I’ve been party to The Great Helmet Debate for well over two decades now. You can’t ride bicycles regularly without numerous people—regardless of whether or not they ride a bicycle themselves—volunteering their opinion on helmets.
And it’s fine. I like debate. I like testing hypotheses. Rigorously. It’s how we make sure we get stuff right, or at the very least it’s how we make sure we’re offering coherent arguments rather than just opinions that you’re not even entitled to.
But there are many fascinating characteristics of The Great Helmet Debate, and one of them is this.
A predictable ending
Whenever I have the discussion with someone who I’d describe as a “helmet evangelist” (a term which I don’t use pejoratively, but I need some sort of shorthand for someone who is either pro-compulsion or vigorously argues that everyone should wear one), it always—provided they have the patience to get this far—ends at one point.
I’ll get to that point in a moment. First, I need to set the scene with the point that precedes it.
The Penultimate Point
The Penultimate Point in the debate is the helmet evangelist’s million dollar question. It rears its head even after we’ve all agreed that it would be nice if we separated motorised traffic from bicycles; even after we’ve made sure that particularly poor drivers aren’t on the road; even after we’ve made sure that people don’t cycle along without any functioning brakes; even after we’ve agreed (or, more likely, agreed to disagree) on exactly how effective helmets are and over what range of potential impacts; even after after we’ve agreed (or again, more likely, agreed to disagree) on whether or not there are certain risks which they may actually increase.
Basically, we can reach this point no matter how much disagreement there is on the effects of helmets in individual incidents and the effects of helmet policy on population level health.
The Penultimate Point is essentially this:
Even if you do everything else – if you change your behaviour, change your environment, do everything you can – why would you still not wear a helmet to mitigate whatever risk remains?
But, the thing is, I don’t need to give a reason.
Because not only do the helmet evangelists already know what the reason is, they’re already using that very reason not to wear a helmet themselves.
Hitting the wall
The Penultimate Point’s premise is that whatever you do, however careful you are, however much you change the environment, you are still at risk of head injury.
And that’s absolutely true.
But it applies not only to cycling. Taking examples only from articles published in the last few days, it applies to crossing the road, walking down a driveway, travelling by taxi, playing football, walking down the street, being a passenger in a car, using the stairs, or… you get the idea. (That’s pretty much the first page of the Google results for “serious head injury” from the last seven days, and I’ve left a number of “pedestrian hit by car” ones out. And, yes, there was one person on a bike who was hit by a bus, too.)
So my subsequent question, which brings us to The Brick Wall, is always this: Why not wear a helmet, and campaign for compulsory helmets, for these activities?
At this point I’ll invariably be accused of being idiotic, ridiculous, unrealistic, stupid, laughable or suchlike. Of course you wouldn’t wear a helmet for these things! They’re different, the risks are so low.
Well, they’re not.
Risk is everywhere
Take walking as an example. Road traffic collision fatality rates for walking are around 20% higher per mile than for cycling. Note also that as a population we walk about three times as far as we cycle, so in road collisions alone the population suffers about 3.5 times the number of lives lost walking as it does cycling.
As for driving, one major study indicated that 57% of all traumatic brain injuries in the UK were attributable to road collisions.
And alcohol is alleged to cause 40% of daytime and 70% of night-time emergency admissions regardless of injury type, and, within those injuries, also causes a significantly higher rate of head injury. Why aren’t the evangelists arguing for beer helmets?
This isn’t intended to be a proof of head injury risk levels; there is no “ta-dah, QED!” here. For a start, fatality figures aren’t head injury figures; but unlike head and brain trauma injuries they’re at least easily measured and reliably recorded, and are arguably a decent indicator of severe danger, which often involves head and/or brain injury. Indeed, German figures show that head injury rates among serious injury casualties are almost identical for walking, cycling and driving.
What it’s intended to show is that the risks of head injury in activities such as walking are not demonstrably lower than the risk in cycling, and that at a population level the scale of the problem within these activities is unquestionably very significantly higher.
The ultimate reason
Risk, taken across the population, does not stop when you get off a bicycle. The figures make that quite clear. In fact they make it clear that it may not even subside.
And this is The Brick Wall against which one has to beat one’s head when trying to discuss helmets: the fact that the evangelists believe cycling to warrant a helmet when real figures show that there’s no demonstrable risk above other activities for which even the evangelists argue that a helmet is not necessary.
(And this is true even with the risks presented by shared roads. Remove that risk and the numbers shift still further: in the Netherlands only 1 in 1000 cyclists wear a helmet, yet suffer a brain injury—including minor ones—only once every 6.5 million miles.)
If anyone still argues that cycling warrants helmets then that’s a perfectly valid argument, provided they also argue that walking and driving warrant it (suitable helmets are readily available). Otherwise, it’s just an opinion, and one based on prejudice and perception rather than information.
So, when helmet advocates ask the reason why, even after I’ve changed my behaviour to ride as safely as possible, I don’t wear a helmet for certain types of cycling (and, believe me, there are types of cycling for which I value my helmet very much) I can only offer one reason.
It is the very reason they (and I, and you) don’t wear a helmet when they’ve changed their behaviour so much that they’re not even cycling.