In other words and despite the claims of helmet law supporters, the proportion of cyclists among Australian work commuters is more than a third less than what it was before helmet laws were introduced in 1990-92. If the proportion was the same as before helmet law enforcement, traffic congestion would ease in all cities with a commensurate improvement in road safety and public health.
Although the data above suggest the cyclist proportion of travel to work methods declined from 1.3% in 2011 to 1.2% in 2016 (rounded), the Australian Bureau of Statistics estimates the 2011-2016 reduction as 1.2% to 1.1% (see ABS media release).
- Total work commuter numbers increased 7.2% from 2011 to 2016.
- Work commuter cyclist numbers increased 3.7% from 2011 to 2016.
- Australia's population increased 6.7% from 2011 to 2016.
- Total work commuter numbers increased 68.7% from 1986 to 2016.
- Work commuter cyclist numbers increased 25.0% from 1986 to 2016.
- Australia’s population increased 51.0% from 1986 to 2016.
- Total work commuter numbers increased 40.5% from 1991 to 2016.
- Work commuter cyclist numbers increased 16.5% from 1991 to 2016.
- Australia’s population increased 39.2% from 1991 to 2016.
Below is a state and territory breakdown of Census Travel to Work single mode cycling proportions from 2001 to 2016.
September 2017: The West Australian newspaper published this story about emergency doctors being dismayed by the increasing number of WA cyclists refusing to strap on a helmet.
The tables associated with the story show that despite the increasing number of cyclists without helmets who are causing the medical and media concern, the number of hospitalised cyclists with head injuries declined significantly from 2013 to 2016.
The proportion of cyclists riding without helmets on WA roads hasn't been officially measured since the 1990s but an anecdotal estimate across Perth suburbia and regional Western Australia is 40% without helmets. The newspaper article has no percentages but reinforces the validity of this estimate.
As in previous years, Royal Perth Hospital State trauma director Sudhakar Rao estimates about 20% of cyclists admitted to the hospital each year had not been wearing a helmet. The proportion of cyclists not wearing helmets admitted to the hospital is smaller than the proportion of cyclists not wearing helmets on WA roads.
Admissions to Royal Perth Hospital from pedal cycle injuries points out that the number of admissions almost doubled from 2010 to 2019 with an increased severity of injuries, yet only 19.4% of all patients did not wear a helmet despite a far greater percentage of cyclists not wearing a helmet on West Australian roads:
The 2019 National Cycling Participation survey showed the percentage of Western Australia's population aged 2+ riding bicycles at least once a week dropped from 23.1% in 2011 to 15.6% in 2019, which equates to 189,466 fewer people cycling each week.
- Emergency department head injuries down from 572 in 2013 to 519 in 2016 - a 9.3% reduction.
- Emergency department all cycling injuries down from 2,995 in 2013 to 2,555 in 2016 - a 14.7% reduction.
- Hospital admission head injuries down from 403 in 2013 to 345 in 2016 - a 14.4% reduction.
- Hospital admission all cycling injuries down from 1,297 in 2013 to 1,173 in 2016 - a 9.6% reduction.
- RPH admissions longer than 24 hours up from 146 in 2012 to 201 in 2016 - a 37.7% increase. Among the 24 hour plus admissions not wearing helmets, the number dropped from 33 in 2012 to 32 in 2016.
- RPH deaths were static at two in 2012 and two in 2016, despite fewer people wearing helmets.
The story points out that 80% or eight of the 10 fatalities at RPH during 2012-2016 were not wearing helmets. However, Reported road crashes in Western Australia 2015 shows that among 27 WA cyclist fatalities from 2010 to 2015, 12 or 44% were not wearing helmets. This is similar to the 40% estimated to be cycling on WA roads without helmets.
The newspaper story also allows a proportionate comparison of cyclist head versus total injuries before mandatory bicycle helmets and in recent years.
Table B9 from Bicycle Crashes and Injuries in Western Australia, 1987-2000 - Road Safety report RR131 (PDF 840kb) provides cyclist head and all body annual injury totals from 1988 to 1991, the year before WA helmet law enforcement.
The proportion of all hospitalised cyclists with head injuries from 1988 to 1991 was 26.6% and from 2013 to 2016 it was 29.2%.
The newspaper data shows an annual average 191 cyclists were admitted for longer than 24 hours at Royal Perth Hospital between 2012 and 2016. Among these 191, an annual average 35 were not wearing a helmet at the time of their accident. This is 18.3% of the total number of cyclists admitted to RPH for longer than 24 hours.
The newspaper data suggests that more cyclists without helmets results in fewer cyclists with head injuries, at the same time illustrating that a greater proportion of hospitalised WA cyclists nowadays have head injuries than in the years before mandatory helmet law enforcement.
There were seven cyclist fatalities in Western Australia during 2017, three of whom were not wearing helmets and three of whom were aged 70-79 years old. The percentage of fatalities not wearing helmets was 42.9% in 2017, very similar to the proportion of West Australians who defy the law and cycle without a helmet (see story about increasing numbers not wearing helmets).
West Australian cyclist head injury numbers declined from 2013 to 2016, as did total injury numbers in line with the cycling participation decline from 2011 to 2017 according to the National Cycling Participation surveys. Among total WA hospital admissions, the head injury proportion was 31.1% in 2013 and 29.2% in 2016 (compared to the 1988-1991 pre law annual average of 26.6%).
So why is there concern that an increasing proportion of West Australian cyclists are not wearing helmets? Fewer people wearing helmets is resulting in a smaller proportion of cyclist head injuries.
The Australian Road Deaths Database published by the Bureau of Infrastructure, Transport and Regional Economics allows a comparison below of cyclist fatality crash types and ages since 1989, when no states had yet enforced mandatory bike helmet laws, till 2016.
The fatality data above mirrors the decline in Australian youth cycling after 1990-92 mandatory helmet law enforcement as well as the shift in demographics as baby boomers increasingly became the main age group who cycle. The data also shows that since 2000 an increasing proportion of cyclist fatalities have been in crashes not involving a motor vehicle.
Youth cycling participation in Australia has suffered an ongoing decline since 1990-92, contributing to the obesity crisis that has developed since then. Baby boomers who learnt to ride without helmets as kids have swelled cyclist numbers, with and without helmets, till 2011 (possibly explaining the increasing number and proportion of falls or accidents not involving motor vehicles that result in death, along with thousands of kilometres of new bike paths being built across Australia which separate them from traffic).
However, more and more baby boomers are retiring their bikes as they age and become increasingly frail. The 2017 National Cycling Participation survey shows a significant reduction in all ages including the elderly since 2011.
Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study, published by the British Medical Journal in 2017 found that cycling to work was associated with a 41% lower risk of dying overall compared with commuting by car or public transport. Cycle commuters had a 52% lower risk of dying from heart disease and a 40% lower risk of dying from cancer. They also had 46% lower risk of developing heart disease and a 45% lower risk of developing cancer at all.
September 2017: Melbourne's Herald Sun newspaper published We want more cyclists. So relax helmet laws, one of the most accurate and truthful articles ever published in Australia about the helmet law impact on cycling participation.
The video above was released in Victoria in September 2017. It's worth watching.
August 2017: The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score–matched study based on a trauma registry system examines deaths and injuries in Taiwan from 2009 to 2015.
Conclusions: Motorcycle helmets provide protection to adult motorcyclists involved in traffic accidents and their use is associated with a decrease in mortality rates and the risk of head injuries. However, no such protective effect of helmet use was observed for bicyclists involved in collisions.
April 2017: A Glasgow University study of 263,450 commuters in Britain linked cycling to work with a 45% lower risk of cancer and a 46% lower risk of heart disease compared with driving to work or using public transport. Cyclists overall had a 41% lower risk of premature death from any cause. The Glasgow study findings confirm the public health implications of at least half a million fewer Australians cycling per capita compared to pre-law levels due to cycling discouragement caused by mandatory helmet use.
April 2017: Portugal’s Government has dropped exploratory plans to introduce a mandatory helmet law for cyclists on the back of strong public opposition and evidence from countries such as Australia that the law has resulted in a huge decrease in cycling levels.
March 2017: Bosnia and Herzegovina has repealed the all-age mandatory bicycle helmet law it had enforced for the previous six years. Globally, more jurisdictions have repealed than enacted all-age bike helmet laws over the past decade (Israel, Dallas, Mexico City have also repealed adult laws), and most countries cite the Australian helmet law failure as their reason for not punishing adults who wish to enjoy cycling exercise. Unfortunately, Australia's academics, politicians and media remain disinterested in public health and road safety.
February 2017: World Transport Policy and Practice published Weaknesses with a meta-analysis approach to assessing cycle helmets, which questions the reliability of numerous meta-analysis studies that overlook the impact of cycling discouragement.
December 2016: Correlates of Helmet Use Among Recreation and Transportation Bicyclists (PDF 206k) published by the American Journal of Preventative Medicine found that surveyed cyclist respondents who wore a helmet had more than twice the odds of suffering an injury over the previous two years than cyclists not wearing helmets, whether riding for transportation or recreation.
The study graphic below shows the estimated percent who were injured among helmet and non-helmet wearers, providing further evidence that risk compensation increases the odds of a bicycle crash and helping to explain why mandatory helmet regulations in the US have had disastrous results.
The 2012/13 Victorian Integrated Survey of Travel and Activity released in March 2016 shows an increase in Melbourne cycling since 2007/08 but a halving in Victoria's regional cycling, with all numbers substantially lower than surveys before 1990 helmet law enforcement (Melbourne pre law 3.4% daily bike trips vs 2.1% in 2012/13). Read more ...
Perth and Western Australia cycling participation: 1985/86 to 2015 compares pre-law cycling participation data with 2015 survey figures, showing a 5.6% decline despite 87.9% population growth.
Australian cyclist numbers and population 1985/86 - 2011 compares government records of cyclist numbers nationally and in all Australian states in pre helmet law 1985/86 and in 2011, showing the rate of growth in Australia's bicycle use among people aged 9+ has been 37.5% less than the rate of 9+ population growth over the past 25 years. In essence, the growth of bicycle trips (20.9%) was almost a third that of population growth (58.4%).
This study was published in May 2012 by World Transport Policy and Practice and referenced by the European Cyclists Federation. Also published in May 2012 by the international journal Risk Analysis was The Health Impact of Mandatory Bicycle Helmet Laws by Professor Piet de Jong from Macquarie University in Australia.
This article seeks to answer the question whether mandatory bicycle helmet laws deliver a net societal health benefit. The question is addressed using a simple model. The model recognizes a single health benefit - reduced head injuries - and a single health cost - increased morbidity due to foregone exercise from reduced cycling. Using estimates suggested in the literature on the effectiveness of helmets, the health benefits of cycling, head injury rates and reductions in cycling leads to the following conclusions. In jurisdictions where cycling is safe, a helmet law is likely to have a large unintended negative health impact. In jurisdictions where cycling is relatively unsafe, helmets will do little to make it safer and a helmet law, under relatively extreme assumptions, may make a small positive contribution to net societal health. The model serves to focus the mandatory bicycle helmet law debate on overall health.
Together, these international papers through leading Australian universities highlight a public health disaster caused by mandatory helmet discouragement of regular recreational exercise.
Note: The biennial update of the Australian cycling participation survey by the Australian Bicycle Council and Austroads has been released for 2015, showing a failure of the 2011-2016 National Cycling Strategy with a statistically significant decline in Australian cycling from 2011 to 2015. The 2015 survey shows 24.5% fewer daily bike trips among cyclists aged 9+ than in 1985/86 (despite 49.7% population growth). Click for an update analysis.
In November 2015, Bicycle helmet wearing can increase risk taking and sensation seeking in adults. (PDF 489k) was published through the University of Bath in the UK, providing further evidence that risk compensation is a major contributor to higher rates of crashes and injuries among helmeted cyclists.
In March 2015, a Swedish study was published showing no relative reduction in head injuries among youth aged 0-15 following the 2005 enforcement of helmet laws for child cyclists.
On 29 November, 2013, a Queensland inquiry into cycling issues by the Transport, Housing and Local Government Committee tabled its findings in state parliament:
The Committee is appreciative of the fact that bicycle helmets, that meet national standards and are correctly fitted, provide some protection against head, brain, and facial injuries and is therefore of the view that the use of helmets should be encouraged. However the Committee is not convinced there is sufficient evidence of the safety outcomes of compulsory helmet wearing to justify the mandating of helmet wearing for all cyclists of all ages regardless of the situational risk.
The Committee is concerned that the introduction of mandatory helmet laws may have had an unintended, adverse impact on cycling participation rates in Queensland and therefore the overall health of the state. It also believes there is sufficient evidence provided by the Northern Territory example that a relaxation of mandatory helmet laws in lower risk situations (such as cycling on footpaths and on dedicated cycle paths), does not inevitably reduce the safety of cycling.
The Committee is therefore of the view that relaxing mandatory helmet laws in specific circumstances is likely to increase cycling participation rates with a range of associated health benefits and economic benefits in tourism areas. The Committee also believes that a relaxation of mandatory helmet laws may assist in normalising the perception of cyclists by motorists.
The Committee is therefore making a number of recommendations regarding relaxation of the mandatory helmet laws in specific circumstances.
The Committee is aware that police enforcement of helmet wearing by children is hampered by the fact that the children are not able to pay the fine and their parents have no legal responsibility to pay the fine on their behalf. The Committee believes parents should be responsible for ensuring their children wear helmets and should therefore be responsible for paying any fine their child incurs.
The Committee notes that a similar provision is currently contained in Schedule 9 of the Transport Operations (Road Use Management – Driver Licensing) Regulation 2010 Part 4-14 which states that a driver of a vehicle failing to ensure a passenger at least 16 years wears a seat belt (without an excuse) is subject to a demerit point penalty and fine.
The Committee recommends that the Minister for Transport and Main Roads:
- introduce a 24 month trial which exempts cyclists aged 16 years and over from the mandatory helmet road rule when riding in parks, on footpaths and shared/cycle paths and on roads with a speed limit of 60 km/hr or less and
- develop an evaluation strategy for the trial which includes baseline measurements and data collection (for example through the CityCycle Scheme) so that an assessment can be made which measures the effect and proves any benefits.
In Queensland, cycling participation slipped from 17.9% in 2011 to 17.0% in 2013, an estimated reduction of 40,291 cyclists. Analysis at this website shows that Queensland had an average 321,900 daily bicycle trips in 1985/86 and 198,546 daily bicycle trips in 2013, despite 74.6% population growth.
In its findings, the parliamentary committee makes a single reference to the 2013 participation survey at 17% in Queensland (p8), but incorrectly states that the survey results changed little between 2011 and 2013. The reduction from 2011 to 2013 was significant but the reduction since 1985/86 is far worse.
A summary PDF of Queensland cycling levels before and since helmet law enforcement can be viewed here. This document has been emailed to Queensland Transport Minister Scott Emerson who is expected to rule on the recommendation in February 2014, but the response from his department suggests he's not interested.
In May 2014, Queensland Transport Minister Scott Emerson announced the parliamentary inquiry's recommendation for a trial repeal of adult helmet laws will be ignored, although fines for cyclists will be increased to bring them in line with penalties against motorists.
May 2015: The Institutionalization of Cycling: A case study of Sydney and Melbourne published by the School of Economics and Management at Lund University in Sweden found:
Australia needs to improve encouragement of cycling through legislation. There is nothing in the law system saying that there is a need to protect the vulnerable people, such as pedestrians and cyclists. Cyclists are forced to protect themselves through the use of bells, fluoric safety wear and helmets, which transfer the responsibility of protection to them. The helmet law does more harm than good because it creates the perception that cycling is a dangerous activity.
The helmet law partly explains the absence of local trips. People need to be re-enabled to ride short commuting trips to the local store. For this to happen, the helmet law needs to be abolished.
Costs and benefits of a bicycle helmet law for Germany (PDF 1.3mb) is a peer-reviewed study by Gernot Sieg published in March 2014, with the primary conclusion:
For Germany, the benefits of a law that obliges cyclists to wear helmets are smaller than the costs. From an aggregated welfare point of view, Germany would therefore lose from introducing such a law.
In December 2013, the final report of the OECD International Transport Forum Working Group on Cycling Safety recommended member countries consider that although bicycle helmet laws may reduce head injury risk, they also increase crash risk and discourage cycling participation with possibly negative health and safety consequences.
These findings vindicate claims made by helmet law critics for almost 20 years. The forum discussions provide an insight to the majority view of bicycle helmets:
Helmet usage reduces the severity of head injuries cycle crashes but may lead to compensating behaviour that otherwise erodes safety gains.
- reduced injury risk (due to increased helmet usage)
- increased crash risk (due to an often claimed change in behaviour amongst cyclists who take up wearing helmet)
- less cycling (leading to a reduced number of accidents and injuries, but also to a higher accident risk for those who still bike)
Read the full findings on bicycle helmets. Australia is a member of this 54 country OECD transport forum. Does Australia endorse these findings? New Zealand, which has national all-age mandatory bicycle helmet laws, is also a forum member.
The OECD Transport Forum final report provides accurate recommendations concerning the injury risk vs health gains of cycling, typified by the chart below:
Barriers and facilitators to public bicycle scheme use: A qualitative approach published November 2012 shows the results of an online and on-street survey six months after the launch of Melbourne's bike share scheme to determine why it was suffering lower than expected usage rates. The survey results are charted:
A quarter of survey respondents cited their dislike of helmets to explain their non-participation and the study authors concede this is probably an underestimate of broader community sentiment due to the nature of the survey. The 25% finding is in line with all studies of decreased cycling participation in Australia when mandatory helmet laws were enacted in 1990-92. It supports all evidence on this website that about a third of potential cyclists are discouraged by helmet laws with consequent harm to public health and overall road safety. See Australian bike hire schemes fail because of helmet laws for more.
June 2013: editorial in the British Medical Journal titled Bicycle helmets and the law: Canadian legislation had minimal effect on serious head injuries explains the various reasons (detailed on this website) why bicycle helmet legislation consistently harms public health while providing minimal head injury benefits.
Formula One racing champion Michael Schumacher's critical head injury from a skiing accident in late 2013 has drawn attention to the efficacy of helmets in the sport. The New York Times reported that with about 70% of skiers now wearing helmets, triple the 2003 proportion, there has been no reduction in US ski fatalities and brain injuries with some studies suggesting a 60% increase. Academics suspect the reason is risk compensation among skiers, similar to more risky behaviour among cyclists wearing helmets.
June 2013: the US Department of Transportation's National Highway Traffic Safety Administration and the National Center for Injury Prevention and Control both agreed to abandon and withdraw from their websites the longstanding claim that bicycle helmets reduce the risk of head injury by 85%.
The disproved 85% claim, based on a 1989 Seattle study, has mislead the public and dominated global bike helmet policy for more than 20 years. The NHTSA and CDC have withdrawn the claim following a petition lodged by the Washington Area Bicyclists Association under the federal Data Quality Act. Read more here and here.
Mainstream media and websites continue to mislead the public with the 85% risk reduction claim. Journalists and helmet law advocates should note that this claim is demonstrably wrong and no longer supported by the US Government.
Effects of Bicycle Helmet Laws on Children's Injuries published February 2013 by the National Bureau of Economic Research in Cambridge, Massachusetts:
Abstract: Cycling is popular among children, but results in thousands of injuries annually. In recent years, many states and localities have enacted bicycle helmet laws. We examine direct and indirect effects of these laws on injuries. Using hospital-level panel data and triple difference models, we find helmet laws are associated with reductions in bicycle-related head injuries among children. However, laws also are associated with decreases in non-head cycling injuries, as well as increases in head injuries from other wheeled sports. Thus, the observed reduction in bicycle-related head injuries may be due to reductions in bicycle riding induced by the laws.
The chart below (courtesy Dorothy Robinson) shows the 2011 Census is affecting different states in different ways, with the most heavily populated south-east states contributing most of the increase in cyclist numbers since 2006. Click here for charts and Census source data on modes of travel to work in Australia.
In the 2011 Census, the highest proportion of cycling to work was again in the Northern Territory where there is no mandatory helmet law for adult cyclists on pathways:
From 2006 to 2011, an additional 829,587 people commuted to work including an additional 13,798 cyclists - 1.7% of the total.
From 1991 to 2011, an additional 2,341,938 people commuted to work including an additional 11,413 cyclists - 0.5% of the total.
From 1986 to 2011, an additional 2,944,613 people commuted to work including an additional 17,712 cyclists - 0.6% of the total.
This ABS Travel to Work data clarifies the extent of Australia's cycling "boom" in recent years - i.e. there were 13,798 more commuter cyclists in 2011 than in 2006, but there were just 11,413 more commuters cyclists than in 1991, despite an extra 2,341,938 people travelling to work in Australia since then.
See also Cycling to work in Sydney: analysis of journey-to-work Census data from 2001 to 2011 by the University of Sydney in November 2012.
The advertisement above began airing on Queensland television in September 2012
Does the wearing of helmets result in cyclists riding faster, a symptom of risk compensation? The following studies, published in 2012 and 2011, give some clues:
Bicycle helmets - A case of risk compensation?
Institute of Transport Economics, Oslo, Norway
The main objective of this article was to investigate if lacking effect of helmet legislation could be due to population shifts or to risk compensation effects. The analysis of responses from 1339 cyclists by use of a SEM model showed that the variable that had the strongest correlation with accident involvement was "fast cycling". Speed happy cyclists seemed to be involved in more cycling accidents. At the same level of equipment use, use of bicycle helmets is not related to accidents.
On the other hand, the strong positive relationship between equipment/helmet use and fast cycling indicate an indirect effect of the helmet on accidents. In other words, by using helmet and other equipment some cyclists race even faster than they would have done without, and thus get involved in more accidents.
The data does not provide any information on what part of the body was injured. In a study bicycle injuries based on a similar but larger sample from the Falck register, Bjornskau (2005) found no significant difference in the injury distribution between helmeted and non-helmeted cyclists. One of the intriguing effects of helmet laws is that they do not change the ratio of head injuries over other types of injuries. It can be surmised that risk of head injury increases with accident severity. Hence, further studies should aim at having more precise information on type of injury in order to check if speed-happy helmeted cyclists are more likely to suffer head injury, due to more severe accidents.
The results of this study indicate that the lacking effect of helmet legislation most likely has to do with a population shift effect, in which the introduction of mandatory bicycle helmet wearing will lead to a decrease of traditional cyclists in the cyling population, who do not have much accidents anyway, whereas the speed-happy helmet- and equipment using cyclists will remain. Reduced cycling will quite clearly have negative social health consequences ...
Emotional reactions to cycle helmet use
Institute of Transport Economics, Oslo, Norway
We found that after having removed their helmets, routine helmet users cycled more slowly and demonstrated increased psychophysiological load. However, for non-users there was no significant change in either cycling behaviour or psychophysiological load.
Whatever the dynamics and confounders of risk compensation, the most important issue for policy-makers and planners remains whether helmet use should be encouraged or not. The results from this study show that helmet users cycle more slowly when the helmet is taken away. It also indicates that the lack of helmet results in a certain emotional experience. It is uncertain if this is a lasting effect. The possibility remains that helmet laws may increase cycling speed among certain cyclists, while discouraging those who find helmets unpractical from cycling.
Risk Compensation: A Male Phenomenon? Results From a Controlled Intervention Trial Promoting Helmet Use Among Cyclists
INSERM Research Center, Bordeaux, France (fire-walled)
Prevention tools are challenged by risky behaviors that follow their adoption. Speed increase following helmet use adoption was analyzed among bicyclists enrolled in a controlled intervention trial. Speed and helmet use were assessed by video (2621 recordings, 587 participants). Speeds were similar among helmeted and nonhelmeted female cyclists (16.5 km/h and 16.1 km/h, respectively) but not among male cyclists (helmeted: 19.2 km/h, nonhelmeted: 16.8 km/h). Risk compensation, observed only among male cyclists, was moderate, thus unlikely to offset helmet preventive efficacy. (Further study details without speed references)
Evaluation of the protective effect of bicycle helmets
Department of Trauma and Reconstructive Surgery, University Hospital "Carl Gustav Carus", Dresden, Germany (slow PDF download)
Casualties wearing a helmet were in average at significantly higher speed (mean=16.8 km/h, SEM=0.6) than cyclists wearing no helmet (14.3 km/h, SEM=0.1).
As formerly described even in our research we found that riders with helmet were in average at higher speed. By the way this may be due to gender differences and difference of type of bicycles (both correlate to helmet use, men were faster than women and did more often wear a helmet)
Figure 6 shows the main cause of accidents surveyed by the estimation of the scientific team. This variable is encoded basing on the official accident cause index. We observed that casualties with helmet more often had accidents because of speeding (8.8% compared to 3.1%) and right-of-way mistakes (40.7% compared to 26.9%), whereas consequently casualties who did not wear a helmet had more often accidents because of using the wrong lane (33.1% compared to 23.0%) and because of inadequate roadworthiness (5.2% compared to 0.9%)
Our results show increased cycling speed and decreased risk perception in a helmet-on compared to a helmet-off condition among cyclists used to wearing helmets, a finding that is in line with the theory of risk compensation. However, for those cyclists not used to helmets there were no differences in either risk or behavior between the helmet-off and helmet-on conditions.
Is cycling more dangerous than other activities and needing special protective legislation? See a comparison of death and injury rates among common recreational pursuits published by the Ohio Bicycle Federation.
An observational study in 1995 found the overall helmet wearing rate for West Australian cyclists to be 77%, compared to 81% in 1993, 62% in 1992 and 39% in 1991 (pre-legislation) (Market Equity, 1995). In January 2001, Royal Perth Hospital (the largest in Western Australia) estimated 16% of cyclist admissions were not wearing a helmet when injured. In 2004, the hospital's records showed 20% of cyclists admitted for trauma injuries were not wearing a helmet. If 23% of cyclists on WA roads are not wearing a helmet but 20% of cyclist hospital admissions are not wearing a helmet, these figures indicate cyclists not wearing a helmet are less likely to have an accident or suffer injuries requiring hospital treatment.
Royal Perth Hospital data published in October 2012 show that in 2010, a total of 79 cyclists were admitted to the RPH trauma unit, among whom nine reported they were not wearing a helmet. This is 11.4% of trauma admissions not wearing a helmet. In 2011, 77 cyclists were admitted to the trauma unit, of whom 21 were not wearing a helmet. This is 27.3% of trauma admissions not wearing a helmet.
Albeit only two years, this averages to 19.3% of all trauma unit patients not wearing a helmet. Authorities have used hospital admissions data for years to obfuscate the relevance of helmet protection, as there has been no official helmet wearing survey in Australia since 1995. Even then the data showed 23% of cyclists on WA roads were not wearing helmets, and anecdotal evidence suggests that the ratio is now close to 40%. These comparisons with the official RPH trauma admissions data again suggest a higher proportion of injuries are suffered by cyclists wearing helmets.
WA Health Ministry data show that from 1 January 2009 to 22 April 2014, helmet wearing was recorded among 56% of fatal and critical cycling injury victims admitted to WA hospitals. Among these, an average 29% were not wearing a helmet at the time of the crash - again a similar or lower proportion than the estimated percentage of cyclists not wearing helmets on WA roads and suggesting a lower risk of serious injuries among riders not wearing helmets. Among crash victims, 82% were male and 18% female, partly reflecting faster and more risky male cycling but also the helmet law discouragement of cycling among women.
Between 2009 and 2013, 16 cyclists were killed in the Perth metropolitan area and six were not wearing a helmet, or 37.5%. Critical injuries were suffered by 43 cyclists, 11 of whom were not wearing a helmet, or 25.6%. Each time the government and health authorities quote the proportion of fatalities and injuries among cyclists without helmets, their data supports other evidence that helmet wearing does not lower and potentially increases the risk of a crash with resultant injury.
Cartoon thanks to Mimi & Eunice
In 2009, Western Australia police issued $50 helmet infringements against 2,400 cyclists - 1,913 adults, 446 youths. This was up from 2008 when there were 1,503 adults and 286 youths punished for riding their bikes without helmets. In 2010, police apprehended and issued infringements against 1,873 cyclists and in 2011 they fined 1,066 cyclists. Although this means 7,128 people were persecuted for cycling from 2008 to 2011, it suggests police enforcement of the helmet law continues to be relaxed with WA hospital admission figures remaining comparatively stable since about the year 2000 as an increasing proportion of people risk prosecution by cycling without a helmet.
The bicycle helmet infringement fine in the state of Victoria in 2012 is $149, having risen from $58 in 2009 when 6,600 cyclists were fined on Victorian roads. This severe punishment for exercising on a bike in Victoria helps explain why the BikeShare hire scheme in Melbourne has been a failure. The helmet fine in NSW is $335 (2019) and in the Australian Capital Territory it is $67. In Queensland between 2007 and 2009, about 7,500 cyclists were fined each year for not wearing a helmet.
Risk Compensation and Bicycle Helmets published in 2012 by Risk Analysis has findings that have been obvious in Australia for 20 years:
"The findings are consistent with the notion that those who use helmets routinely perceive reduced risk when wearing a helmet, and compensate by cycling faster. They thus give some support to those urging caution in the use of helmet laws."
Bicycle helmets – A case of risk compensation? published in September 2012 by Transport Research abstracts that "the results indicate that at least part of the reason why helmet laws do not appear to be beneficial is that they disproportionately discourage the safest cyclists".
May 2 2012: Australia's helmet law disaster published by the Institute of Public Affairs.
Watch this 60 second advertisement calling for repeal of Australian mandatory bicycle helmet laws by Helmet Freedom and Sputnik Films, both contributing their services at no charge to highlight the damage these laws are causing to public health and safety.
August 4 2011: The Israeli Knesset (parliament) has passed an amendment to that country's mandatory helmet legislation so that adults in cities and towns no longer have to wear them. The all-age mandatory helmet law had been in place for four years. Israel and Mexico City have effectively conceded the failure of adult bicycle helmet laws and their decisions were largely influenced be the discouragement of cycling that jeopardised their bike hire schemes. A survey by Tel Aviv municipality showed a 54% increase in cycling participation from 2010 to 2012, indicative of the increases likely in the world's few mandatory jurisdictions if they stopped punishing adults who want to enjoy active transport.
Hospital Separations due to Injury and Poisoning, Australia 2005/06 (PDF 5mb), published in 2010 by the Research Centre for Injury Studies at Flinders University, shows in chapter 2.3.1 Land Transportation (p37) that out of 50,763 land transport accidents, 8,823 or 17% were pedal cyclists.
Australian Bureau of Statistics figures (PDF 2mb) show that nationally, the average proportion of people using a bicycle as their transport to work or study among all Australian states was 1.5% in 2006. The average proportion of people using a bicycle as their recreational transport among all Australian states was 4.8% in 2006.
According to the Flinders University report, the most common mode of transport for females injured in non-traffic accidents were pedal cycles (32%; n = 771) followed by cars (25%; n = 606), whereas the most common for males were motorcycles (46%; n = 5,073) followed by pedal cycles (30%; n = 3,359).
Age-standardised rates for injury hospitalisation of car occupants declined from 96 per 100,000 of the population in 1999/00 to 90 per 100,000 in 2005/06. Rates for motorcyclists increased from 48 per 100,000 in 1999/00 to 62 per 100,000 in 2005/06. Pedal cyclist rates increased from 40 per 100,000 in 1999/00 to 44 per 100,000 in 2005/06. Rates for pedestrians declined from 24 per 100,000 of the population in 1999/00 to 19 per 100,000 in 2005/06.
For traffic injury cases (p43), pedal cyclists represented 4,378 out of 31,530, or 13.9%. For non-traffic injury cases, pedal cyclists represented 4,130 out of 13,578, or 30.4%.
With cycling representing less than 4.8% of land transport but 17% of hospital admissions, it clearly has a disproportionately high accident/injury rate. Head injuries represent 20-30% of all body injuries and helmet law proponents argue that helmets reduce the incidence of head injury by up to 85%.
Note that from 1985/86 to 2011, Australia's rate of cycling participation was 37.5% less than the rate of population growth.
Social Inclusive Bicycle Riding in Multicultural Australia published in July 2011 by Victoria University shows that Japanese, Vietnamese, Sri Lankan and Arab-African immigrants living in Melbourne used bicycles three times less than they had done previously in their home countries, with helmet laws a repeated reason for their decisions to no longer cycle or to cycle less.
Cartoon thanks to Yehuda Moon and the Kickstand Cyclery
March 21, 2012: Australian children are among the most ''cosseted'' and ''chauffeured'' in the world with a study showing more than 60% are driven to and from school and the numbers who walk, cycle and take public transport are falling to new lows.
Not all doctors agree that bicycle helmets should be mandatory in Australia. Read the views of Dr Grant Fraser from the emergency rooms of Nambour General Hospital in Queensland.
In June 2011, the British Medical Journal published The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study of the Bicing bike share scheme in Barcelona to estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment:
Results: Compared with car users the estimated annual change in mortality of the Barcelona residents using Bicing (n=181,982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77). The annual number of deaths avoided was 12.28. As a result of journeys by Bicing, annual carbon dioxide emissions were reduced by an estimated 9,062,344 kg.
Conclusions: Public bicycle sharing initiatives such as Bicing in Barcelona have greater benefits than risks to health and reduce carbon dioxide emissions.
This peer-reviewed study in the British Medical Journal confirms the point repeatedly made by helmet law critics: the discouragement of cycling has far worse health consequences for society than any perceived safety benefits of mandatory helmets. See bike hire failure in Australia for further information, or read the observations of the Bicycle Helmet Research Foundation.
In April 2011 the Transport and Health Study group, an independent British society of public health and transport practitioners and researchers, published the landmark report Health on the Move 2 containing Cycle Helmet Evidence that should be closely studied by all Australian and New Zealand politicians, bureaucrats and reporters.
|The Cycling Promotion Fund and Australian Heart Foundation have published their Riding a Bike for Transport 2011 Survey Findings. This is a survey of 1,000 Australian adults. Although the word "helmet" is not used once in the survey text, its tables show that among the 240 who had cycled in the previous month, 16.5% (40) cited "don't like wearing a helmet" as their reason not to cycle more often, and among the 700 not considering riding a bike for transport at all, 15.7% (110) cited "don't like wearing a helmet". Traffic volume and road safety would improve if 16% more people cycled instead of driving their cars and Australia's rate of cycling participation would double.|
In October 2011, the Australian Broadcasting Commission's Drum program polled the question "On National Ride to Work Day, do you think bike helmets should be compulsory?" (poll 1010) with 3,928 respondents and a final vote of 51% No and 49% Yes.
In September 2010, the Sydney Morning Herald conducted a two day opinion poll asking if cyclists should be forced to wear helmets. The poll recorded 10,571 votes, by far the largest response to any issue polled on the web by the newspaper's Life&Style section, with 53% voting against the law and 47% voting for the law. With such a large public response and with a majority against the helmet law, this poll again suggests it might be time for Australia's politicians to listen to their voters.
In July 2011, a survey by the British Medical Journal found that among 1,439 respondents, many of them doctors, 68% didn't believe that bicycle helmets should be mandatory for adult cyclists in the UK.
On August 16, 2010, the Australian media published and broadcast a Sydney University study disproving the effectiveness of helmet laws, including headlines such as Bicycle helmet laws 'not needed', Scrap bike helmet law, says health expert and Call for repeal of bike helmet laws.
The reports were based on a study, The effects of bicycle helmet legislation on cycling-related injury: the ratio of head to arm injuries over time, by Associate Professor Chris Rissel and Dr Alexander Voukelatos from Sydney University's School of Public Health into the ratio of cyclist head and arm injuries from 1988 to 2008, showing most of Australia's fall in head injury rates occurred before helmet laws were introduced. Listen to Dr Rissel's views in a 10 minute radio interview.
Cartoon thanks to Mimi & Eunice
In June 2011, the medical peer-review journal Accident Analysis and Prevention published The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia, which asserts that mandatory bicycle helmet laws in NSW should not be repealed because the ratio of cyclist head vs limb injuries before and after 1991 law enforcement proves that helmets reduce head injuries. This critique of the study shows how it inaccurately estimates the reduction in child and adult cycling numbers after law enforcement and provides more evidence that accidents/injuries per cyclist increased after helmets became mandatory in NSW.
Much of the argument supporting mandatory helmet legislation in Australia is based on a meta-analysis of studies by Attewell, Glase and McFadden, published in 2001, which concluded that the risk of head injury is reduced by 60% (see here and here). However, in early 2005 the international peer-review journal Accident Analysis and Prevention published a paper (PDF 68kb) by researcher Bill Curnow disproving the Attewell et al. meta-analysis. In January 2011, Accident Analysis and Prevention published here and a paper by Norwegian researcher Rune Elvik (PDF 291kb) further disproving the safety and injury criteria upon which helmet laws are based.
Elvik extract: Do bicycle helmets reduce the risk of injury to the head, face or neck? With respect to head injury, the answer is clearly yes, and the re-analysis of the meta-analysis reported by Attewell et al. (2001) in this paper has not changed this answer. As far as facial injury is concerned, evidence suggests that the protective effect is smaller, but on balance there does seem to be a slight protective effect. The risk of neck injury does not seem to be reduced by bicycle helmets. There are only four estimates of effect, but they all indicate an increased risk of injury. When the risk of injury to head, face or neck is viewed as a whole, bicycle helmets do provide a small protective effect. This effect is evident only in older studies. New studies, summarised by a random-effects model of analysis, indicate no net protective effect.
Bicycle Helmets extract (PDF 139kb) from The Handbook of Road Safety Measures, 2nd edition published in 2009 by Rune Elvik et al.
The discouragement of cycling through mandatory bicycle helmet laws caused immediate increases in traffic density in all Australian and New Zealand jurisdictions as many people chose to drive their cars instead, resulting in thousands of additional road casualties through car vs car, car vs motorbike, car vs pedestrian and car vs cyclist accidents.
The studies above reflect the findings of Road traffic injury prevention: an assessment of risk exposure and intervention cost-effectiveness in different world regions, published in 2008 by the World Health Organisation.
WHO extract: Assuming (contested) baseline effect sizes, legislation and enforcement of bicycle helmet use produced very little health gain in the high-income sub-region of the Americas, but was the second most effective single strategy in two sub-regions with a relatively high burden of bicycle-related injury ... For example, in highly motorized regions of the world of America or Europe, the proportion of total fatal injuries attributable to bicyclists and to children not wearing a bicycle helmet is very small (< 2%), so the public health impact of increasing helmet use among this road user group will be correspondingly modest (and relatively cost-ineffective given the fixed costs of its full implementation). By contrast, in other settings where there is a low overall motorization rate or a high dependence on bicycles as a mode of transport, fatal injuries to bicyclists account for a much larger share of the avertable burden, thereby making increased helmet use a more favorable option.
Australia has the second highest kilometres of driving per capita in the world (behind America).
In August 2011, the Copenhagen City Heart Study found that male cyclists who ride quickly extend their life expectancy by 5.3 years, while those who cycle at average speeds will live an average 2.9 years longer. Among women, the ratio is 3.9 extra years for speedsters and 2.2 years riding at average speeds.
It should be noted that although the Australian Bicycle Council thus recommends that brisk cycling by adults is preferable to slow cycling, the injury prevention of helmets decreases progressively with increased speed to the point of no return above about 20kmh.
As for cycling discouragement, if a very conservative estimate of 100,000 (average speed, non-lycra) Australians don't cycle because of the helmet law, that's about 260,000 years of life lost. Australian longevity averages 80 years so that's about 3,250 lives.
The West Australian media has failed to report the story of NSW woman Sue Abbott who in September 2009 unsuccessfully challenged her prosecution for failing to wear a helmet (March 7, 2009, in the NSW town of Scone) on the grounds of potentially harming herself through compliance with the law. You can read about this woman's court battle on the Danish website copenhagenize.com or watch her story on video.
On August 28, 2010, the Sydney Morning Herald published Heady freedom as judge agrees helmet laws are unnecessary, describing how NSW District Court judge Roy Ellis quashed Sue Abbott's conviction, finding she had "an honestly held and not unreasonable belief as to the danger associated with the use of a helmet by cyclists".
"It is clear that there is a significant argument taking place in certain scientific circles regarding the efficacy of helmets, in terms of their ability to protect. On one view, they appear to pose as much danger when worn as the danger of not wearing them. Unfortunately, that issue is an issue for Parliament in terms of whether they should rescind the mandatory requirement for helmets to be worn by cyclists," said the judge. Read his ruling here (PDF 22kb).
Read about the progress of Sue's court appeals in the Law Society Journal published in June 2010 or read her blog. On September 5, 2010, the Brisbane Times published Court battle turns focus on helmet laws.
Update: Sue Abbott has received a $67 mandatory victims compensation levy which she refuses to pay for convictions quashed by the District and Local courts, particularly in the absence of a victim and in view of recent amendments to the compensation legislation that should exempt her from the levy. As a result, her drivers license has been suspended in November 2011 for the crime of riding a bicycle. See No bicycle helmet, no car licence - only in Australia.
Update: The State is due at Sue Abbott's door to steal her possessions in lieu of compensation for the victims of her riding a bicycle without a helmet. See Bailiff to come calling after Sue the cyclist heads for helmet showdown.
Update: The only proven thing helmets protect us from are fines was published by The Guardian newspaper in the UK in November 2012, allowing Sue Abbott to further explain her extraordinary persecution by the NSW government.
Read Should Bicycle Helmet Laws be Abolished? published in March 2011 by Australian Women's Health magazine.
Risk compensation is one of various reasons believed responsible for increased accidents and injuries due to mandatory wearing of helmets, including increased traffic density. Published in March 2011 by the Society for Risk Analysis, Risk Compensation and Bicycle Helmets (PDF 102kb - authors Ross Owen Phillips, Aslak Fyhri and Fridulv Sagberg) found that:
Whatever the dynamics and confounders of risk compensation, the most important issue for policymakers and planners remains whether helmet use should be encouraged or not. The data in this article show that cyclists accustomed to helmets may either cycle faster with the helmet on or may slow down when the helmet is taken away. Whether cyclists would continue to cycle more slowly without a helmet is uncertain, but the possibility remains that helmet laws may increase cycling speed among certain cyclists, while discouraging those who find helmets uncomfortable from cycling. Given the association between speed and risk of accidents, this might even explain reports that helmets and helmet laws have not been shown to reduce the risk of injury per cyclist.
May 2012: A study of first-time bicycle-helmet users published in the American Journal of Public Health found men who wear helmets cycle significantly faster than men who don't wear them, adding further weight to evidence that risk compensation is responsible for the increase in accidents/injuries per cyclist in mandatory helmet jurisdictions.
In October 2011, Queensland hospital emergency doctor Grant Fraser questioned the need for helmet laws which he says do little to prevent injury and discourage exercise in a country grappling with obesity.
Listen to ABC Radio National Background Briefing on bicycle helmet laws - September 19, 2010 (mp3).
A health benefit model developed at Macquarie University in Sydney and published in March 2009 suggests Australia's national mandatory bicycle helmet laws incur a health cost to the country amounting to hundreds of millions of dollars every year.
In a jointly-sponsored report published in August 2010, the Australian Local Government Association, the Bus Industry Confederation, the Cycling Promotion Fund, the National Heart Foundation of Australia and the International Association of Public Transport estimate that government encouragement of active transport such as cycling, walking and public transport could save 16,000 lives a year with annual Australian health-care savings of more than $1.5 billion a year.
The Northern Territory government of Australia repealed compulsory bicycle helmet laws for adults on paths not adjacent to roadways in 1994 following a public campaign including a petition signed by 8% of the population. People were stopped in the streets of Darwin, the capital of the Northern Territory, and asked what effect mandatory helmets had on their cycling behaviour. 22% claimed to have given up cycling because of the helmet legislation and 20% to 30% said they cycled less.
The film below was produced by documentary-maker and researcher Mike Rubbo in mid-2010:
Australia Cycling: Bicycle Ownership, Use and Demographics 2004 draft (PDF download, 944kb) shows that cycling to work is more popular in the Northern Territory than anywhere else in Australia. The Northern Territory percentage of 4.2% compared with a national average of just 1.3% in 2001. Cycling generally is more popular in the Northern Territory than anywhere else (15.3% of people cycle in the Northern Territory for exercise, recreation or sport... compared to a national average of 9.5%). Why? One reason is because women are not discouraged by the law. According to the 2001 Census, 35.6% of recreational cyclists in the Northern Territory are women, compared to a national average of 32.2%. In the Territory, 31% of people who cycle to work are women. This is the highest percentage in Australia and compares with a national average of just 19%. The report shows that just 75 cyclists were hospitalised in the Northern Territory in 2001 - a number disproportionately low by comparison with the Territory's population of 210,000 in 2001 (the lowest proportion of any Australian state or territory and the only place in Australia where adults can and do legally cycle without a helmet).
The graph below clearly illustrates that women in the Northern Territory are far more likely to cycle than women in other Australian cities:
The Northern Territory has an atrocious road safety record with the worst injury rate in Australia for all road user types - except cyclists. Click here for an extract from Serious injury due to land transport accidents, Australia 2006-07 (RTF 1.5mb) published in 2009 by the Australian Institute of Health and Welfare. The data shows the Northern Territory car occupant serious injury rate was 124 compared to a national average of 78, its motorcyclist serious injury rate was 45 compared to a national average of 35 and its pedestrian serious injury rate was 19 compared to a national average of 13. The Northern Territory cyclist serious injury rate was exactly the same as the national average at 23 and better than several states where helmet use is mandatory for adult cyclists in all public places.
This data shows the Northern Territory car occupant serious injury rate with a high threat to life was 54 compared to a national average of 23, its motorcyclist serious injury rate with a high threat to life was 15 compared to a national average of 9 and its pedestrian serious injury rate with a high threat to life was 6 compared to a national average of 5. The Northern Territory cyclist serious injury rate with a high threat to life was exactly the same as the national average at 4.
On the comparatively dangerous roads of the Northern Territory, the only road users with an average rate of serious injury are cyclists who aren't forced to wear helmets.
The chart above from Cycling in NSW (PDF 8.7mb) shows the Northern Territory public cycling participation and injuries rates based on 2006 Census data.
In June 2007, the Norwegian Centre for Transport Research published research (PDF 920kb) noting that:
"There is evidence of increased accident risk per cycling-km for cyclists wearing a helmet. In Australia and New Zealand the increase is estimated to be around 14%. The introduction of a bicycle helmet law in these countries has additionally lead to a reduction of cycling-kilometres of 22%. This effect is likely to be larger for adolescents than for adults, and smallest for children."
Helmet Laws: Creating Consensus from Controversy and Contradictions (PDF 380kb) by Dorothy Robinson from the Bicycle Helmet Research Foundation presents analysis of bicycle helmet laws around the world.
In 2008, mechanical engineer and British Cycling Federation coach Colin Clarke pubished Assessment of Australia's Bicycle Helmet Laws (PDF 208kb), summarising and exposing key points about the harm caused to public health since mandatory helmet laws were enforced in 1990.
In May 2009, the Danish Parliament voted 90 against 21 to defeat a Bill tabled by the Socialist People's Party for a mandatory bicycle helmet for children under 12. Danish politicians looked at the helmet law results in Australia since 1990 and decided not to harm their own society.
Cartoon thanks to Mimi & Eunice
The lack of a sun visor on bicycle helmets may increase the risk of facial skin cancer. Queensland resident Alex Reid, who has cancer on his face, has been lobbying that state's government on the grounds that the helmet law should be unenforceable because it endangers the wearer. However, in June 2011 his legal challenge failed. Research by Diffey and Cheeseman suggests that a hat with at least a 7.5cm brim is necessary to provide reasonable protection around the nose and cheeks, those sites on which non-melanoma skin cancers commonly occur.
Published in the American Journal of Preventative Medicine in April 2009, Deakin University research shows a link between reduced cycling and Australia's obesity crisis, as reported by the Australian Broadcasting Corporation:
"At the same time the proportion of children cycling to school is now so low it is statistically too insignificant to be considered on its own, says Hume, of Deakin University's Centre for Physical Activity and Nutrition Research. Hume says the decrease in what is known as active commuting has occurred at the same time as obesity rates among children have increased. Although, the researcher says "it is drawing a long bow" to directly link the two, the decrease in walking and cycling to school is part of the overall reduction in physical activity amongst children." (see Child cycling)
Do you believe your foam soft top bike helmet is better than those hard shells worn by motorcyclists? Think again.
Do you question whether risk compensation caused by helmets increases the number of accidents and injuries? Find out how your kids react when using "safety" equipment such as helmets. Similar study findings here and here.
Watch New York journalist Lenore Skenazy interviewed on ABC Australia's 7.30 Report on September 29, 2010, to defend her book Free Range Kids which criticises helicopter parents with a risk obsession who are stifling the health and development of their children.
In March 2010, Intended and Unintended Effects of Youth Bicycle Helmet Laws (PDF 172kb) was published by Christopher Carpenter and Mark Stehr from the University of California: In this paper we confirm that helmet laws reduced fatalities, but we uncover robust evidence of an alternative and unintended mechanism: helmet laws significantly reduced youth bicycling.
Australia has the worst public cycling participation rate in the world. This is not surprising since the state governments of Australia punish people for cycling.
The diagram above shows the bicycle share of trips in Europe, North America and Australia (percent of total trips by bicycle) and is sourced to 2007 data from the Australian Bureau of Statistics and the statistical services of all countries involved. In New Zealand, which has mandatory all-age bicycle helmet laws, the percentage is 1.8% of all trips. Australian helmet law supporters claim cycling popularity is booming in Australia. The truth can be found in the diagram above.
This research is sourced to Making Cycling Irresistible (PDF 876kb) (Pucher and Buehler, Transport Reviews, Vol. 28 2008). The research notes:
In the USA, much of the effort to improve cyclist safety has focused on increasing helmet use, if necessary by law, especially for children. Thus, it is important to emphasize that the much safer cycling in northern Europe is definitely not due to widespread use of safety helmets. On the contrary, in the Netherlands, with the safest cycling of any country, less than one percent of adult cyclists wear helmets, and even among children, only 3-5% wear helmets (Dutch Bicycling Council, 2006; Netherlands Ministry of Transport, 2006). The Dutch cycling experts and planners interviewed for this paper adamantly opposed the use of helmets, claiming that helmets discourage cycling by making it less convenient, less comfortable, and less fashionable. They also mention the possibility that helmets would make cycling more dangerous by giving cyclists a false sense of safety and thus encouraging riskier riding behavior. At the same time, helmets might reduce the consideration motorists give cyclists, since they might seem less vulnerable if wearing helmets (Walker, 2007).
Below is a presentation by Planning and Public Policy Professor John Pucher at Rutgers University, Vancouver, on May 15, 2008: Cycling for Everyone: Lessons for Vancouver from the Netherlands, Denmark, and Germany (video one hour 20 minutes but highly informative : courtesy Simon Fraser University):
In November 2008, TransportXtra published an article by transport planner Richard Burton titled Cycle helmets have no measurable benefits and many disbenefits, so why are they advocated?
In the Netherlands, urban densities are approximately the same as in Sydney. Recent surveys show there are 14 times as many person trips by bike and 810% more bicycle kilometres ridden than in Australia. However, deaths of bike riders per 100,000 population is a third of that in Australia. Bicycle helmets are not mandatory and are rarely worn in the Netherlands.
cycled and helmet wearing rates in various countries.
In March 2010, the Sydney Morning Herald newspaper reflected on cycling in Sydney: SYDNEY will never be a bicycle-friendly city until it develops a 'second cycling culture' which encourages relaxed European-style riding without the compulsory use of helmets, experts have warned.
In 2003, the Injury Prevention journal published research demonstrating that the more cyclists on the road, the safer it is for all (PDF 140k).
Cycle Helmets and Road Casualties in the UK is a 2005 study that finds: "There is no evidence that cycle helmets reduce the overall cyclist injury burden at the population level in the UK when data on road casualties is examined."
Serious injury due to land transport accidents, Australia, 2003 - 2004 (PDF 840kb) by the Australian Institute of Health and Welfare (p33) shows that helmeted cyclists had about the same percentage of head injuries (27.4%) as unhelmeted car occupants and pedestrians (28.5%). See graph here. Helmeted motorcyclists had a percentage of 10.6%. Vehicle and pedestrian accidents are obviously different to bicycle accidents but the wearing of a helmet nevertheless seems to have no discernible impact on the risk of head injury. Motorcycle accidents do have similarities to bicycle accidents, although motorcyclists normally travel much faster than cyclists and only on roads. Motorcyclists had almost three times less chance of a head injury in an accident, suggesting that hard shell motorbike helmets work whereas soft shell bicycle helmets do not work.
Cycling injuries in Australia: Road safety's blind spot (PDF 218kb) published in the August 2010 issue of the Journal of the Australasian College of Road Safety details Australia's poor cycling participation and injury rates: "Cycling rates are relatively low in Australia, but cyclists comprise about 1 in 40 traffic crash fatalities and about 1 in 7 serious injuries. While fatalities and serious injuries for car occupants (drivers and passengers) have declined over time, cyclist fatalities have remained steady, and serious injuries have increased."
Cyclists represented 17% of all road users admitted to West Australian hospitals in 1992, the year mandatory bike helmet legislation was enforced. This had risen to 25.9% by the year 2000.
Cartoon thanks to Yehuda Moon and the Kickstand Cyclery
In December 2007, the British government agency Cycling England published Cycling and Health: What's the Evidence? (PDF 3.6mb), considered the most comprehensive guide ever written regarding the health benefits of cycling. This is a benchmark publication that should be read by all health professionals who want to encourage rather than discourage healthy exercise.
An economic evaluation by the Road Accident Prevention Research Unit of the University of Western Australia found the mandatory helmet legislation most probably had a negative cost impact as high as $21 million between 1991 and 1998. Download a copy in PDF (442mb). This paper also highlights various of the medical and safety failures of Western Australia's mandatory bicycle helmet legislation.
In 2003, the Health Promotion Journal of Australia published an article by Dr Chris Rissel who states that "The focus on bicycle helmets obscures the real issue for cyclists..." (PDF 232kb). Dr Rissel is also quoted in September 2008 within ScienceDaily - A Virtuous Cycle: Safety In Numbers For Bicycle Riders and at a seminar by the University of New South Wales Injury Risk Management Research Centre in September 2008.
Reported on May 7, 2009, by The Guardian newspaper, research from the UK's main cycling organsation, the Cyclists Touring Club, showing that where there are more riders on the road there are generally fewer accidents. "Struck by the Dutch success, a group of British MPs has just returned from a fact-finding trip to the country. There, along with reams of information about bike lanes and secure parking, they were let in to a less well-known secret for spurring a national cycling culture: throw out the Lycra and the helmets."
The Cycle Helmet: Friend or Foe? (PDF 137mb), by Senior Fellow Emeritus Mayer Hillman from the Policy Studies Institute in London, concludes that bicycle helmet wearing should be neither mandated or encouraged and that life years gained through cycling have been calculated to exceed life years lost in cycle fatalities by a factor of 20 to 1.
Published in July 2010 by the US National Institute of Environmental Health Sciences, Do The Health Benefits Of Cycling Outweigh The Risks? (PDF 225kb) found that "For individuals who shift from car to bicycle, we estimated that beneficial effects of increased physical activity are substantially larger (3-14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8-40 days lost) and the increase in traffic accidents (5-9 days lost) ... on average the benefits of cycling were about 9 times larger than the risks of cycling, compared to car driving for the individuals making the shift".
See also how the Australian Bicycle Council calculates the enormous health benefits of cycling compared to the risk of injury or death.
The New York Times has analysed America's increasing use of bicycle helmets, voluntary and mandatory, and found "the rate of head injuries per active cyclist has increased 51 percent just as bicycle helmets have become widespread". You can read the same story in The St Petersburg Times or here.
In recommending education rather than legislation for bicycle safety equipment such as helmets, the Montana Bicycle Safety Study (PDF 1.6meg) published in 2002 found: A 1997 analysis of U.S. National Highway Transportation Safety Administration data uncovered no statistically significant drop in cyclist fatalities in the eight states which had implemented mandatory helmet laws for at least one year. In fact, mandatory helmet laws have contributed to significant drops in children cycling to school after the introduction of the helmet laws and reductions in the overall numbers of cyclists (p12). See United States.
Cycling, safety and health by Danish cycling expert Thomas Krag was published in April, 2011.
Bike helmets research before law enforcement in Western Australia found "there is an indication that severe overall injuries are actually slightly more common among helmet wearers".
Western Australia Health Department statistics show that between 1981 and 1995 the average length of hospital stay was declining for most cyclist injury types. However, as demonstrated on this injury table, the length of hospital stay for skull, intracranial and other head injuries either stopped falling or increased significantly after 1992, when mandatory bike helmets were enforced.
In other words, the hospital recovery time for ALL injury types EXCEPT head injuries went down significantly over the study period. The Western Australia Health Department claims hospital duration for cyclist injuries has fallen from 5.1 to 3.3 days over the study period, but it is apparent the reduction is due to shorter recovery times for almost all other injury types EXCEPT those involving the head - the one and only part of the body supposedly protected by helmets.
It has been argued that the increase in cyclist injuries on West Australian roads is a result of greater motor vehicle numbers since 1991, when the helmet law was enacted. However, cycleways throughout Perth are far better now than in 1991, extensive construction providing a safer non-road environment. This has been one of the claimed infrastructure improvements of West Australian governments for the past decade and Perth is now recognised as having the best cyclepath network of any Australian city. The percentage of crashes involving only the cyclist and not another vehicle increased from 78.8% in 87/89 to 84.7% in 93/95 - an increase of almost 6%. In July 2009, Perth was voted by Travel + Leisure magazine to be the 5th most cycle-friendly city in the world due to its extensive cycleways.
Further to this, less cyclists = more cars. Tens of thousands of cyclists abandoned their bicycles when Western Australia's mandatory helmet law was enforced on July 1, 1992, many instead choosing to drive their cars. An immediate increase in hospital admissions from vehicle crashes suggests the resultant rise in car numbers increased the safety risk for all road users.
Research by Wasserman et al. (PDF 388k) in 1988 involved the questioning of 516 cyclists on the streets of Vermont as to whether they had struck their heads in a cycling mishap over the previous 18 months. The research indicated less likelihood of head injury to cyclists wearing a helmet. However, at the time of questioning 7.8% (40) were wearing helmets and 476 were not. Of the 21 cyclists who reported striking their heads in the previous 18 months, eight were wearing helmets at the time of the mishap. This is 20% of the 40 helmeted cyclists questioned. The 13 other unhelmeted cyclists who had struck their heads represented 2.7% of the 476 unhelmeted cyclists who were questioned in the study. This suggests helmeted cyclists were about seven times more likely to have struck their heads than unhelmeted cyclists. Such results help to explain why most helmet law supporters believe a helmet has saved their life - it's partly because they are more likely to have an accident, during which they are more likely to hit their heads.
Rotational brain injury is thought to be exacerbated by the centrifugal force of the helmet (see eMedicine for more detail). Research commissioned by the Department for Transport in the UK and published in 2007 found there is cause to believe greater head injury results from helmets in angular impacts, dependent upon speed and the size of the helmet. Most accident helmet impacts are angular rather than direct blows and angular impact causes the most brain damage.
A 2003 study by the American Academy of Pediatrics into the correct wearing of bicycle helmets notes that improper bicycle helmet fit increases the risk of head injury compared to a properly fitted helmet. The survey study concludes that "ninety-six percent of children and adolescents wore helmets in inadequate condition and/or with inadequate fit". You can also download the full survey study (PDF 80kb).
You might like to read the opinion of Brian Walker, a leading expert on the mechanics of helmets whose company Head Protection Evaluations is the principal UK test laboratory for bicycle helmets.
Cartoon thanks to Mimi & Eunice
The Victorian Government in Australia has increased the penalty for not wearing a bike helmet from $20 to $50, stating that it "confidently expected" a safety benefit because 125 non-wearers were casualties in 1999. However, the government gave no number for wearers. According to official figures, wearers outnumber non-wearers by a ratio of 3 to 1 across Victoria. If helmets work, the ratio should obviously be less. In fact, with 695 casualties wearing helmets in 1999, the ratio exceeded 5 to 1. The full statistics from VicRoads are as follows:
|Accidents||Fatal||Serious Injury||Other Injury||Total|
|Helmet not worn||3||48||74||125|
The table shows that out of the 820 casualties whose helmet wearing was known, 695 or 85% wore one. Of the corresponding 249 who suffered fatal or serious injury, 198 or 80% wore a bike helmet. Both of these proportions exceed the latest measured statewide wearing rate of 75%. A rational response to these disturbing results would be to review the bike helmets law, not to blindly increase the penalty and increase the injury risk by forcing more cyclists to wear helmets.
(Research courtesy Cyclists Rights Action Group)
Since the bicycle helmet law was introduced in Victoria, cycling in Melbourne has been unable to recover its previous share of the transport split. In 1985/86, 3.4% of trips in Melbourne were by bicycle. Data released in 2004 showed the cycling proportion at 2%.
Statistics for all Australian States are dependent upon research conducted by each government. Bill Curnow from the Cyclists Rights Action Group has written an analysis.
American Heritage invention and technology magazine provides a detailed history of all types of helmets.
On football helmets introduced in the 1950s, the magazine notes: "However, it had a paradoxically catastrophic effect on injuries. It reduced some head damage but was held responsible for a tripling of neck injuries and a doubling of deaths from cervical spine injuries."
Colin Clarke presented the world's first helmet petition to the Victorian parliament in 1991, calling for repeal of the mandatory bike helmet legislation in that Australian state. Colin, who is a qualified mechanical engineer, cycling coach and road safety campaigner, has prepared an explanatory document providing technical details about the mechanical deficiencies of helmet design and the socially damaging impact of their mandatory use. For answers to questions you may have explaining why helmets don't perform the way you've been told, click here.
History of helmet law in Australia details the negligent lack of research that preceded the enactment of mandatory bicycle helmet legislation.
The first West Australian ever jailed for riding a bicycle was put behind bars in December 1992.
Various West Australians were imprisoned in the early 1990s for failure to pay helmet infringement fines. One man was booked 14 times and placed behind bars five times for riding his bike without a helmet, claiming officers were stationed at his address to monitor his activities. Under new legislation, fine defaulters have their driver's licence suspended or have household goods seized by the bailiff to the value of the unpaid fine... for riding a bike.
Aboriginal children were imprisoned in the 1990s for failing to wear a bicycle helmet.
Pepper spray and batons were used by West Australian police in February 2001 to subdue an enraged cyclist who was booked for cycling without a helmet. This case was extreme, but highlights the level of simmering public anger over the theft of their civil rights.
West Australian cyclist hospital admissions 1985-2000
623 in 1985
660 in 1986
630 in 1987
698 in 1988
596 in 1989
638 in 1990
730 in 1991
574 in 1992
633 in 1993
644 in 1994
660 in 1995
715 in 1996
754 in 1997
850 in 1998
862 in 1999
913 in 2000
Cyclist road number surveys in Perth show cycling participation had recovered to slightly exceed pre-law figures by 1998/99.
To put the cycling injury rate into perspective and despite the increased risk of accident/injury caused by Western Australia's mandatory helmet law, it is worth considering the reasons for admission to Perth's Princess Margaret Hospital for Children in the summer of 2007/08:
- Falls involving play equipment, raised surfaces and ride-on toys - 1,027 cases
- Other blunt force such as sports injuries or contact with hard surfaces - 744 cases
- Injuries involving cars with children as passengers or pedestrians, quad bikes and bicycles - 304 cases
- Poisoning including pharmaceuticals and cleaning products - 119 cases
- Non-venomous animal bites - 61 cases
860 West Australians were admitted to hospital emergency departments in the 1999/2000 financial year for dog bites, and 46 people drowned. More than 4,000 elderly West Australians are admitted to hospital each year because of a fall, and 74 Australians died between 1996 and 1999 when they fell off a ladder. An estimated 18,000 Australians die every year and thousands more are injured because of mistakes made in hospitals.
On average, seven cyclists died each year in Western Australia before helmet law enforcement in 1992, and this average has dropped to five. Before 1992, an average 655 West Australians were admitted to hospital each year for bike injuries. In 1997, 1998, 1999 and 2000, the consecutive annual hospital admissions of cyclists were 754, 850, 862 and 913.
Studies show that almost as many people are injured playing golf as cycling. See Golf-related head injuries in children increasing along with sport's popularity and Golfplan international golf insurance.
Dubai enforced mandatory all-age bicycle helmets and high-visibility jackets in 2010. Read how cyclists find way around safety helmet law.
Every day, about 190 West Australians aged over 65 will fall over. About 60 will be so seriously injured they will need to go to hospital. More than 4,000 elderly West Australians are admitted to hospital each year as the result of a fall (not bicycle-related). One in three people over the age of 65 will have falls requiring hospital treatment. Of these, between 20% and 40% will be dead within a year, meaning that falling over matches cancer and cardiovascular disease as a major killer of the elderly. Why aren't helmets mandatory for the elderly in their own homes?
Do you believe helmets protect you from attacks by magpies? Mapgies are an Australian native bird common in most cities with an aggressive attitude toward intruders during nesting season. Have a look below at what magpies think of bike helmets ...
The fun experiment above suggests that magpies are particularly aggressive toward shiny helmets - the shinier, the more aggressive - but either don't bother with bare heads or go back to the nest when the helmet is taken off. Which suggests that if you wear a helmet, you're more likely to be attacked by magpies. Flinders University research on injuries involving magpies confirms that bike riders are by far the most likely victims of aerial attack.
On October 26, 2013, the Subiaco Post newspaper in Perth published Magpies target cyclists, which describes a pair of magpies persistently swooping and potentially endangering only cyclists in the suburb of Cottesloe. The story references a call for warning signs and makes no mention of helmets encouraging magpie attacks, but the Department of Parks and Wildlife recommends that cyclists leave their helmets on. Cottesloe cyclists should consider the evidence above and decide if they want to be attacked because they're wearing a helmet.
The risk of injury requiring hospital treatment as a result of cycling is around 0.005 per 100 hours. This compares with 0.19 for football, 0.13 for squash, 0.11 for basketball and netball and 0.06 for soccer.
Errors in hospitals claim the lives of 4,550 Australians every year, according to the final report of the National Health and Hospitals Reform Commission released in July 2009.
A Health Department of Western Australia study concludes that "the results of this analysis are similar to those identified in other studies around Australia. The rates of bike injury hospitalisations and deaths have remained fairly constant in Western Australia over the period 1981 to 1995, in comparison with a marked decrease in vehicle crash and overall injury rates. Bike injury rates are measured against the whole population, however, rather than against the cyclist population. If trends in the number of Western Australian cyclists over the study period do not parallel overall changes in the WA population, these results may be misleading. Unfortunately, accurate exposure data for bicycle-riding in Western Australia were not available for this analysis."
Accurate exposure data for bicycle riding in Western Australia is available, as demonstrated on this website, and the results are only misleading in that they mask the true damage caused by the mandatory helmet legislation.
Every day, Perth residents make 240,000 car trips that are less than one kilometre long. Discouragement of cycling through helmet laws results in more vehicle traffic on the road for short trips, worsening both pollution and the injury and fatality toll among motorists, cyclists and pedestrians.
|The West Australian newspaper|
May 8 2004
The West Australian newspaper|
July 6 2009
The percentage of people in Western Australia suffering bike accident head injuries, as opposed to other causes, fell from 22 per cent in 1991 to 17.3 per cent in 1992 when the helmet law was enforced by police, but then rose to 21.7 per cent in 1993.
The number of cyclist head injuries in 1994 was about two per cent less than in 1991, the year the compulsory helmet law was introduced.
The average percentage of head injuries suffered in the four years after the 1992 introduction of the law in Western Australia was 3% less than the previous four years, even though the percentage of recreational cyclists wearing helmets increased from 39% in 1991 to 77% in 1995, and the number of cyclists on the road fell by about 30%.
Find out about transport trends in Australia since the 1970s in Unsustainable trends in the Australian Census Data for the journey to work in Melbourne and other cities in Victoria (PDF 1.2meg).
Read Making Walking and Cycling Safer: Lessons for Australia from the Netherlands Experience (PDF 388kb) and ponder why the author mentions the word "helmet" just once in the entire document.
Within public submissions to the West Australian Parliament's 1994 Select Committee on Road Safety inquiry into Compulsory Helmet Wearing For Bicyclists and Other Bicycling Issues, 3% fully supported the helmet legislation, 33% cent gave conditional support and 66% were either totally opposed or opposed to compulsory helmets for adults. Below is an extract from the select committee report:
"As a consequence of newspaper advertisements which invited submissions to the Committee on any road safety issue within its Terms of Reference, 412 submissions were received to 1 March 1994 on numerous safety matters. The number of submissions in which the bicycle helmet wearing issue was referred, totalled 327. These represent 79% of all submissions. There were 1598 signatories on 19 submissions, almost all of which opposed helmet wearing for adults. The relevance of these statistics is diminished by the fact that some single submissions were from organisations and associations who may represent significant additional numbers of people but counted as a single submission".
Bicycle helmets offer little protection against impact from a motor vehicle. To protect against a 20mph impact, the helmet needs 6.5 inches of foam; 30 mph - 15 inches; 40 mph - 29 inches. The common half inch adds virtually no protection from a vehicle impact. A Bell Sport 2000 motorcycle helmet weighs 1700 grams and a Giro Ventoux bike helmet weighs 200 grams. Yet the motorcycle helmet only protects against a 12mph impact.
But seatbelts save lives! Not necessarily. They also cause more death and injury to pedestrians and cyclists, and you might be surprised if you visit Seat Belt Laws: Why You Should be Worried.
In 2011, the Enabling Change website published The dark side of regulating behaviour: the case of seat belt laws (PDF download 246kb).
If law supporters believe helmets should be mandatory because they prevent head injuries, their principle should be equitably applied by having mandatory helmets for motor vehicle occupants. Prevention of head injuries to car occupants: an investigation of interior padding options published by Monash University found that total benefits associated with headwear in the form of a soft shell bicycle helmet for car occupants are as high as $500 million per year in Australia. Do bicycle helmet law supporters want to prevent half a billion dollars worth of head injury by wearing a helmet every time they get in their car?
In 2004, the Australian Transport Safety Bureau published Road Safety in Australia: "The research has found that helmets would be substantially more effective than many vehicle design options, including improved interior padding, side-impact airbags and advanced restraint systems. As head injuries to car occupants in Australia cost about $3.7 billion per year, helmets could save the community as much as $950 million, or about 25 per cent of annual head injury cost."
Australian bicycle helmet law advocates who drive cars (all of them) for some reason aren't interested in mandatory vehicle helmets saving so much money and so many lives.
The legal liability of victims (RTF 88kb) who do or don't wear helmets is examined in this insightful and informative document by Queens Counsel Bill Braithwaite from the Personal Injuries Bar Assocation in the UK.
But helmets are good for motorcyclists, aren't they? Not necessarily. In America, the motorcycle fatality rate in helmet-law states is 2.97 deaths per 100 accidents versus 2.79 in helmet-free states. This amounts to 18 additional deaths per 10,000 accidents in mandatory helmet states.
On June 16, 2000, Governor Jeb Bush signed legislation to repeal the mandatory motorcycle helmet law in Florida, making it the 30th American state where motorcyclists have freedom of choice. Why? Because of the mass of evidence that motorcycle helmets do not reduce death and injury rates as is so widely believed, and because adults have been deemed to have a right to make their own choice in a democratic country.
Research (PDF file 140kb) titled "The Effect of the Repeal of Florida's Mandatory Motorcycle Helmet-Use Law on Serious Injury and Fatality Rates" was released in April 2003 by Lisa Stolzenberg and Stewart J. D'Alessio from Florida International University. Extract: "When motorcycle registrations, preexisting trends, and seasonal factors are taken into account, the repeal of Florida's helmet-use law has little observable effect on serious injury and fatality rates... Because our findings show that Florida's repeal of its mandatory motorcycle helmet use law did not increase the serious injury or fatality rates, we conclude that policy makers should probably consider revising or repealing these types of laws."
Research published in 2007 concluded: "There was a significant rise in motorcycle fatalities after Florida's helmet law repeal, which appears to be associated with an increase in the number of motorcycle riders. Injury prevention efforts focusing on factors other than helmet use should be developed in light of continuing repeal of universal motorcycle helmet laws across the nation."
Pennsylvania repealed its mandatory motorcycle helmet law in 2003. It's worth considering the injury rate since then (PDF 40kb).
But footballers wear helmets, so they must be good! Wrong. Click here to see why.
Cartoon thanks to Mimi & Eunice
Read in the Montreal Gazette (February 18 2008) why a coroner has recommended that helmets should not be compulsory for skiiers in Quebec.
A telephone survey of adults in Western Australia found a figure equivalent to 64% of current adult cyclists would ride more if not legally required to wear a helmet.
Extracts from the report Bicycle Crashes and Injuries in Western Australia (March 1998) relating to the study period of 1987-1996, a reasonable balance of pre and post legislation:
"The number of hospitalised cyclists has shown no clear trend over the period."
"Cyclist admissions as a proportion of all road crash casualties admitted to hospital have shown no clear trend, varying between 12% and 16%."
"The number of cyclists admitted to hospital per 100,000 cyclists has fluctuated around 90 over the 10 year period"
"Sixty eight percent of cyclists admitted to hospital were less than 17 years old..."
"The percentage distribution of injuries by severity levels remained more or less constant over the 10 year period."
"Injuries to the upper extremities has shown an almost steady increase from 118 (17%) in 1988 to 223 (31%) in 1996."
"The total number of recorded injuries to cyclists increased from 590 in 1987 to 1,223 in 1996. This averages one injury per cyclist in 1987 (excluding cyclists admitted for observation who had no recorded injury) and 1.7 per cyclist in 1996. This increase most likely reflects better coding of injuries in hospitals."
"The number of bicycle crashes reported to the police in Western Australia decreased from 1,011 in 1987 to 718 in 1996. Over this period, the share of bicycle crashes as a percentage of all reported crashes decreased from 2.5% to 1.7%."
"The number of cyclists recorded as being hospitalised in the police data was 23% of the number actually admitted to hospital over this period."