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China: a return to the “kingdom of bicycles”?

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k94 (Published 15 January 2018) Cite this as: BMJ 2018;360:k94

Rapid Response:

Does one have to dress up like an extra from Robocop to go for a bike ride?

I enjoyed the editorial by Hu and Yin until the last paragraph plug for compulsory helmets and high viz. I ride a bike every day to get to work and for house calls and don't like helmets and high viz. Firstly they 'dangerise' cycling, implying cycling as unusually hazardous and productive of head injuries. Secondly, they demonstrate the wearer has bought into the idea that they are safer wearing one despite all the evidence to the contrary.

Cycling has an image problem. One doesn't wear a helmet during other low risk activities like walking or driving; most would view such activities as too safe to warrant it, but cycling is somehow different. In a DfT survey in 2014 (1) 64% of people considered it too dangerous for them to cycle on the road. But this perception is false. Cycling is safer than walking per km travelled and is comparable to riding in a car per hour spent (2). A typical urban cyclist in Britain exposes themselves to similar risk as a Dutch cyclist (3). Helmets and high viz reinforce cyclists as an 'out' group and put people off cycling. Cyclists benefit from a safety in number effect (4) so anything that reduces cycling makes it less safe. There is overwhelming evidence that cycling, helmeted or not is health enhancing (5). Helmets laws have skewered cycle hire schemes in Australia and Seattle (6, 7, 8). In Israel and Mexico City cycle hire schemes only took off when helmet laws were repealed (9, 10). No jurisdiction exists that combines high helmet use with high cycle use. In the safest cycling countries like the Netherlands and Denmark people wear normal clothes and few cycle with helmets. Cycle helmets and high viz are a barrier to cycling.

An BMJ editorial from 2013 nicely summarised the debate about helmet effectiveness (11). One can pick and choose from a weak evidence base either way, but the promised benefits of helmet wearing from case control studies have never materialised in real life. One would hardly expect great things from the design envelope of a cycle helmet, which is supposed to withstand about a 13mph impact (12). Those racing down hills at 35mph may as well wear a rabbit foot around their neck as a helmet for all the good it'll do them.

If cycling is to flourish as the authors wish, an absence of helmet laws will help. The Australian and NZ experience with large falls in cycling since their laws were enacted should be enough of a warning to China (13, 14). I found it surprising that the authors think it will encourage more people to cycle by punishing those who don't wear helmets. Cycling organisations the world over oppose compulsory helmets for good reasons, it was so sad to see it plugged in this editorial.

1. British Social Attitudes Survey 2014, DfT.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
2. Reported road casualties in Great Britain, main results: 2015
https://www.gov.uk/government/statistics/reported-road-casualties-in-gre...
3. History, risk, infrastructure: perspectives on bicycling in the Netherlands and the UK,
Malcolm J.Wardlaw, Journal ofTransport&Health1(2014)243-250
https://www.sciencedirect.com/science/article/pii/S2214140514000838
4. Safety in numbers: more walkers and bicyclists, safer walking and bicycling, P L Jacobsen, Injury Prevention 2003;9:205-209
5. Health on the Move 2. The Transport and Health Study Group. http://www.transportandhealth.org.uk/?page_id=32
6. https://indaily.com.au/news/2016/09/08/car-culture-helmet-laws-threaten-...
7. http://www.cycle-helmets.com/bike-hire-schemes.html#hire
8. On your bike: the best and the worst of city cycle schemes , The Guardian. https://www.theguardian.com/money/2017/feb/25/best-and-worst-city-cycle-...
9. How did we revise the compulsory helmet law in Israel? Sustainabilitiy.org.il http://www.sustainability.org.il/home/bike-news/How-did-we-revise-the-co...
10. http://www.copenhagenize.com/2010/04/mexico-city-repeals-bike-helmet-law...
11. Bicycle helmets and the law, Goldacre, Spiegelhalter , BMJ 2013;346:f3817 doi: 10.1136/bmj.f3817
12. Heads Up, Walker, B. Cycle Magazine, Jun/Jul 2005 http://www.cyclehelmets.org/1215.html
13. Australian per capita cycling participation in 1985/86 and 2011. Chris Gillham, Chris Rissel, World Transport Policy and Practice, Volume 18.3 May 2012
14. Cycling New Zealand Household Travel Survey 2011 - 2014

Competing interests: Contributor to the charity Roadpeace and member of Cycling UK.

19 January 2018
Peter W Ward
GP
Central Gateshead Medical Group
Gateshead