The November CJSM: A Discussion on the Mandatory Use of Bicycle Helmets
November 12, 2013 20 Comments
The November issue of CJSM has been out for a week, and I hope you’ve had a chance to look at our latest offering. It is also our last offering for 2013 (CJSM is a bimonthly, publishing 6 times a year). The next time the journal will hit your mailboxes and inboxes will be January 2014.
2014 promises to be a big year in sports and sports medicine. The Winter Olympics take place in Sochi, Russia; the FIFA World Cup is in Brazil; and the Commonwealth Games are in Glasgow, Scotland. On the sports medicine front, the Canadian Academy of Sports and Exercise Medicine (CASEM) hosts the FIMS 2014 World Congress of Sports Medicine in Quebec City, and earlier in the spring the AMSSM annual meeting takes place in the Big Easy. And this brief listing, of course, merely scratches the surface of what is to come.
But before I get ahead of myself, best to hold on to the mantra, “Be Here Now,” and share with you a little of what’s in store when you delve into this month’s CJSM.
Headlining the November issue is CASEM’s position statement on the mandatory use of bicycle helmets. This document is a revision of a previous statement made in 2002, and incorporates the medical evidence in support of such use that has accumulated over the last 10+ years. There is an associated lead editorial by Murray Maitland, PhD that is definitely worth a read as well.
I was particularly interested in the CASEM offering at least in part because I am a regular bicycle commuter here in Columbus, Ohio who recently had his interest in such matters piqued after reading a provocative article in the NY Times: “Is it OK to Kill Cyclists?”
That’s a rhetorical question mind you!
First having ensured the life insurance policy had been paid up, I then read through the CASEM statement, which packs a lot in two pages. The statement surveys the field of what is known about the use of bicycle helmets and injury prevention, and then makes recommendations. Some of the salient points I walked away with: 1) wearing a properly fitted helmet decreases head injuries by 63% to 88% in all ages of bicyclists; 2) introduction of legislation (i.e. not merely relying on education campaigns) is associated with a decreased injury rate and has not been shown to decrease ridership (importantly, as we seek to increase physical activity in our sedentary population); 3) youth populations are more likely to wear helmets where there is legislation that applies to riders of all ages as opposed to only 18 years and younger; 4) youth are more likely to wear helmets when cycling with an adult wearing a helmet (95%) than when cycling with an adult not wearing a helmet (41%).
The CASEM statement draws several conclusions from these data, but most importantly recommends “That all Provincial and Territorial governments should enact comprehensive legislation mandating that bicyclists of all ages wear helmets.”
I would concur with those recommendations, and I would love to hear your thoughts after reading the CASEM statement, either here in the comments section or on twitter @cjsmonline. The CJSM executive editor, Chris Hughes, has written about this subject in a 2011 blog post, and notes that the associated poll of the readership taken at that time got more traffic than any other. I’m hoping this month’s articles on the subject, and this blog post, encourages that same sort of commentary.
My position on the matter (pro) is uncomplicated. I think the data are clear and in favor of mandatory use of bicycle helmets: mandatory legislation reduces serious injury; it encourages the most vulnerable (children) in the use of an injury prevention device; and it has not been shown to decrease ridership.
I don’t think one needs to appeal at all to anecdotal evidence. That said, I suppose any regular bike commuter can share a story like mine. Earlier this year, casually biking down a bike path on a windy day, not a car or any obvious danger in sight, I passed a construction zone marked off with flourescent orange, plastic netting. A sudden gust of wind blew a lengthy piece of the netting into the path, and before I realized what was happening, a tendril of the netting had snared a pedal, bringing me crashing immediately to the asphalt. Getting up, I immediately surveyed my bike (of course) for catastrophic damage before doing a survey of self. Bad abrasions on my left shoulder and hip, a large contusion over the latter (months later still is a mild nuisance), and a helmet which was dented–no question without that equipment I would have come away with some sort of head injury, it is only a matter of how severe.
My training and interest in public health likewise underpin my support of mandatory bicycle helmet laws, which are little different in my mind than mandatory seat belt laws. Regarding injury prevention in public health, I would suspect most students are exposed to the “Haddon matrix”, which breaks down injury prevention into two axes: time of intervention (pre event, event, post event) and risk factors (host or human factors, agent factors (e.g. equipment), and environmental (including social) conditions). Haddon developed this matrix while thinking systematically about motor vehicle crash prevention, but it can be extended almost universally when considering public health issues: addressing the ‘concussion crisis,’ reducing gun violence in America, or, in this case, reducing catastrophic injury in bicyclists.
Before there were, at least in America, seat belts, shatter proof windows, collapsible steering columns, air bags, special roads for high-speed travel, etc., there were proportionally many more motor vehicle accidents resulting in death. It was common in that era, I have read, to attribute these accidents and deaths to driver failure (e.g. speeding), not to car or road failure. (The NY Times article, “Is it OK to Kill Cyclists?” explores this same idea: it was the bicyclist’s fault!)
None of the interventions I just listed were put into common practice voluntarily: I still hear grumbling about mandatory seat belt laws from some friends, and hear spurious arguments about the one person they know who survived a car accident because they had been thrown from a car while those who remained restrained died. Auto manufacturers have frequently dragged their collective feet on these issues.
If I understand his work, Haddon, and other pioneers in the field of injury prevention, began to shift the focus more toward addressing the ‘agent factors’ involved in motor vehicle accidents: that is, protecting the body during a car crash (e.g. seat belts, etc.). A person may be driving too fast for the road, but let’s let them live another day. I am fairly certain if Dr. Haddon were alive he would most definitely support the CASEM statement in favor of mandatory bicycle helmets. He would frame such an intervention as addressing an agent factor in the equation of bike safety, with plenty of data to support it. The legislation CASEM is recommending in its statement would allow more bicyclists to walk away from an accident, even if it were ‘their own fault.’
Public Health is ‘pro-health.’ It is not ‘anti-‘ anything really. It is not ‘anti-smoking,’ ‘anti-free choice,’ ‘anti-gun,’ ‘anti-football.’ On a very fundamental level, it recognizes that human beings are frequently irrational. It tries to educate people to help them avoid making unhealthy choices, but it also argues that when someone makes a mistake, it is prudent to try to mitigate the damage of that mistake. It does not take away free choice: public health allows for human error, and attempts to ensure that the person can live another day after their mistake or accident. It uses tools like education and, at times, legislation to push people to make healthy choices. I see the call for mandatory bicycle helmet use in countries like Canada, the UK, the USA, etc. in that light.
Take the time if you can to read the statement and the editorials in the November CJSM and let me know what you think. We’re looking forward to a robust discussion. Please respect peoples’ differences of opinion. All comments will be moderated.