Further research published in the Canadian Medical Association Journal suggests a 62% reduction in cyclist numbers in Halifax the year after helmet law enactment, with more cyclist injuries recorded than before the law and a nominal reduction in head injuries (8 less head injuries in 1999).
As has happened in Australia, New Zealand and America, mandatory helmet use among cyclists in Canada has not reduced cyclist fatalities at any greater rate than among other road users.
The Canadian province of Alberta enforced mandatory helmet laws for cyclists aged less than 18 from 1 May, 2002. The meta-analysis Bicycle helmet use and bicyclists head injuries before and after helmet legislation in Alberta Canada (PDF 1.5mb) published in 2011 by the University of Alberta concluded that the law increased helmet use and decreased head injuries among the target group.
The analysis proved helmet wearing increased among children and adolescents and decreased the number and proportion of head injuries, but dismisses its own key finding of a commensurate proportional decline in cycling participation.
Below is an extract from the analysis showing the declines in <18 cycling in Albera from 1999 to 2006, despite an increase in cycling among adults who were not forced to wear helmets.
Below are the bicycling rates per hour at specific Alberta sites from 2000 to 2006 for cyclists aged less than 13:
Below are the bicycling rates per hour at specific Alberta sites from 2000 to 2006 for cyclists aged 13 to 17:
Below are head injury and overall hospital admission rates for cyclists and pedestrians in all Alberta hospitals from 1 April 1999 to 31 March 2007:
Below are head and overall emergency department rates for cyclists and pedestrians in all Alberta hospitals from 1 April 1999 to 31 March 2007:
The data shows the total <18 hourly bicycle rate dropped from 1,810 in 2000 to 934 in 2006 - a 51.6% reduction in child and adolescent cycling in Alberta which has implications for public health.
Despite this 51.6% decline in cycling clearly caused by the enforcement of <18 mandatory helmet laws in 2002 ...
- The number of <18 cyclists appearing with head injuries in Alberta hospital emergency departments totalled 2,907 from 1999-2001 and 2,573 from 2003-2005 - an 11.5% decrease.
- The number of <18 cyclists appearing with non-head injuries in Alberta hospital emergency departments totalled 7,640 from 1999-2001 and 8,853 from 2003-2005 - a 15.9% increase.
- The number of <18 cyclists appearing with head injuries in Alberta hospital admissions totalled 182 from 1999-2001 and 122 from 2003-2005 - a 33% decrease.
- The number of <18 cyclists appearing with non-head injuries in Alberta hospital admissions totalled 321 from 1999-2001 and 406 from 2003-2005 - a 26.5% increase.
Note that <18 head and non-head injuries for pedestrians fell substantially during this period. This indicates an increase in accidents/injuries per <18 cyclist on Alberta roads following helmet law enforcement in 2002, despite improved injury rates for other road users, with a decline in head injuries less than the decline in <18 cycling.
The following story was published in the Edmonton Sun newspaper on July 12, 2003.
|Head injuries up after helmet law?
By David Sands, EDMONTON SUN
Surprising stats suggest bike-accident head injuries have increased since Alberta passed a mandatory helmet law.
Figures from nine health regions show a sharp spike in the percentage of bicycle-related head injury cases coming into their emergency wards. And that spike peaks in the six months following the government's mandatory helmet law.
"I would urge caution in interpreting these statistics beyond anything more than, 'That's interesting,' " said renowned injury-prevention specialist Dr. Louis Francescutti.
Stats were compiled by emergency room surveys for six months - May to October - in each of 1999, 2000, 2001 and 2002.
The helmet law, which applies to riders under 18, took effect in May 2002.
In the years 1999 to 2001, the percentage of head injuries among all bicycle-related injuries remained relatively constant at just above 5%.
By the end of October 2002, however, it shot up to above 10% for children and just under 10% for all age groups.
The stats are "a bit of a surprise," said Alberta Transportation spokesman Leanne Stangeland. "We did introduce the bike helmet legislation and so it is a bit of a surprise there would all of a sudden be an increase like this."
The figures are "really suspect" and could be skewed by several factors, said Kathy Belton, co-director of the Alberta Centre for Injury Control and Research, which gathered the stats. "So you can't really say that bicycle head injuries are going up. There's issues in terms of how the data is reported because there's been a change in how the data is actually coded."
The "coding classification change" took effect in April 2002. "It looks like they went up (but) what you need to remember is that's just a sampling of the regional health authorities that reported. If we had the other regions, I think we might be seeing a decline," Belton said.
Health regions were under no obligation to complete the survey. Belton said the centre is now waiting for data from Alberta Health, which will include every region.
The explanations offered by the injury agency are all likely valid, Stangeland said, but one at least is disturbing if true: "... the perceived safety of wearing a helmet, thus increased risk-taking behaviour."
"We would hope that there would not be increased risk-taking behaviour - our legislation was put in place to keep kids safe, not so they take more risks," Stangeland said.
Francescutti has further cautions.
"It's a very short time frame for drawing conclusions," he said, adding the actual number of head injuries could be so small that even slight increases lead to dramatic-appearing percentage increases. And "if you take a look out there, there's been a little bit of an increase in helmet use, but it's still not as high as you might expect."
Both Stangeland and Francescutti said a long-term, in-depth analysis is required.
Attempts to introduce a bike share scheme in Vancouver have been delayed until spring 2012, largely because of difficulties with British Columbia's mandatory bicycle helmet legislation. Read the working paper opinion of consultants to the World City Bikes forum in 2008 who strongly recommend that a bike share scheme in Vancouver should exempt users from the mandatory helmet laws. For a full analysis of international bike share schemes, see Australian bike hire schemes fail because of helmet laws.
In 2011, Vancouver resident Ron van der Eeden has mounted a court challenge against the validity of bicycle helmet laws in British Columbia under Canada's Charter of Rights and Freedoms.
In April 2013, the province of Manitoba enacted legislation enabling mandatory helmet laws for cyclists below the age of 18 from 1 May 2013.
From 2005 to 2009, 374 children were hospitalized for cycling-related injuries in Manitoba, according to the province. Fifty-four were hospitalized for cycling-related head injuries - i.e. an average 75 child cyclist hospital admissions per year in Manitoba and nine child cyclist head injuries per year. This is about 14% head injuries without a helmet law.
By comparison, Western Australia's pre-helmet head injury ratio was 26.6% from 1988-1991 and 21.8% after helmet laws were enforced from 1993-1996.
There are different data sources for Manitoba cyclist injuries. The Winnipeg Regional Health Authority Injury Data Report 2007 shows 162 pedal-mv and 538 pedal other injury hospital admissions from 1994 to 2003, totalling 700 and averaging 70 per year with a rate of 10.7 per 100,000 population. Over the 10 years, the injuries comprised 14 aged 1-4, 102 aged 5-9, 103 aged 10-14, 50 aged 15-19, 49 aged 20-24, 90 aged 25-34, 114 aged 35-44, 76 aged 45-54, 34 aged 55-64, 50 aged 65-74, and 10 aged 75-84.
According to the Chief Medical Examiners Office, 27 Manitoban cyclists died in accidents between 1999 and 2008, averaging 2.7 per year. The office states that every year about 140 cyclists are admitted to Manitoba hospital emergency departments with injuries including about 40 with head injuries, or 28.6%. About 60 of the 140 annual cyclist injuries are children aged less than 15.
The Winnipeg Regional Health Authority provides useful information to compare injury data from Manitoba (without any helmet laws) with Western Australia (where all-age helmet laws have been enforced since 1992):
- 10 cycling deaths between 1992 and 1999, and 724 cycling hospitalisations between 1992 and 2001 (72 per year) within the Winnipeg Health Region.
This is approximately one cyclist death per year. Western Australia has an annual cyclist death rate around 4.5 per year since helmet enforcement, which is about the same annual per capita death rate. The average annual cyclist hospital admission rate in Western Australia since 1992 is around 880.
- Bicycle crashes result in 2 to 4 deaths in Manitoba annually, most commonly due to head injuries suffered as a result of bicycle-motor vehicle collisions.
Again, the same per capita fatality ratio as Western Australia's mandatory helmet jurisdiction.
- Seventeen cycling deaths occurred in Manitoba between 1992-1999, of which 16 involved motor vehicle traffic.
41 cycling deaths occurred in Western Australia between 1992-1999.
- There were 1,427 cycling injury hospital admissions in Manitoba from 1992-2001.
There were 6,605 cycling injury hospital admissions in Western Australia from 1992-2000 (2001 data is unavailable so the actual WA total is around 7,500 hospital admissions from 1992 to 2001).
Physical Activity and Sport Participation Rates in Canada 2012 suggests that in 2002/03, about 22% of adults aged 20+ in Manitoba cycled at some time in the three months prior to survey (p7), whereas Australian Cycling Participation 2011 suggests an average 13.3% of adults aged 18+ in Western Australia cycled in the prior week (p48). Across Australia, 17.2% of adults aged 18+ cycled in the prior month and 29.7% in the prior year, which extrapolates to around 20% in the prior three months (p22). The Manitoba and Western Australia estimates are not directly comparable but Australian cycling participation was substantially higher in 2011 than 1992 to 2001 and during the Manitoba survey period of 2002/03. Census Profiles 2001 shows commuter cycling to work aged 15+ in Winnipeg was 2.2% for males and 0.7% for females, while in Manitoba province it was 2.1% for males and 0.7% for females. This compares to Australian work commuter cycling in 2001 of 1.7% for males and 0.5% for females.
Winnipeg had an average annual population around 618,000 from 1991 to 2001 and Manitoba's population averaged 1.1 million. Western Australia's population averaged 1.8 million from 1991 to 2001.
Manitoba without helmet laws has/had roughly half the per capita cyclist injury rate as does Western Australia with all-age helmet laws.
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 October 2010, the Union of British Columbia municipalities voted against mandatory helmet use by skateboarders, inline skaters and scooter riders.
CBC News reported in April 2010 that "most children in Canada, even toddlers, are failing to get the recommended amount of physical activity". Look at the photograph leading the story and you'll begin to understand why.
The Vehicular Cyclist provides ongoing updates and analysis of cyclist helmet laws, numbers and injury trends in Canada.
Read in the Montreal Gazette (February 18 2008) why a coroner has recommended that helmets should not be compulsory for skiiers in Quebec.