Recently the Saskatchewan Urban Municipalities Association (SUMA) adopted a resolution saying that bicycle helmets should be mandatory for all Saskatchewan cyclists. Prince Albert Mayor Greg Dionne was quoted in the Star Phoenix as saying “There’s lots of medical proof out there now that shows bike helmets not only save lives, (but also) brain injuries, all kinds of things.”
As with any such resolution there is considerable debate between the medical community, cycling advocates, and politicians. The debate is mainly because helmets offer considerable individual benefit and little benefit to the population as a whole.
I want to try and get out of the generalities of the discussion and ask, what would a mandatory bicycle helmet law look like in Saskatchewan? I pulled together some information from the Traffic Accident Information System (TAIS) of SGI. In 2013 (the most recently available data), there were 142 people on bicycles injured and 2 killed in road traffic collisions. This is down from 155 injured and 1 killed in 2012.
We now have some baseline information. At best, assuming all injuries were head injuries, the helmet bylaw is going to prevent 1-2 deaths on bicycles per year and 142-155 injuries per year. I don’t think either assumption is very good. Also, there is no specific Saskatchewan data in the TAIS on helmet use so we need to make some assumptions.
Table 1. 2013 Traffic collisions statistics in Urban Communities with a Population of 5,000 or more
Note. The table above combines information from Table 11.2, 11.3, and 11.4 from the 2013 TAIS annual report.
Assumption 1: Find additional information about the risk of death when a cyclist is involved in a collision when wearing or not wearing a helmet. A study from Ontario estimates that of 129 deaths on bicycles in Ontario 58 (45%) could have been avoided if the person was wearing a helmet.1 Applying that estimate to Saskatchewan the helmet bylaw could potentially save 0.5 to 1 life per year.
Assumption 2: Find additional information about the percent of people on bicycles head injuries compared to total injuries. In another recent study2 the percent of head injuries compared to all injuries was 40% (update – I had an email from Kay Teschke at UBC who mentioned that the 40% figure was an overestimate because of the registry used in the study. She is current conducting a study that shows that the number for Saskatchewan is 26%). So assuming that head injuries take place in 40% of injuries on bicycles a mandatory helmet law would result in 57 (142*0.40) to 62 (155*0.40) fewer head injuries. Updated numbers range from 37 (142*0.26) to 40 (155*0.26). We haven’t changed the number injured, that’s still between 142 and 155.
In an editorial by the Star Phoenix, SGI is quoted as saying that it “focuses its efforts on positive reinforcement and education rather than legislation.” I cannot speak to the costs of enforcement but my guess is, given the small benefit and high cost of enforcement, SGI does not think the helmet law worthwhile.
The statement by SGI is also crucial because the discussion above includes a third assumption, that helmet enforcement is perfect. That everyone involved in a collision on a bicycle would be wearing a helmet if a law were in place. This is unlikely to be the case. As a public health researcher, an equitable enforcement strategy is crucial if a helmet law were to pass. We cannot burden those who cannot afford helmets, in particular children, with fines (or other penalties) for non-compliance.
One final note, research is increasingly clear that bicycle-specific facilities that reduce interactions between cyclists and cars can prevent 50% of all bicycle injuries.3 Using the data from 2013, with infrastructure improvements like separated bike lanes and traffic calming we could reduce all cyclists injuries, not only head injuries in Saskatchewan from 142 to 71 and have the same net benefit (0.5 to 1 life saved) for deaths as the helmet law. There is also no enforcement problem. The infrastructure does the enforcement so SGI does not have too.
- Persaud N, Coleman E, Zwolakowski D, Lauwers B, Cass D. Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case–control study. Canadian Medical Association Journal. 2012:1–3.
- Graves JM, Pless B, Moore L, Nathens AB, Hunte G, Rivara FP. Public Bicycle Share Programs and Head Injuries. 2014;104(8):e106–e111.
- Reynolds CC, Harris M, Teschke K, Cripton PA, Winters M. The impact of transportation infrastructure on bicycling injuries and crashes: a review of the literature. Environ Health. 2009;8(1):47.
More Reading (some paywalls)
- Dennis J, Ramsay T, Turgeon AF, Zarychanski R. Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis. BMJ. 2013;346:f2674–f2674.
- Goldacre B, Spiegelhalter D. Bicycle helmets and the law. BMJ. 2013;346:f3817–f3817.
- Bateman-House A. Bikes, Helmets, and Public Health: Decision-Making When Goods Collide. American Journal of Public Health. 2014;104(6):986–992.