Helmets and health care

Did you see this story in yesterday’s New York Times? It’s about bike-sharing programs in cities around the world—existing ones in Amsterdam, Dublin, Melbourne, Minneapolis, and Paris, and the upcoming one in New York—and the effect that helmet rules have on their success. The basic thrust of the article is that forcing riders to wear helmets discourages the use of bikes in these programs and that whatever safety benefits helmets provide are negated, in terms of overall public health, by the higher rates of obesity and heart disease in populations that don’t do as much bike riding.

I won’t argue the value of helmets one way or the other, because I haven’t seen the accident statistics. I will say, though, that I was surprised to see no mention in the story of either mandatory seatbelt laws or national health care programs.

It’s not that I think seatbelt laws are truly analogous to bike helmet laws. There are certainly similarities: both seatbelts and helmets are safety devices that do nothing to prevent accidents but lessen the severity of injury during accidents; and both are devices that one would advise every individual to use. But advising an individual and advising society are two very different things. Seatbelt laws don’t discourage driving,1 and even if they did, less driving doesn’t make people less healthy. Bike helmet laws, on the other hand, do discourage riding—among adults, anyway—and less riding makes for a more sedentary, less heathy population. So there’s a distinct health tradeoff with bike helmet laws that doesn’t exist with seatbelt laws.

The more puzzling omission is that of national health care. The cities with successful bike sharing programs do not require helmets and most of them—Minneapolis and Washington being the exceptions—are in countries with national health care, which flies in the face of the “nanny state” stereotype many Americans associate with socialized medicine. Is it because these cities have weighed the costs and benefits and made a cold, rational decision that lots of helmetless riding is better for the health of the citizenry (and is therefore less expensive to the national health care program) than a little helmeted riding? This is ultimate practical application of cost/benefit analysis, and the article is utterly silent on it.2

Health care in the United States, what it costs, how it gets paid for, and future restrictions that may be imposed, has been the subject of a continuing argument here for years. It’s a prominent issue in the presidential campaign and will certainly be addressed in this week’s debate. This the kind of story that could show that national health care involves more than just hospitals and insurance companies and government bureaucrats. But it didn’t. A missed opportunity.

  1. Has anyone ever given up driving because he was forced to wear a seatbelt? If so, we’re all better off with him off the road. 

  2. The story does include quotes from a researcher in Australia whose studies suggest that the benefits of increased riding that come when helmets are not required outweigh the risks by 20 to 1. But there’s no indication that his work had any effect on the rules of any bike sharing program. 

10 Responses to “Helmets and health care”

  1. Wes Campaigne says:

    The article skips past one other argument against mandatory helmet laws: The safety of bicycling is strongly correlated with rate of bicycling in the population. The more people bike, the safer it gets — drivers become more accustomed to (and respectful of) co-existing with bikes on the roads, and city infrastructure shifts to become more bike-friendly.

    IIRC, some studies have shown that in certain instances, mandatory helmet laws have paradoxically reduced the overall safety of biking, in part because of the significant drop in the rate of biking that came about as a result.

    There’s also some research that indicates that drivers are more likely to drive aggressively around a biker when they can see (s)he’s wearing a helmet.

  2. Ray Greenwell says:

    Seat belts can prevent collisions. After a collision, the seatbelt holds the driver in place, potentially allowing him or her to continue operating the car. Steering and breaking may prevent a second or third collision, something not possible if the driver went through the windshield or has been ragdolled into the back seat.

  3. Terrence Dorsey says:

    I agree that there are questions about how health care systems might affect societal choices here, there are too many basic problems with un-examined references to statistics, unsupported causation and “researchers say” in this article to even consider its larger policy implications.

    Seatbelts are single-handedly responsible for bringing auto fatalities below the number of suicides in the US? No affect from ABS brakes? Better impact-absorbing structures? Improved tires?

    What is a “really low” accident rate? In 2009, there were about 37,000 traffic fatalities. That’s about .0001 percent of the US population. Is this really a problem that affects general health across the nation? Are the kinds of injuries we’re talking about much more expensive to care for?

    And that’s all before we get to the assertion that biking rates have a direct affect on overall health and obesity. More so than diet? Smoking? Is there any correlation between people who are inclined to bike and other lifestyle choices?

    There’s just simply no actual data from which we can understand or test any of the assertions made in this article. It’s all anecdote and conventional wisdom. That’s poor thinking and poor reporting. Worse yet, this is now a resource people will reference supporting their claims, yet it’s based on no factual evidence.

    All that said, I agree with the premise. Seatbelts and helmets are probably a good idea. Getting people on bikes is probably a good idea. We could be less pushy about helmets, which probably do turn people off from bikes (like wrinkled clothes used to turn people off from seatbelts - yes, I’m old enough to remember those early seatbelt law laments).

  4. Deserttrek says:

    As an avid cyclist I believe in helmets but not a legal requirement to wer them. On the positive side when I was hit by a car, went head first into the windshield frame and then to the pavement, the helmet took all the shock. It is in pieces now and my head isn’t.

  5. Jif says:

    The other problem is that helmets are certified for low speed bike on bike collisions, not high speed car versus bike scenarios. I don’t have it to hand, but I recall an emergency room study that suggested the primary function of helmets is to reduce scalp lacerations - the was no statistical reduction in concussions.

  6. Mark Beattie says:

    I’ve been driving for 20 years and not once been in a serious accident. I started cycling to work 3 months ago and have already had several near misses, including the driver of a parked car opening their door right in front of me without looking.

    I escaped this time with just some paint on my pants where the door clipped me on the way past, but next time I might not be so lucky. There’s no way I’d consider cycling without a helmet, or condoning anyone else doing the same.

    Cycling to work is hard, much harder than driving or taking the bus/train. You have to eat well and work hard at it. I don’t think it’s mandatory helmet wearing that leads to obesity& heart-disease… :)

  7. David says:

    Friday afternoon I rode hard. I took on the hills, spun my pedals at about 90 rpm’s on some descents and then did a cool-down easy spin down my palm lined victorian SoCal avenue. When I made the simple left turn into my own driveway the bike slid out from beneath and I was down in an instant. But I remember my head banging the concrete of the driveway and the helmet absorbing the impact. I wake today with a giant hematoma on my left hip and a few road-burns on my left arm - but no concussion. I don’t know a serious rider who does not wear a helmet. If it is a matter of choice, I choose to not invite a head injury.

  8. MB says:

    PS: http://www.theaustralian.com.au/news/nation/helmets-bike-paths-halving-number-of-head-injuries-in-cyclists-nsw-study-finds/story-e6frg6nf-1226487190018?sv=4c8ea4c7b34918d4ce121c6476bfb9a1#.UGwXFQPm0PI.twitter

  9. Dr. Drang says:

    Thanks for the link, MB. A news article with actual statistics instead of hand waving. Still, it addresses injury rates only, not the question of overall health.

    A few things I suppose I should make clear:

    1. This post was more about what I saw as a failing of the Times article than about bike helmet laws per se. Obviously, I do think the question of what’s best for an individual vs. what’s best for society is an interesting one—it was the omission of that question from the article that prompted my post.
    2. I’m not for or against bike helmet laws. I haven’t heard enough evidence to make a decision one way or the other. It is important, though, to recognize that accident statistics are only part of the evidence.
    3. I think the right choice for an individual is clear. I commute by bike 8-9 months of the year, and I wear a helmet.
  10. Jif says:

    One reasonable research article is here


    It makes a clear case for mandatory helmets. One potential criticism though is lack of definition of “injury”. It is nice that they bring up the notion of risk compensation but they don’t really discuss that issue here in much depth.