The pros and cons of mandatory bicycle helmets are hotly contested, as regular Croakey readers will know.

In the article below, Daniel Vujcich offers a suggestion for how to move the debate forward.

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Laying down a challenge to all sides of the bicycle helmet debate

Daniel Vujcich wries:

The debate about the appropriateness of mandatory helmet laws has resurfaced recently.  Lower than anticipated levels of public interest in both the Brisbane and Melbourne city cycle schemes has been attributed by some to the inconvenience of having to wear a helmet or risk a penalty.

In this blog, comments on previous posts regarding the health benefits of helmets have closely resembled Newton’s Third Law – that is to say, almost every empirical claim has a tendency to be met with an equal and opposite counter-claim.

The babel of a statistical warfare can often be hushed by the clear voice of a Cochrane Review. 

A 2008 review (up-to-date as of September 2009) accounted for the methodological quality of available studies and “found positive evidence that bicycle helmet legislation both increases bicycle helmet use and reduces bicycle related head injuries”, with the proviso that “enforcement is necessary to ensure compliance”.

However, the conclusion was accompanied by a number of caveats – namely, (1) it is difficult to obtain full and accurate information about actual helmet use; and (2) it is difficult to determine whether decreases in head injury rates are a product of helmet laws or other factors such as changes in hospital admission procedures, or lower levels of bicycling.

While the Review only included studies with a comparative control group so as to discount alternative explanations, five of the six studies compared child head injuries (following the introduction of a mandatory child-specific helmet law) with those of an adult control group.  The Review authors noted that “comparing adults with children may be problematic”.

Three years on and the promise of a statistical cease-fire has proved ephemeral.

Yet, to employ a school yard analogy, there is only so much that one can achieve by countering every “is not” with an “is so” when it comes to political debates.

Until the day that the much coveted Study-to-End-All-Studies is delivered, I argue that pro-helmet proponents need to bolster their discursive arsenal if they are to effectively defend their position in the face of a recurring media appetite for reform.

Aside from statistics, one weapon that is currently invoked by pro-helmet advocates is the ‘precautionary policy principle’ – the idea that, in the absence of scientific consensus, policy makers are justified in adopting a course of action which allays a suspected risk.

However, the precautionary principle leaves us wanting.  As Cass Sunstein (2003) has forcefully argued, the central weakness of the precautionary principle is not that “it leads in bad directions, but because … it leads in no direction at all.  The principle threatens to be paralysing, forbidding regulation, inaction, and every step in between.”

Protecting society from the suspected risk of increased rates of head injuries in turn exposes it to the suspected risk of a potentially less active population, and all that that entails.  Thus, through an application of the precautionary principle, the two warring camps once again find themselves at an impasse.

From my perspective, a better strategy for helmet law proponents is to rely on the economic/cognitive behavioural theory of loss aversion.  In short, the theory states that most people favour avoiding losses to making gains.

Thus, in the present situation, when faced with a lack of scientific consensus, the general public should prefer to maintain the status quo. This is because if the current law is lifted there is a plausible risk that bicycle-related injuries and mortalities might increase, which would constitute a loss to society.

Since avoiding plausible losses is preferable to making plausible gains, the promise of a potentially more active (and perhaps more healthy) society than we currently have would be considered insufficient to justify the risk.

The onus therefore shifts to those in favour of reform to demonstrate that the potential societal health gains are big enough (and inevitable enough) to warrant a deviation from the default preference for loss aversion.

Should the pro-reformers manage to achieve this, those arguing for the status quo would rightly be left helmet in hand.

Daniel Vujcich is a graduate of the University of Western Australia.  He is currently on a Rhodes Scholarship to the University of Oxford where he has completed a Master’s degree in International Development, and now reads for a doctorate in Public Health.  His research relates to the way in which Indigenous Australian health policies are formulated.

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Peter Fray
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