Evidence in support of bicycle helmet legislation
The central argument of submitters in favour of MHL was that, by
reducing the risk of head injuries including traumatic brain injury (TBI),
bicycle helmets protect the individual and save the community from the expensive
health and social costs associated with TBI.
Such submitters argued that bicycle helmets are the most effective way
to prevent injury and death in the event of a crash.
The Department of Infrastructure and Regional Development (department) stated:
There is clear evidence from research that helmet wearers
suffer fewer head injuries and that mandatory bicycle helmet legislation leads
to a reduction in reported head injuries (Carroll, Kinnear, Helman, Hynd and
Cuerden, 2014). In Australian research, a case-series study by McIntosh,
Curtis, Rankin, Cox, Pang, McCrory and Finch 2013 found that in the event of an
accident, bicycle helmets significantly reduce the likelihood and severity of
head and brain injuries for cyclists by a factor of 79 [per cent]. This study
also concluded that if helmet wearing rates increased, head and brain injury
reductions would be greater.
In response to concerns regarding helmets and personal choice, the point
was made that:
Even if a helmet is considered an impost or a reduction of
civil liberty, the long term effect of a head and brain injury on a victim's
family, carers and society are worse. For the child or adolescent with many
fulfilling years ahead of them, the event may be devastating.
Three key points raised in this regard were that:
helmets reduce the risk of serious injury by approximately 60 per
cent and in the case of death, by 74 per cent;
helmet wearers admitted to hospital represent a national health
resource burden which is less than half that of non-helmet wearers;
there is strong community support for MHL.
Therefore, in direct contrast to the opponents of MHL, the proponents
argued that the health and societal risks associated with traffic injuries far
exceed any benefits from cycling without a helmet.
Bicycle helmets and head injuries
The Neurosurgical Society of Australasia (NSA) argued that scientific
evidence, both prior to and after the introduction of MHL, indicated that
helmets have been effective in reducing the risk of head injuries, such as TBI
NSA drew on a study in Queensland which found that the risk of head
injury in bicycle accidents was reduced amongst children wearing a helmet by 63
per cent, while the risk of a loss of consciousness was reduced by 86 per cent.
Furthermore, it argued that, following the introduction of MHL, hospital
admission data in NSW revealed that head injury rates amongst cyclists had declined
significantly more than limb injury rates at the time of the legislation. It
concluded that, despite numerous data limitations, there was evidence of a
positive effect of MHL on cyclist head injuries at a population level such that
'repealing the law cannot be justified'.
Other evidence presented to the committee to demonstrate the efficacy of
helmets in relation to head injuries included:
a 2001–2009 NSW study which found that helmet use was associated
with reduced risk of head injury in bicycle collisions with cars of up to 74
per cent, and the more severe the injury considered, the greater the reduction;
a crash simulation study in children found that the risk of death
from head injury was reduced from 40 per cent to 0.3 per cent, while the risk of
death from a neck injury fell from 11 per cent to 1 per cent in those wearing a
the Cochrane review, which found that helmets provide a 63–88 per
cent reduction in the risk of head, brain or severe brain injury for all ages
a 1994 study in Victoria found that there had been a significant
reduction in the rate of cyclists head injury claims since the introduction of
MHL and a 40 per cent reduction in head injuries resulting in hospital
According to studies cited by The George Institute for Global Health,
non‑helmeted cyclists were more than three times more likely to sustain
intracranial injuries and four times more likely to sustain TBI when compared
to helmeted cyclists.
Further, it was noted that in each case-control study conducted to assess the
association between helmet wearing and head injury, it was found that the 'odds
of a head injury were significantly diminished for cyclists wearing helmets
versus those that did not'.
According to the Neuroscience Research Australia (NeuRA) Injury
Prevention Research Centre, bicycle helmets reduce the load that is transferred
from a head strike with the ground, or another object, 'via the helmet's
ability to attenuate energy'.
Specifically, bicycle helmets protect the head by reducing
the rate at which the head and brain are decelerated and by dissipating the
impact energy over an increased area. The effectiveness of the helmets are
therefore governed by the laws of physics, as long as helmets are designed
adequately...Furthermore, there is a large body of evidence from both laboratory
and real world studies that conclusively show that the use of a bicycle helmet
reduces a rider's chance of head injury.
Professor Raphael Grzebieta, Past President of the Australasian College
of Road Safety, informed the committee that the Curnow hypothesis, which argues
that on impact, a helmet can grip the road and twist the head, thereby causing
serious brain injury, had not been substantiated through appropriate testing.
He explained that testing conducted at the University of NSW had found that
wearing a helmet not only reduced the acceleration that is imparted to the
brain but also reduces the rotation of the head.
Similarly, the department stated:
Although some opponents to mandatory bicycle helmet
legislation have claimed that bicycle helmets contribute to rotational head
injuries, a review by Hynd, Cuerden, Reid and Adams (2009) found no evidence of
an increased risk of these injuries with a helmet compared to without a helmet.
Economic, health and social costs of head injuries and road trauma
The consequences of TBI were highlighted in evidence to the committee.
Dr Julie Brown, Senior Research Fellow at the NeuRA Injury Prevention
Research Centre emphasised the point that TBI can change the course of
someone's life, disrupt their family and reduce opportunities for education and
participation in the workforce.
An Access Economics report on the economic costs of TBI in Australia
detailed its impact as follows:
TBI can cause long-term physical disability and complex
neuro-behavioural effects which disrupt quality of life, including neurological
impairment (e.g. motor function impairment and sensory loss), medical
complications (e.g. spasticity and post-traumatic epilepsy), cognitive
impairment (e.g. memory impairment and problems with planning, language
and safety awareness), personality and behavioural changes (e.g. impaired
social and coping skills) and lifestyle consequences (e.g. unemployment,
difficulty maintaining interpersonal relationships and loss of independence).
NeuRA stated that head injuries can result in long-term or lifelong
physical, cognitive, behavioural and emotional consequences, and that:
In the acute setting, the costs to the healthcare system from
traumatic brain injuries and severe injuries are significant, making head
injury one of the most expensive diagnoses in the public hospital system.
The involved costs of TBI to survivors, their families and the community
were highlighted in evidence to the committee. In 2009, the estimated lifetime
costs per incident of TBI in Australia were $2.5 million and $4.8 million for
moderate to severe traumatic brain injury respectively.
The overall burden from TBI to Australia was estimated to be $8.6 billion
annually. According to NeuRA, the majority of these cases are due to transport
incidents, including bicycle injuries.
Furthermore, this cost extends for the duration of the patient's life as those
with severe traumatic TBI have more frequent and longer hospital visits and
require ongoing tests, investigations and follow-up.
As head injuries can result in long-term or lifelong physical,
cognitive, behavioural and emotional consequences, unlike some physical
consequences of severe injuries, many TBI issues fail to resolve over time.
Individuals with TBI may be precluded from obtaining an education,
participating in the workforce and in society more broadly.
Submitters highlighted the stress and financial hardship of providing
appropriate levels of care and support to effected families and friends with
Relatives who are carers may have to leave the workforce. Amongst parent carers
of children who sustain such injuries, there are higher rates of parental
separation and family breakdown along with high rates of anxiety, depression,
social withdrawal and isolation, financial difficulties as well as other role
Witnesses presented evidence arguing that the use of helmets by cyclists
presented a significant economic saving to the community. Representing a
combined membership of thousands of road safety and injury prevention experts
and organisations, the Australasian College of Road Safety (ACRS), Australian
Injury Prevention Network (AIPN) and Royal Australasian College of Surgeons
(RACS) provided evidence to support this view. They informed the committee that
data from the Victorian Injury Surveillance Unit revealed that there are over
500 hospital admissions of cyclists with head and neck injuries in Victoria
every year. These are in addition to a further 1000 emergency department
presentations for cyclist head, neck and facial injuries.
ACRS, AIPN and RACS argued that:
The natural extrapolation is that cyclists who do not wear
helmets are costing Australia's national health system three times as much as
those who do wear helmets – in terms of crash costs.
The point was also made in evidence that the causes and consequences of
road trauma can have a serious impact on Australia's national productivity as
well as its collective public health.
According to evidence, road trauma is arguably the highest ranking public
health issue the nation faces today.
ACRS, AIPN and RACS stated in this regard:
By the time we reach the final year of Australia's National
Road Safety Strategy 2011–2020, and assuming the 30% target reduction is
reached, road trauma will still have cost the Australian economy a
staggering $264 billion dollars over this 10 year period.
ACRS, AIPN and RACS argued, therefore, that any evidence-based measures
to decrease the rate of road trauma will have a 'positive impact on Australia's
collective public health as well as national productivity'.
They noted that the impact of road trauma not only left victims incapacitated
for life but that communities as a whole are affected by such deaths and
injuries – including workplaces, friendships and community networks – not to
mention the toll on the mental health of emergency workers and ambulance
workers, to name a few.
The NSA concluded that repeal of the MHL would:
...result in an enduring economic burden on our community and a
needless level of personal suffering for families left caring for individuals
disabled by traumatic brain injuries that will result from the inevitable
accidents involving bicyclists that do not wear helmets.
Furthermore, Headwest Brain Injury Association of WA noted that rates of
obesity are often used as an argument against MHL. However, it stated the view
...if an individual will not cycle purely on the basis of the
helmet laws, there are alternative sporting activities available. There are no
alternatives to a brain injury.
Dr Christian Kenfield, Chairman of the Victorian Trauma Committee of
the RACS also challenged the argument that Australians at risk of obesity
are not riding bicycles because of the MHL. Speaking as an obesity surgeon, Dr
Those patients who are already overweight and obese tend not
to want to ride a bike. They do not feel safe on a bike, and I speak to them
about this on a regular basis. When they have lost weight after the operations
that I perform, many of them do take up cycling and it is one of their great
joys. I dispute though that the people in society who are at risk of becoming
obese are not riding bicycles because of compulsory bicycle helmet laws.
Deficiencies with cycling infrastructure not helmets
Some submitters challenged the view that cycling participation rates had
not recovered since the introduction of MHL. ACRS, AIPN and RACS drew on
evidence from the Monash University Accident Research Centre which found that,
while there had been an initial reduction in the number of people cycling in
Victoria following the introduction of MHL, within two years, the number or
riders had returned to levels similar to that prior to the legislation for both
adults and children.
MHL supporters further argued that MHL did not serve as the barrier to
increased cycling participation that other submitters had suggested.
The George Institute for Global Health argued that:
There is no known research which demonstrates a negative
population health impact caused by decreased cycling due to the introduction of
mandatory helmet laws in Australia.
Furthermore, the view was put that there is no evidence to uphold the
argument that abolishing MHL would result in higher cycling rates.
Rather, it was argued that research had indicated that a combination of
increased personal safety and dedicated bike paths are the most effective way
to encourage greater levels of cycling.
This argument was supported by market research undertaken by VicRoads
along with a review of the Victorian road rules. Both sets of data revealed
that perceptions of safety and safe infrastructure, rather than MHL, were a greater
barrier to improving cycling participation rates.
According to evidence submitted to the committee, an estimated 94 per
cent of Australians support helmets and safe cycling infrastructure, rather
than removal of MHL, as the key to increasing cycling participation.
In this regard, the George Institute of Global Health stated that cycle
participation rates continue to increase in the major cities which have cycle
infrastructure that is conducive to personal safety.
The Cycling Promotion Fund Survey (2011) asked respondents who had
ridden a bicycle for transport in the past month what discouraged them from
riding for transport more often.
Out of the 158 respondents:
A common theme for not cycling more often was due to road traffic
conditions or safety. Respondents were likely to rate unsafe road condition,
speed/volume of traffic, lack of bicycle lanes or safety as key reasons for not
Similarly, the Women and Cycling Survey 2013 by the Cycling Promotion
Fund, found that, from a random sample of 1007 Australian women aged 18 years
and over, the main safety concerns associated with cycling, aside from personal
safety, involved traffic and cars; the speed and volume of cars and trucks; and
Sixty per cent of the women surveyed reported they would like to cycle more
than they currently do.
Professor Rebecca Ivers, Member of the Executive Council of AIPN, noted that:
...where people are asked about whether cycle helmets stop them
from cycling—if people cite cycle helmets it is a long way down the list. Even
if they cite cycle helmets as being important, it is still a stretch to
actually say, 'If we reduce helmet legislation, all of those people would cycle
and would become regular transport cyclists.'
In a submission to the inquiry, Dr David Dolan further argued that:
...a lack of suitable bicycle infrastructure, a lack of
suitable bicycle commuter cycle paths, a few over aggressive cyclists, a few
motorists with poor awareness of cyclists and much greater average commuter
distances than in many overseas cities can be considered the deterrents to more
people not cycling.
Submitters and witnesses put it to the committee that the lack of safe
cycling infrastructure was a major barrier to cycling in Australia, rather than
According to the George Institute of Global Health, the 100 per cent reported
increase in the number of people cycling to work in Sydney from 2011 to 2014
can likely be attributed to the 110 km of bicycle lanes constructed in and around
the central business district.
It argued that designing solutions which make cycling a safer experience would
prove to be much more effective than the removal of MHL.
In regards to questions on MHL deterring bicycle use in the public bike
share scheme environment, Associate Professor Jake Olivier, Member of ACRS
argued that Australian bike sharing schemes have been poorly set up and are
expensive to use. He stated that on the Gold Coast, the bike share scheme costs
$99 for three days. Alternatively, the tram costs $5 a day.
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