Increasing the number of cyclists is more important

Editor–Ronald M Davis and Barry Pless's letter about the value of cycle helmets once again illustrates the worrying reductionist tendency in research into health promotion and illness prevention, which often results in sight being lost of the ultimate goal of promoting health.1 Narrow sectoral approaches–in this case the view that wearing a helmet reduces head injuries among cyclists–address only part of the issue. Purely medically based prescriptions for change fail to consider behavioural responses to environmental changes. The case for all cyclists to wear helmets, as argued, fails to acknowledge the disbenefits that have resulted when such strategies have been enforced through legislation. Evidence from Australian states where laws have been enacted to require the use of helmets suggests that “the greatest effect of the helmet law was not to encourage cyclists to wear helmets, but to discourage cycling.”2

We are familiar with the evidence of the benefits of regular physical activity and of the levels of inactivity in the population.3 Cycling has been viewed as an ideal form of aerobic physical activity: it is available to a large section of the population and can be incorporated into daily life without requiring additional time. In the past year or so several high level statements have been made about the value of moderate physical activity as part of the routines of daily living. These have come from the surgeon general and the National Institute for Health in the United States, the World Health Organisation and the International Federation of Sports Medicine, and, not least, the Department of Health in Britain.4

The evidence is that the health benefits of cycling outweigh the dangers posed to cyclists.5 There is now a government led national cycling strategy, with a target to quadruple levels of cycling to a modest 8% …