BMJ 1999;318:1505 ( 5 June )

News

Cycle helmets should not be compulsory

Douglas Carnall , BMJ

Cyclists are advised to wear helmets but legislation to make them compulsory is likely to reduce the number of people choosing to cycle and would not be in the interests of health, concludes the BMA's Board of Education and Science.

International evidence shows that the compulsory use of helmets results in a fall in the number of cyclists. The Australian state of Victoria made the use of helmets compulsory in 1990, and in the following year deaths and head injuries among cyclists fell between 37%and 51%However, 40%fewer adults and 60%fewer children continued to cycle after the introduction of the laws.

About one in five cyclists in Britain currently wears a helmet. This proportion would have to be increased by promotional campaigns encouraging voluntary action before legislation could hope to be effective.

Some cyclists are opposed to wearing helmets. Research by the European Cycling Federation found that non-cyclists tended to be most in favour of helmets. In fact, a much greater number of lives would be saved if pedestrians and car occupants were encouraged to wear helmets.

The board's previous reports have concluded that the benefit to health of regular exercise from cycling outweighs the British cyclist's comparatively high risk of trauma. In countries such as the Netherlands and Denmark pedestrians and cyclists form a much smaller proportion of those injured or killed on the road, though helmets are little used. Instead, these countries have concentrated on safety programmes to reduce motor traffic speeds to 30 km/h in urban areas and separate cyclists from fast moving traffic.

Properly fitted helmets manufactured to accepted standards can reduce the severity of head injury in a crash, though the tests on which these standards are based mimic a fall from a cycle rather than collision with a fast moving vehicle, which is most likely to harm an adult cyclist.

Children are more likely to simply fall off their bicycles and may therefore derive more benefit from wearing a helmet. However, the costbetween £12 and £90and the necessity of replacing helmets every few years as the child grows may be prohibitive.

The report recommends that the government should consider subsidising this cost, along with other measures to promote helmets manufactured to the highest standard (Snell B95). It also recommends that every child should be given the opportunity to learn cycling proficiency and that the driving test should be modified to test specifically for awareness of cyclists and other road users.

(Credit: PETE SALOUTOS/THE STOCK MARKET) Children may derive more benefit than adults from cycle helmets

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© BMJ 1999

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