Go to draft National Road Safety Strategy submission 1 - Cyclist numbers
Go to draft National Road Safety Strategy submission 3 - All road casualties
Mandatory Bicycle Helmet Law in Western Australia
Submission to draft National Road Safety Strategy 2011-2020
Note: the NRSS 2011-2020 was released on May 27, 2011. Despite several public submissions highlighting the failure of bicycle helmet laws, the word "bicycle" is mentioned only twice in the 10 year strategy. You can view and download this submission as a PDF document. This submission is without copyright and can be distributed freely.
Cyclist injury data before and after helmet law in Western Australia
Western Australia's compulsory bike helmet law was enforced from July 1992.
Surveys show Western Australia's mandatory helmet legislation reduced public cycling numbers by at least 30%, yet total hospitalised cyclist injuries did not decline at all. The reduction in head injury numbers was marginal. West Australian cyclist numbers recovered in the decade to 2000 but hospital admissions were at record levels from 1997, roughly 30% above pre-law levels by 2000.
In essence, the results strongly suggest that the mandatory wearing of helmets increases the risk of accidents and thus injuries.
As reported in March 2007 and based on data from Western Australia, Queensland and Victoria, the number of Australian children walking or riding a bicycle to school has plunged from about 80% in 1977 to the current level around 5%. In June 2008, research at Melbourne's Baker IDI Heart and Diabetes Institute found that Australia is now the fattest nation on earth.
In early 2005, the prestigious international peer-review journal Accident Analysis and Prevention published a paper (PDF 68kb) disproving the conclusions of most international case control studies since 1989 that have been used to justify the mandatory wearing of bicycle helmets.
In March 2006, the British Medical Journal published Do enforced bicycle helmet laws improve public health? (PDF 137kb) by Dr Dorothy Robinson, senior statistician at the University of New England in New South Wales. The study concludes from worldwide data that any reductions in head injury following enactment of mandatory bicycle helmet laws are due to the consequent reduction in numbers of cyclists on the road, not because of injury-prevention benefits afforded by helmets. The BMJ has also published a critique of the Robinson article (PDF 100kb). For further analysis of Australia's mandatory helmet law by Dr Robinson, see Head Injuries and Bicycle Helmet Laws (PDF 1mb).
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."
As detailed on this website, mandatory bicycle helmet legislation in the State of Western Australia resulted in cyclist injury increases and cyclist number declines around 30%.
There are various reasons why mandatory helmet wearing increases cyclist risk, including research published in September 2006 by Bath University in the UK suggesting that "bicyclists who wear protective helmets are more likely to be struck by passing vehicles" (also see New York Times). Other causes include a doubling of the head size likely to make impact, rotational brain injury and risk compensation.
All evidence shows that mandatory bicycle helmet laws discourage one of society's most popular, regular and beneficial activities involving healthy recreational exercise - that is, riding a bicycle. Click here or here for evidence of reduced cycling, or read the March 2005 issue of the Health Promotion Journal of Australia (PDF 88kb). Alternatively, read about it in the Sydney Morning Herald (April 28 2005).
Australia is suffering an obesity health crisis caused by its increasingly sedentary lifestyle, with reports in 2008 that the average Australian lifespan will fall by two years (click here for press clippings or read an ABC radio interview about Australia's obesity crisis recorded in February 2005).
Australian obesity rates have doubled since bicycle helmet law enactment at the beginning of the 1990s. Obesity is linked to various ailments including cardiovascular disease, diabetes, cancer and reduced quality/duration of life. It was reported in April 2010 that obesity is a bigger killer than smoking in Australia.
The lifespan of Australians is falling because they are becoming increasingly fat, yet its citizens are punished if they want to enjoy regular exercise without wearing a hot, uncomfortable, inconvenient helmet that is proven to increase their risk of accident and injury.
Click here to download a PDF summary (610kb) of government charts showing cyclist survey numbers/injury results before and after 1992 helmet law enforcement in Western Australia.
The introduction of mandatory helmet legislation in 1992 heralded a major downturn in cyclist numbers (approximately <30%) on West Australian roads by 1996.
Despite this, the number of cyclist hospital admissions per annum increased after 1992 helmet law enforcement to consecutive record levels. The increase in hospital admissions was in line with the recovery in cyclist numbers to pre-law levels by 1998/99.
In 1997, a record 754 WA cyclists were hospitalised and 20% of seriously injured road users were cyclists. The previous hospital admissions record was 735 in 1991, the year the law was enacted. Before 1991, when there were more cyclists on West Australian roads, an average 642 cyclists were admitted to hospital each year.
In 1998, a new West Australian cyclist injury record was established when 850 people were hospitalised... 10% more than 1997.
In 1999, a total of 862 West Australian cyclists were hospitalised - another record despite cyclist road numbers similar to pre-law levels. In 1999, cyclists comprised 23.6% of all serious road crash hospital admissions - up from 17% when bicycle helmet laws were first enacted.
In 2000, there were 913 cyclists admitted to WA hospitals - another record and about 30% more than the pre-law average. Cyclists comprised 25.9% of all serious road crash hospital admissions in 2000, almost equalling car drivers as the predominant road user group admitted to hospital.
West Australian hospital cyclist admissions: 1985-2000
|
1985 - 623 1986 - 660 1987 - 630 1988 - 698 1989 - 596 1990 - 638 1991 - 730 1992 - 574 1993 - 633 1994 - 644 1995 - 660 1996 - 715 1997 - 754 1998 - 850 1999 - 862 2000 - 913 |
|
|
Hospital Admissions Data: Number and Percentage of Cyclists Admitted, Western Australia, 1987-2000 (single years) (Source: Bicycle Crashes and Injuries in Western Australia, 1987-2000 - Road Safety report RR131 (PDF 840kb) commissioned by Road Safety Council, dated November 2003 and authored by Lynn B. Meuleners, Arem L. Gavin, L. Rina Cercarelli and Delia Hendrie)
No medical or other research data was used by any Australian state government to justify drafting and gazettal of the law. A cursory glance at statistics suggests that bicycle helmet wearing resulted in a marginal reduction in skull and intracranial injuries as a proportion of WA's total hospitalised cyclists. However, as shown in the following graph, this proportional reduction went hand in hand with a substantial increase in the overall number of cyclist injuries: 
Research from Bicycle Crashes and Injuries in Western Australia, 1987-2000 - Road Safety report RR131 commissioned by the WA Road Safety Council, dated November 2003 and authored by Lynne B. Mueleners, Arem L. Gavin, L. Rina Cercarelli and Delia Hendrie from the Injury Research Centre at the University of Western Australia. Note that the graph data for 1999 is based only on six rather than 12 months. Public cycling participation during the study period declined by more than 30% after helmet law enforcement and had recovered to pre-law levels by 2000. Per cyclist on the road, there was little discernible reduction in head injuries but a substantial increase in upper limb fractures (up by 147% from 1987 to 1998 - 17% of all cyclist injuries in 1988 to 37% in 1999). This substantial increase in upper limb fractures is largely responsible for the increase in total WA hospital cyclist admissions in the eight years following 1992 helmet law enforcement.
The above graph would indicate a major change occurred within cyclist behaviour and accident patterns during 92/93. There was a sharp rise in Perth cycling popularity during 1998/00, official figures showing the number of cyclists on Perth roads was slightly more than in 1991. It should be noted that the West Australian population increased by about 15% during this time and petrol prices rose by more than 30%. It should also be noted that Australian Bureau of Statistics figures released in June 2002 confirm that the residential population of Perth's Central Business District - the region in which most cyclist surveys are conducted - increased by 33% between 1996 and 2001. The graph below is extracted from the WA Road Safety Council's Reported Road Crashes in Western Australia 2006. The data shows traffic crash hospitalisations involving cyclists rather than total cyclist hospital admissions as quoted above. The traffic data below indicates cyclist hospital admissions have continued their disproportionate increase in the new millennium.
During this time, the numbers of cyclists admitted to West Australian hospitals and reported deaths and serious injuries per 10,000 regular cyclists fell by 48% and 33% respectively. Since 1992 helmet law enforcement in Western Australia, cyclist hospital admissions have risen by 20-30% in proportion to surveyed cyclist numbers on the road, and reached consecutive records in 1997, 1998, 1999 and 2000 - by which time cyclist road numbers had recovered to pre-law levels. Total cyclist head injury figures were higher in 1995 and 1996 than during any year before the law was introduced, an exception being 1988, and the proportion of cyclist upper body injuries almost doubled between 1988 and 2000. Females represented 30% of the 630 cyclists admitted to West Australian hospitals in 1987. In 2000, females represented 20% of the 913 cyclist hospital admissions. The proportional drop in female hospital admissions began in 1992, the year of law enforcement, adding to anecdotal evidence that women in particular are dissuaded from cycling because of helmets. The Health Promotion Journal of Australia reported in 2003 that Australia has a disproportionately low number of female cyclists (PDF 228kb). Police statistics also show a marginally higher proportion of helmet wearing crash victims required hospital treatment, compared to those not wearing a helmet. 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 of approximately half a billion dollars every year. Read a public submission to the NSW parliament's Inquiry into Vulnerable Road Users in 2010 calculating that "the risk of death and serious injury increased by 50% after the helmet law".
1985 - 623
The Road Safety Council (PDF 117kb) has published admissions figures from 1996 to 2006 showing a significant ongoing increase in cyclist hospitalisations from cyclist traffic accidents on public highways. A study obtained by the ABC in December 2009 shows cycling injuries are being grossly under-estimated. The same study was also reported the following day by The Australian newspaper. The under-estimation of cyclist injuries by Australian authorities was reported six years earlier in Pedal cycle injuries in NSW: A comparison of data sources, published in the Dec 2003 issue of Road & Transport Research. Similar findings can be found in Emergency presentations by vulnerable road users: implications for injury prevention, published by the Injury Research Centre at the University of Western Australia. West Australian cyclist fatalities 1985-2008
1985 - 5 DEATHS The data above should be compared with Australia's overall annual road toll from 1965 to 2007:
This reduction in road fatalities may seem contrary to evidence that road injuries bottomed and increased from 1990-1992, but this may be due to stricter enactment and enforcement of laws curtailing extreme driving behaviour (speeding, drink-driving)... i.e. more crashes but at lower speeds with fewer fatalities and more injuries. The discrepancy might also reflect improved medical technology that prevents the death of road accident victims when hospitalised, adding to rather than reducing the numbers injured in more collisions. Note: In the United Kingdom, cyclist deaths fell from 256 in 1990 to 114 in 2003 - a drop of 56%. The UK does not have mandatory bicycle helmet laws and people were not discouraged from cycling during the 1990s. It might also be worth noting that in 2006/07, preventable errors in West Australian hospitals killed 30 patients (* West Australian Health Department Sentinel Event Report 2006-07). According to a report tabled in parliament by the West Australian Auditor-General in October 2007, an estimated 45,000 mishaps are harming patients and jeopardising treatments in hospitals every year, with 820 adverse events in 2006 rated as critical, causing serious harm or death. These include medication errors and patients falling.
In its April 1995 issue of Cycling in the West, the Bicycle Transportation Alliance of Western Australia writes: "Comparisons with data from previous years suggest that compulsory helmet legislation has not been nearly as successful as predicted in reducing the cyclist injury rate.". Pre and post law comparisons of WA serious head injuries and fatalities of cyclists (PDF 32kb) can be made based on the following data from the WA Morbidity Data Base given to the Legislative Assembly of the West Australian parliament on June 27 2000 by then WA Transport Minister Murray Criddle: WA adult cyclist serious head injuries - 5 year comparison pre law / with law Pre law - Average annual number of serious head injuries to WA adult cyclists aged 16 and over 1987/88 to 1991/92 = 18.4 With law - Average annual number of serious head injuries to WA adult cyclists aged 16 and over 1992/93 to 1995/96 = 14.8 This is a reduction of 19.5% (Bridge surveys show cyclist decline of 25-30%) WA juvenile cyclist serious head injuries - 5 year comparison pre law / with law Pre law - Average annual number of serious head injuries to WA juvenile cyclists aged 15 or under 1987/88 to 1991/92 = 13.8 With law - Average annual number of serious head injuries to WA juvenile cyclists aged 15 or under 1992/93 to 1995/96 = 9.6 This is a reduction of 30.5% (more than 50% decline in schoolchildren cycling from 91 to 96, according to Bikewest) WA adult cyclist fatalities - 7 year comparison pre law / with law Pre law - Average annual number of fatalities to WA adult cyclists aged 16 and over 1985/86 to 1991/92 = 4.2 With law - Average annual number of fatalities to WA adult cyclists aged 16 and over 1992/93 to 1998/99 = 4.7 This is an increase of 12% (Bridge surveys show cyclist decline of 25-30%) WA juvenile cyclist fatalities - 7 year comparison pre law / with law Pre law - Average annual number of fatalities to WA juvenile cyclists aged 15 or under 1985/86 to 1991/92 = 3.2 With law - Average annual number of fatalities to WA juvenile cyclists aged 15 or under 1992/93 to 1998/99 = 1.4 This is a reduction of 55% (more than 50% decline in schoolchildren cycling from 91 to 96, according to Bikewest / figures skewed by 9 deaths in 85/86)
Table: number of serious head injuries to cyclists in Western Australia by financial year and age of cyclist, compared to average weekly counts of cyclists using the Causway and Narrows bridge paths from October-December of that year. The data used for this graph is crude but nevertheless shows the law does not appear to have produced any obvious benefit in terms of reducing serious head injuries relative to the amount of cycling. Below is a West Australian Health Department table showing the number and age-standardised rates of hospital admissions for injuries sustained in bicycle crashes from 1981 to 1995. Note an increase in cyclist admissions during the three years after 1992 helmet law enforcement, despite an estimated 30% reduction in overall cyclist numbers on West Australian roads, a 50% reduction in cycling to school and about 80% of cyclists mandatorily wearing helmets that are supposed to reduce head injuries. Bicycle crashes
Below is a West Australian Health Department table showing the percentage of cyclist injury types sustained in Western Australia hospital admissions between 1981 and 1995.
Western Australia, 1981-1995 |
| Site | Injury1 | 1981-1983 | 1984-1986 | 1987-1989 | 1990-1992 | 1993-1995 | Total |
| Head | |||||||
| Skull fractures | 3.4 | 5.6 | 4.7 | 3.4 | 2.3 | 3.9 | |
| Facial | 6.9 | 9.1 | 11.6 | 11.5 | 10.6 | 10.0 | |
| Intracranial | 38.0 | 35.3 | 27.1 | 22.3 | 21.2 | 28.6 | |
| Other head | 1.1 | 1.2 | 1.7 | 1.5 | 0.9 | 1.3 | |
| Total | 49.5 | 51.2 | 45.2 | 38.7 | 35.0 | 43.7 | |
| Non-Head | |||||||
| Spinal | 0.2 | 0.4 | 0.6 | 1.3 | 1.0 | 0.7 | |
| Lower limb fractures | 11.1 | 10.1 | 11.2 | 11.0 | 10.4 | 10.8 | |
| Upper limb fractures | 15.7 | 14.7 | 16.4 | 22.9 | 28.6 | 19.8 | |
| All other fractures2 |
0.7 | 0.9 | 1.1 | 1.5 | 1.5 | 1.2 | |
| Dislocations/ sprains |
1.1 | 1.2 | 1.4 | 1.8 | 1.9 | 1.5 | |
| Superficial | 13.2 | 13.8 | 15.7 | 14.8 | 13.1 | 14.1 | |
| Internal | 2.9 | 2.2 | 2.2 | 2.4 | 2.3 | 2.4 | |
| Other | 5.5 | 5.5 | 6.2 | 5.7 | 6.2 | 5.8 | |
| Total | 50.5 | 48.8 | 54.8 | 61.3 | 65.0 | 56.3 |
|
The actual number of intracranial injuries was 423 in 1990-1992 and 403 in 1993-1995 (-4.8%). The estimated percentage of West Australian cyclists wearing helmets increased from 39% in 1991 to 77% in 1995. Skull fractures usually don't inflict long-term disability and intracranial injuries mostly require less than one day of hospital treatment. Nevertheless, both injury types can be serious. The decline in skull fractures in the three years after helmet law enforcement amounts to an average seven per year. The decline in intracranial injuries in the three years after helmet law enforcement also amounts to an average seven per year. That's an average 14 less head injuries per year from a total bike ownership of more than 750,000 West Australians, and with tens of thousands of people giving up cycling after the law was enforced. The actual number of head injuries fell marginally after helmet law enforcement. However, upper limb fractures rose sharply. Cyclist upper extremity injuries in Western Australia increased from 118 (16.9% of all injury locations) in 1988 to 274 (32.2%) in 1998. Research by McDermott et al. (Trauma, 1993, p834-841) found a significant increase in neck injuries for helmet wearers. 3.3% of unhelmeted riders sustained neck injuries while 5.7% of helmeted riders sustained neck injuries - a 75% greater risk among helmet wearers. The study compared 366 helmeted riders and 1344 non helmeted riders admitted to hospital in the Australian state of Victoria before helmets were mandatory.
* No neck injuries because cyclists with a neck injury also sustained injury of the same severity to a higher ranking body region. Table B9 / Bicycle Crashes and Injuries in Western Australia, 1987-2000 - Road Safety report RR131 (PDF 840kb) commissioned by Road Safety Council, dated November 2003 and authored by Lynn B. Meuleners, Arem L. Gavin, L. Rina Cercarelli and Delia Hendrie Although head injuries represent a smaller percentage (or proportion) of overall cycling injuries, this is mostly because of a much greater number of upper body injuries within the smaller pool of cyclists on the roads. In other words, upper body injuries replaced head injuries as the dominant injury following helmet law enforcement but mostly because the actual number of upper limb fractures rose so sharply. Various factors explain the overall (all body) increase in injuries, which add to the public health / pollution / transport infrastructure consequences of having fewer cyclists. These include greater risk-taking when wearing a helmet, an increase in head surface area likely to contact or graze a solid object, and greater brain injury through the added rotational force of the helmet - particularly soft tops which grip the road surface (see eMedicine for more detail). A further reason for the failure to reduce overall injury numbers is that tens of thousands of citizens who have abandoned cycling are instead driving their cars, increasing traffic density and further endangering all road users including pedestrians, other motorists and the remaining cyclists. Below is extracted from Serious injury to land transport accidents, Australia, 2005-06 by the Australian Institute of Health and Welfare.
Following is a summary of WA Health Department data showing actual and averaged numbers of hospitalised cyclist injury types in Western Australia on an annual basis:
Skull fractures 89/90/91 - 75 ( = average 25 per year)
Facial 89/90/91 - 198 ( = average 66 per year)
Intracranial 89/90/91 - 458 ( = average 152 per year)
Other head 89/90/91 - 36 ( = average 12 per year)
Spinal 89/90/91 - 23 ( = average 8 per year)
Lower limb fractures 89/90/91 - 220 ( = average 73 per year)
Upper limb fractures 89/90/91 - 388 ( = average 129 per year)
All other fractures 89/90/91 - 29 ( = average 10 per year)
Dislocations/sprains 89/90/91 - 30 ( = average 10 per year)
Superficial 89/90/91 - 307 ( = average 102 per year)
Internal 89/90/91 - 44 ( = average 15 per year)
Other 89/90/91 - 116 ( = average 39 per year)
Total 89/90/91 - 1924 ( = average 641 per year) Surveys consistently show that cyclist numbers fell by approximately 30% from 1992 to 1995 (three years of helmet law enforcement). When this 30% reduction in public cycling numbers is considered, the above results suggest a slight improvement in skull fractures and a worsening in intracranial injuries (which should have averaged close to 100 per year following law enforcement). Despite far fewer cyclists, the numbers of non-head injuries either remained fairly static or, in the case of upper limb fractures, worsened markedly. Age-standardised rates of hospital admissions for injuries sustained in bicycle and vehicle crashes
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.
This graph highlights the ratio of cyclist fatalities to estimated distance cycled and helmet wearing rates in various countries. 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. 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. Read more about rotational brain injury. 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 Word or PDF, or view the report on your browser. This paper also highlights various of the medical and safety failures of Western Australia's mandatory bicycle helmet legislation. 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. Read the views of an Accident and Emergency doctor: "Forcing people to wear helmets demonstrably reduces the number willing to ride a bicycle. Less cycle use means more obesity, heart attacks, and use of other, less environmentally-friendly means of transport. Making helmet use compulsory gives cycling an undeservedly dangerous profile, and may discourage bicycle use even further." America's Injury Prevention magazine published an article in 2003 titled Safety in Numbers: more walkers and bicyclists, safer walking and bicycling (PDF 140kb) which concludes that policies increasing walking and bicycling can improve the safety of other road users. A summary of the WA mandatory helmet law impact including further important information (PDF 610kb).
Go to draft National Road Safety Strategy submission 3 - All road casualties Mandatory Bicycle Helmet Law in Western Australia |
