Intended for healthcare professionals

Rapid response to:


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

BMJ 2018; 360 doi: (Published 15 January 2018) Cite this as: BMJ 2018;360:k94

Rapid Response:

Bike-share schemes improve safety - helmet laws do not

One of the best ways to build a healthy and safe cycling environment is to encourage more people to cycle and so increase safety in numbers. Cycling has not only flourished in many cities that introduced bike-share schemes, safety has improved considerably.

New York’s scheme had 8.2 million bike-share trips in its first year (2013) yet deaths and serious injuries in the bike-share zone fell by 17%. Deaths and serious injuries per 100 million bike trips in the entire city fell from 446 in 2006-2010 to 292 in 2011-16 [1].

Dublin’s scheme launched in 2009 with 450 bikes. There were over 2,200 trips per bike (more than 6 trips per bike per day) in its first year [2]. It was considered to be very safe with no reported injuries in the first 10 months and only one bike going missing [3].

As cycling flourished in Dublin, it became much safer. Before the bike-share scheme, only 3.8% cycled to work in the Dublin Regional Authority (2006 census), increasing to 5.0% in 2011 and 6.7% in 2016. In Dublin city, 10.3% now cycle to work (2016 census); 13.9% of those aged 19+ and 8.6% of 13-18 year olds cycle to school, college or university. Annual counts of cyclists entering Dublin from 7-10 am increased from 6,143 in 2008 to 12,089 in 2016 [4]; cycling now accounts for 12.9% of traffic in central Dublin [5]. Despite these substantial increases, road deaths to cyclists in Dublin have not increased, implying that cycling is now safer as well as more popular [6].

Prof Kay Teschke collated statistics on cycling to work in four North American cities that introduced bike-share schemes, compared to five that did not. There was a substantially greater increase in bicycle commuting in the bike-share cities, yet the total number of injuries decreased in bike-share (but not control) cities, again showing that more cycling means safer cycling [7].

Sadly, Melbourne and Brisbane’s bike-share schemes (with only 0.3 to 1.0 trips per bike per day, a tiny fraction of Dublin’s 9, Barcelona’s 6, or China’s 3 trips per bike per day [8-10]) have not generated the same increases in cycling nor safety. In a survey about Melbourne Bike-Share, 61% of respondents identified helmets as the main barrier to using the scheme [11].

Two recent studies associated helmet use with increased injury rates. 1) Individuals with documented helmet use had 2.2 times the odds of non–helmet users of being involved in an injury-related accident [12]; 2) helmet use by transport cyclists was associated with being injured while cycling in the past 2 years, OR=2.81 [13].

In a study of Canadian cyclist injuries, helmet legislation was not associated with reduced hospitalisation rates for brain, head, scalp, skull or face injuries. Females had lower hospitalisation rates than males, and higher cycling mode share was consistently associated with lower hospitalisation rates for traffic-related injuries, suggesting a ‘safety in numbers effect’ [14].

New Zealand introduced helmet laws in 1994. Travel surveys (conducted in 1989 and 1997) show big declines in time spent cycling per week, from 28 to 15 minutes per child aged 5-12, from 52 to 31 minutes for 13-17 year olds and 8 to 5 minutes per week for adults. The declines in cycling were accompanied by increased injury rates per million hours of cycling [15]. Evidence from Australia also suggests that injury rates per cyclist increased, compared to what would have been expected without the helmet law [16]. Cycling injuries continue to increase in Australia [17] without any increase in participation [18].

Hu and Yin discuss the major health and environmental benefits of cycling for transport, but then advocate helmet laws, which have resulted in substantial reductions in cycling, e.g. a 48% drop in numbers of teenage cyclists counted in Melbourne a year after the introduction of the helmet law[16].

The recommendation for helmet legislation seems to be misguided. The most likely outcome is that fewer people will cycle than without the law, leading to lost health and environmental benefits, together with increased injury rates from risk compensation and reduced safety in numbers.

1. NYCDT, Safer Cycling: Bicycle Ridership and Safety in New York City. New York City Department of Transportation. Available at:, 2017.
2. Daly, M., What's the secret of the Dublin bike hire scheme's success? The Guardian Bike Blog,, 2011.
3. Mangan, S., More than 37,000 use bike scheme, in Irish Times, Dublin. Available at
4. Kelly, O. More than 12,000 cyclists a day commute into Dublin city. Available at: 2017.
5. Cycle, I. Pedestrians-and-cyclists-nearly-50-of-traffic-in-dublin-city-centre-counts. Available at: 2018.
6. Cycle, I. Cyclist deaths and injuries on Irish roads. Available at: 2017.
7. Teschke, K. and M. Winters. Letter to the Editor of the American Journal of Public Health, available at: 2014.
8. Rogers, M. and C. Keenan, Making Dublin More Accessible:The dublinbikes Scheme,, 2012.
9. Fishman, E., Bikeshare: A Review of Recent Literature. Transport Reviews, 2016. 36(1): p. 92-113.
10. Hu, G. and D. Yin, China: a return to the “kingdom of bicycles”? BMJ, 2018. 360.
11. Fishman, E., et al., Barriers to bikesharing: an analysis from Melbourne and Brisbane. Journal of Transport Geography, 2014. 41: p. 325-337.
12. Pedroso, F.E., et al., Bicycle Use and Cyclist Safety Following Boston’s Bicycle Infrastructure Expansion, 2009–2012. American journal of public health, 2016. 106(12): p. 2171-2177.
13. Porter, A.K., D. Salvo, and H.W. Kohl Iii, Correlates of Helmet Use Among Recreation and Transportation Bicyclists. American Journal of Preventive Medicine, 2016. 51(6): p. 999-1006.
14. Teschke, K., et al., Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share. BMJ open, 2015. 5(11): p. e008052.
15. Trends in Cycling, Walking & Injury Rates in New Zealand. Available at: 2014.
16. Robinson, D.L., Head injuries and bicycle helmet laws. Accid Anal Prevent, 1996. 28: p. 463-475.
17. Beck, B., et al., Road safety: serious injuries remain a major unsolved problem. The Medical Journal of Australia, 2017. 207(6): p. 244-249.
18. Munro, C., Australian Cycling Participation Survey. Results of the 2017 National Cycling Participation Survey, 2017, Commissioned by the Australian Bicycle Council. Available at:

Competing interests: No competing interests

24 January 2018
Dr Dorothy L Robinson
Adjunct Senior Research Fellow
University of New England
Armidale, Australia