Intended for healthcare professionals


Bicycle helmets and the law

BMJ 2013; 346 doi: (Published 12 June 2013) Cite this as: BMJ 2013;346:f3817

benefits of compulsory helmets for motorists could be greater than benefits of compulsory helmets for cyclists

More motorists experience fatal injuries than cyclists. UK Government statistics for road casualties in 2013 by road user type, show that car occupants were the largest casualty type across all severities. Of the 1,713 people killed in reported accidents in 2013, 46 per cent were car occupants. Pedestrians were the second largest casualty type followed by motorcyclists, accounting for 23 per cent and 19 per cent respectively. Cyclists accounted for 6%. Ie car users comprise more than seven times as many road casualties as cyclists. (

Australian research indicates that improved head protection for car users is an important and feasible target for intervention:
"Car crashes remain a significant source of head injury in the community. Car occupants have an annual hospital admission rate of around 90 per 100,000 population. Of drivers who are admitted to hospital, the most serious injury is usually to the head (O'Conner and Trembath, 1994).

In a previous study, McLean et al. (1997) estimated the benefits that are likely to accrue to Australia from the use of padding of the upper interior of the passenger compartment. This study specifically examined the effects of the ammendment to the United States Federal Motor Vehicle Safety Standard 201 (FMVSS 201) in which passenger cars have to pass head impact tests with the upper interior. That report estimated the total annual reduction in harm to the Australian community to be around $123 million.

But more impressive were the estimates of introducing protective headwear for car occupants. The authors of the report estimated that the annual reduction in harm would be in the order of $380 million. The benefit of padding the head is that the head is protected from strikes with unpadded automotive components, exterior objects and in vehicles that predate any eventual introduction of padded interiors." These are Australian numbers. (

Compulsory helmets for cyclists, by reducing cycling, risks reducing the public health benefits of cycling as part of an active lifestyle.

If compulsory helmets for car users discouraged car use this would have a positive effect on population health as car users moved to public transport, walking and cycling, reducing harmful emissions and increasing physical activity.

Legislation for compulsory helmets should be directed towards car occupants as this would have a greater impact on public health and health costs than legislation for cycle helmets.

Competing interests: No competing interests

10 November 2015
Daniel McQueen