Cycling: health and safety
study for HotM2
Presenters:DrJenniferMindel
MalcolmWardlaw
JohnFranklin
Cycling Seminar, University College London, 26th September 2011
Topics
 Health & Safety basics – the Hierarchy of Controls
 Risk in cycling and other modes of travel
 Cycling and health
 Review of cycle helmet research and experience
 HotM2 conclusions on cycling – what should be done?
 Q&A
 Discussion– “achieving a cycling revolution”
Cycling Seminar, University College London, 26th September 2011
HSE fundamentals - The Hierarchy of Controls
Most effective
Risk
 Reduce hazard at source – reduce and enforce speed limits,
increase cyclist numbers, reduce traffic, reduce vehicle size, strict
liability law, enforce existing manslaughter law, “friendly” vehicle
design, raise driving age to 21yo
 Contain the hazard – restrict motor traffic access, limit HGV
access to major roads
Risk
 Reduce exposure to hazard – traffic calming, off-highway
cycle routes, cycle paths on trunk roads
 Training and supervision – National Cycling Proficiency,
parental supervision
Risk
 Personal protective equipment – helmets and high-viz jackets
Least effective
Cycling Seminar, University College London, 26th September 2011
Risk in cycling and other modes of travel - 1
“Traditionalist” risk assessment creates confusion…..
22 KSI per billion KM travelled
530 KSI/Bn KM based on police-reported casualties
24 x driver risk
1,850 KSI/Bn KM based on hospital admission data (HES)
84 x driver risk
….so cycling is really dangerous?
NO!
370 KSI/Bn KM based on police reported casualties
17 x driver risk
430 KSI/Bn KM based on hospital admission data
20 x driver risk
6,500 KSI/Bn KM if admissions due to falls* are included
295 x driver risk!
Pedestrian falls don’t count as “transport accidents” in HES…
99% of road safety researchers do not grasp this point….
Cycling Seminar, University College London, 26th September 2011
2006 UK data from Road Casualties Great Britain 2007
* Falls “in highway “and “in unspecified location”.
Risk in cycling and other modes of travel - 2
Subtleties of STATS19 & ICD-10 (HES) have led to confusion…..
….. Popular wisdom has it that serious cyclist injuries are under-reported by the police…………
..or..
= “non-traffic transport accident” (HES)
(“unspecified transport accident” actually)
c. 5,000 admissions in 2006
= “fall” (HES) c.120,000 admissions in 2006
..or..
not coded as transport accident in ICD-10
not reported by police in STATS19
In HES, ALL cycling injuries are coded as “transport accidents” irrespective….
…… popular wisdom is wrong….
……..in reality, pedestrian transport injuries are mis-coded as falls in HES (ICD-10).
Cycling Seminar, University College London, 26th September 2011
Risk in cycling and other modes of travel - 3
Time is the most important basis in transport risk….
5 km/hr
13 km/hr
40 km/hr
+
40-50 km/hr
Cycling Seminar, University College London, 26th September 2011
Risk in cycling and other modes of travel - 4
…indeed, riding motorbikes
is relatively dangerous…
Cycling Seminar, University College London, 26th September 2011
…averages reveal and yet conceal…
…cycling risk within range of drivers’ risks.
Figures based on 2006-2008 data
Risk in cycling and other modes of travel - 5
Risk in UK cycling and driving across the decades…
 Best years for cyclists’ safety 1973-1981, with fast growth in cycle use;
 Cyclist and driver safety have run parallel for >40 years.
Cycling Seminar, University College London, 26th September 2011
Risk in cycling and other modes of travel - 6
Does it matter if risk is exaggerated?
Conditioned promotion of cycling:
YES.
“Negative” infrastructure:
Contributory negligence:
Contributory negligence:
Risk compensation:
Cycling Seminar, University College London, 26th September 2011
Risk in cycling and other modes of travel - 7
Conclusions regarding the risks of cycling and other modes of transport:
1. Risk per hour is the most meaningful basis of comparison;
2. Risks of motorcycling are clearly much higher than other modes;
3. Risks of cycling vary by place and by time;
1. Over time, the risks fall in line with road safety improvements;
2. Risks vary from place to place in similar range to drivers’ risks;
3. More cyclists mean safer cycling (of which, more later);
4. Young drivers face higher risks than young cyclists;
Current safety policies for cycling do not match actual risks.
The correction of flawed policies will be the fundamental task…..
Cycling Seminar, University College London, 26th September 2011
Cycle helmet research and experience - 1
A confrontation of views lasting decades……
•
•
•
Clinical evidence of effectiveness (60+%
reduction in head injury);
Reinforced by meta analysis;
Widely supported by emergency medicine
community;
•
•
•
Health benefits of cycling greatly exceed
the risks of an accident;
Cycling is benign;
Helmet laws and promotion deter people
from cycling;
Both sides missed the point: no risk assessment!
Cycling Seminar, University College London, 26th September 2011
Cycle helmet research and experience - 2
The problem is the chaos of evidence…..
Helmets must have
a hard outer shell to
be effective.
Case-control studies show
that helmets prevent 6088% of brain injuries.
Helmets reduced child
cyclists fatalities by 50% in
Ontario.
Helmets increase the
risk of diffuse brain
injury due to rotation.
Risk compensation leads to
more serious crashes.
Ahem! Helmet use did not change
in those years…..
Biomechanical
evidence shows that
helmets can save lives.
Observational studies
are not reliable – look at
cannabis smoking and
schizophrenia…
…and the paucity of proof…………
Cycling Seminar, University College London, 26th September 2011
Cycle helmet research and experience - 3
This is a populationlevel result.
Effect of New South Wales (AU) helmet law
These
are
not.
Effect of New Zealand helmet law
Cycling Seminar, University College London, 26th September 2011
Cycle helmet research and experience - 4
Three “bridges” link the contradictory evidence:
•
•
Meta-analyses of case-control studies did not account for
publication bias or time-trends bias;
Inclusion of neck and facial injuries reduced (corrected) net
protective effect to zero in recent studies;
Selective recruitment – those who choose to wear a helmet
tend to be from social groups the least likely to suffer death or
severe injury in accidents (i.e. mid to upper income and
educational attainment).
Biomechanical tests do not replicate real-world accidents.
Plastic yielding of helmets is rarely, if ever, seen outside the
laboratory. Helmets crack and break up in practice.
Cycling Seminar, University College London, 26th September 2011
Cycle helmet research and experience - 5
Effects of (enforced) helmet legislation on cycle use:
New Zealand, 75% drop in children cycling 1989-2008
(helmet law from 1/1/94)
“Only” 30% drop in children walking…
Utility cycling in Australia is almost nothing and
is going nowhere.
Beware.. .Helmet laws not enforced won’t deter cycling! (not too much…)
•
•
•
Ontario Under-18’s helmet law 1995;
California Under-18’s helmet law 1994;
Many other US state child helmet laws;
Cycling Seminar, University College London, 26th September 2011
HotM2 principal conclusions on cycling - 1
• The risk in cycling is very low – in the range of driving or walking –
helmet promotion not indicated;
• Cyclists rarely harm 3rd parties;
• More cyclists mean safer cycling – and safer roads;
• Health and Safety policies must reflect these facts!
• At present they do not……….
The health benefits of cycling are very large –
as great as cessation of cigarette smoking…
Cycling Seminar, University College London, 26th September 2011
HotM2 principal conclusions on cycling - 2
What should be done?
Parking
&
“bike docks”
Training
+
Bike
&
Combined with
public transport
More “positive” infrastructure
(i.e. Hierarchy of Provision)
Respect the safety case for cycling:
*Cycling is low risk; *Safety in numbers; *Cycling is a source of safety.
*Change Highway Code; *Change BMA policy; *Stop contributory negligence.
“Myth shall prevail if the wise remain silent….”
Cycling Seminar, University College London, 26th September 2011
Priority
Quality
Network
Beware… myths die hard…..
“In the Netherlands, 45% of those seriously injured on the roads are injured while cycling
with no motor vehicle involved….”
(from European Transport Safety Council 5th Road safety PING Report 2011).
“Pedal cyclist casualties account for 17 per cent of HES road traffic accident casualties in
England…”
(from Road Casualties Great Britain (2006)).
“A specialist biomechanical assessment of over 100 police forensic cyclist fatality reports
predicted that between 10 and 16% could have been prevented if they had worn an
appropriate cycle helmet.”
(from p1 of DfT summary of Report PPR446 (2009).
“…it was not possible to quantify the amount of benefit offered by modern cycle helmets in
the UK from the literature review alone.”
(from p3 of same summary report).
… and finally: my helmet saved my life.
Cycling Seminar, University College London, 26th September 2011
Cycling Seminar, University College London, 26th September 2011