Tom Perry remembers vividly the January day in 2007 when he wiped out on his bike. The Vancouver doctor had checked in with other cyclists who’d already been out to see if the roads were icy and waited till mid-morning before setting out. Then he approached a roundabout on West 12th Avenue.
“When I came out and straightened my wheels, I hit black ice and crashed,” Perry says in a phone interview from Vancouver General Hospital. “There was no warning whatsoever. There was a horrible crack when my head hit the sidewalk curb, and my right shoulder hit at the same time.”
Perry was wearing a helmet, which was damaged inside and out after his fall. In extreme pain and worried about a concussion, he went to the hospital. He had no head injury, but an X-ray revealed that his collarbone was smashed. He says he’s thankful he was wearing that helmet.
“With a blow that shattered my collarbone into multiple pieces, I’m sure I avoided a head injury because of the helmet, or possibly death,” Perry says.
A former MLA, Perry was in government when helmets became mandatory in B.C. in 1996. He started cycling to and from work in the early 1990s and was already committed to using a helmet: a fall while cycling on a busy street in years earlier scared him so much he didn’t feel safe without one.
“It’s exactly like getting into a car without a seat belt: you don’t feel right without it,” he says. Looking back at the buildup to getting the law passed, there was concern among members of the NDP that making it illegal not to wear a helmet was too heavy-handed. But other provinces like Ontario, then under the lead of Mike Harris, were proposing similar legislation, and by the time the law was proposed here, support among other MLAs was overwhelming.
“It seemed to be an obvious, good thing to do at the time,” Perry says.
Ever since that law was passed, however, there’s been friction among academics, policymakers, the public, and members of the cycling community itself over whether helmets should remain mandatory. Those opposed to the law say being fined for not wearing a helmet is a barrier to bicycling and that personal safety should be an individual choice. Advocates say helmets help prevent serious injuries and reduce the public-health-care expense involved in treating them. The debate is certain to come to the forefront as Vancouver launches its bike-sharing program in the future.
Former Non-Partisan Association city councillor Peter Ladner worries about the compulsorary helmet laws impact on ridership.
“I don’t think helmets should be mandatory because I would rather see somebody cycling without a helmet than not cycling at all,” Ladner says in a phone interview. “People’s long-term health is more endangered by choosing not to cycle than by not wearing a helmet.
“People may say helmets are too sweaty, they’re not cool, it wrecks their hair when they’ve got to go to work… For them, those are reason enough not to ride a bicycle….It’s an added expense, which means some people can’t afford to ride a bike.
“Bike-sharing just won’t work, plain and simple, with mandatory helmets,” adds Ladner, who wears a helmet when he cycles. “Everybody’s doubtful vending machines are going to work. I think it should be up to individuals to make up their own minds how to keep themselves safe.”
The debate is playing out in other jurisdictions. The Canadian Pediatric Society recently stated it should be mandatory for Canadians of all ages to wear helmets. Halifax cyclists, meanwhile, want the province to drop the mandatory-helmet law. Legislation is being considered in Washington D.C., yet the Washington Area Bicyclist Association is opposed. Like some in Vancouver’s cycling community, the organization supports helmet use, but not compulsory helmet use.
In the United States, the National Bicycle Dealers Association opposes mandatory helmet laws. Bicycle Retailer and Industry News, which covers bicycling in North and South America, Europe, and Asia, has editorialized against them.
Some experts argue that wearing a helmet could increase the risk of injury. Ian Walker, a senior lecturer in psychology at the University of Bath who researches road safety and environmental behaviour, found in a 2006 experiment he did himself that drivers overtaking him on his bike actually passed closer to him when he was wearing a helmet. When he wore a wig to give the appearance he was female, passing traffic gave significantly more leeway. “The helmet effect”, as Walker calls it in a briefing document, “is likely the result of drivers judging cyclists’ skill levels from their appearance and adjusting their overtaking accordingly”. Walker also found that drivers of buses and heavy-goods vehicles got significantly closer to cyclists than those in automobiles.
Focusing on mandatory helmets takes away from the bigger issue of urban planning and infrastructure geared to cyclists’ safety, says Kay Teschke. The professor at UBC’s School of Population and Public Health says that helmet use should not be mandatory.
“It’s been a mistake,” she says by phone. “It has really distracted us from policies and behaviours that could have much greater benefits to the safety of cyclists, in particular building infrastructure that is safe—for example, separate bike lanes [and] off-street bike paths. Those are measures that can lower injury risk by 50 percent or more….When those kinds of infrastructure are available, they [cyclists] tend to choose those safer routes.”
Making helmets compulsory, Teschke adds, creates the perception that cycling is far more hazardous than it really is, a notion that may deter some people from adopting the activity. “People think of it as a sport rather than a mode of transportation,” she says. “The risk of death from walking is about the same as it is for cycling. Other sports are considerably more dangerous. There’s no helmet law for mountain biking, and it’s a much more dangerous sport.
“Those of us in public health have a real responsibility to address the issue of bicycling safety in what I call primary prevention mode, and that is trying to stop crashes from happening in the first place,” she adds. “In places where that approach has worked, such as Holland, Denmark, and other parts of Europe, they try to separate out motor-vehicle traffic from bicycling traffic, the same way we separate motor-vehicle traffic from walking traffic. The injury risk is about a half to a third of what it is in North America….The chance of being in a fatal crash is much lower, and there’s no helmet law in those places.”
Studies done to date on the effectiveness of helmet laws are controversial because of differences in analysis, Teschke says. However, she notes that some of the most comprehensive research shows helmets are of little benefit in reducing the risk of injury or death.
A study published in the British Medical Journal in May 2013 found that reductions in the rates of admission to hospital for cycling-related head injuries were greater in provinces with helmet legislation. However, injury rates were already decreasing before the implementation of legislation, the study found, and the rate of decline was not appreciably altered on introduction of legislation.
“While helmets reduce the risk of head injuries and we encourage their use, in the Canadian context of existing safety campaigns, improvements to the cycling infrastructure, and the passive uptake of helmets, the incremental contribution of provincial helmet legislation to reduce hospital admissions for head injuries seems to have been minimal,” the authors stated.
“We have not seen the dramatic reductions which everyone was hoping for,” Teschke says. “In my view, we’ve taken the wrong approach. We’ve taken the ‘after the crash, try to mitigate damage to the head’ approach, and that is not a true public-health approach. A true public-health approach is how to stop the crashes in the first place.”
Dr. Hedy Fry, MP for Vancouver Centre and former president of the B.C. Medical Association, has been a proponent of mandatory bike helmets for decades. She says by phone that medical knowledge surrounding concussions has progressed tremendously and that helmet use is a “no-brainer” when it comes to the prevention of brain injuries.
“This is an incredibly important preventive safety measure,” Fry says. “Concussion does indeed create problems with long-term cognition, memory loss, and people’s physical and mental state. The idea that you can prevent concussion—and cyclists can theoretically sustain multiple concussions—is well-documented. Why are we questioning things that are preventable?
“People will not stop biking just because they have to wear a helmet,” she adds. “Mandating is important, and so is public education.”