Cycle helmet promotion by Stockton Borough Council
Stockton Borough Council have released a radio advertisement, broadcast on Galaxy FM, to promote cycle helmet use. I do not currently have a transcript so please excuse any minor inaccuracy in transcription, however the gist of it is as follows:
A voiceover (in the style of radio storybook readings): One day whilst he was cycling to school Timmy saw Daniel with a cycle helmet on. Timmy laughed at Daniel and said to him: "Look at you with your helmet on, you big 'nana!" Daniel felt bad, but he went on wearing his cycle helmet anyway. The very next day Timmy saw Daniel wearing his helmet again and began to laugh out loud. Then, all of a sudden, a car came round the corner and knocked them both to the ground. Bounce! went Daniels helmet on the kerb. Smash! went Timmy's fragile head. Splosh! went his brains as they spewed onto the path. Oh dear! Timmy wasn't laughing any more. Timmy would never laugh again.
Few people dispute that cycle helmets are of some utility in reducing minor injuries and even concussions in cyclists. That is not the point.
Equally, few, if any, would suggest that a cycle helmet offers effective protection against massive trauma suffered in collision with motor vehicles. To suggest, as this advert does, that a cycle helmet, made of polystyrene foam, is capable of bouncing off from an impact sufficient to smash the skull and splatter brains on the road simply beggars belief. The human skull is not fragile, it is remarkably tough.
Consider if you will the ASA's reaction if a cycle helmet manufacturer were to use this story in an advertisement. Would the ASA consider the claims adequately supported by evidence?
Now consider the possible adverse effects of a trusted source - the local authority - essentially telling children that helmets will provide complete protection when hit by a car. Can the Authority think of any possible good outcome from this?
Complaints
1. The implied claim that helmets are specified for or effective in road traffic crashes lacks an evidential basis and is misleading.
a. No cycle helmet currently on sale in the UK (or anywhere in the world to my knowledge) is designed or certified to resist impacts by motor vehicles. To suggest that they are capable of protecting in collision with motor vehicles is to imply a claim well beyond those which the manufacturers can or do make.
b. The most widely-cited study supporting helmet efficacy includes no helmeted cyclists in collision with motor traffic. This is not unusual. In fact, I know of no robust evidence that helmets have any significant proven efficacy in preventing serious or fatal injuries, particularly those sustained in collision with motor vehicles (Thompson et. al, 1989).
c. Whole population data indicates that substantial changes in helmet use rates are not matched by equivalent changes in head injury rates in road traffic crashes (Scuffham & Langley 1997, Robinson 2000 etc.)
2. The implied claim for efficacy in converting an impact sufficient to cause the injury described, into a simple "bounce", is greatly in excess of the published standards and is therefore misleading.
a. The test to which helmets are subjected under EN1078 is under 50J for a flat surface impact; this is equivalent to a drop of around 1.5m and is highly unlikely to cause the injury described - and even then many helmets fail this test.
b. Notwithstanding the above, in as much as evidence exists for efficacy against anything other than trivial injuries, it is mainly based on hard-shell helmets certified to the Snell B90 standards; such helmets are now very rare in the UK, almost all helmets on sale in UK shops are certified to EN1078 which is substantially weaker than the Snell standard (Walker, 1998).
c. Notwithstanding the above, children's helmets are tested to a lower energy level than adult helmets (around half the energy of the largest adult helmets); the studies cannot therefore be robustly extended to cover performance of children's helmets (Walker, pers. comm., 2005).
3. The advert is an unwarranted appeal to fear.
a. The type of injury described is rare. In 2003 fewer than six hundred of the estimated six million children with bicycles - one in ten thousand - suffered a head injury which could justly be classed as serious, and fewer than twenty were killed cycling (Hansard 2004, Department for Transport, Department of Health, Franklin & Chapman, 2005).
b. Of those injuries recorded as serious, most would have no lasting consequences. The definition of serious injury in Stats 19 returns is largely subjective but will include cuts severe enough to require stitches, broken wrists, many scalp cuts (which tend to bleed out of all proportion to their actual severity) and other injuries which are not life threatening.
c. The risk for child pedestrians is at least as great (as measured by the proportion of injuries which are head injuries and serious head injuries), and arguably much greater (as measured by the numbers of child pedestrians killed or injured), as that for cyclists, so any appeal to fear based on cycling is a misdirection and likely to deter a healthy activity. There is evidence that cycling is deterred by aggressive cycle helmet promotion which portrays cycling as dangerous (TRL, 1994).
d. Therefore, there is no sound evidential basis for the idea that such injuries are likely, or that cycling is more likely than any other cause to lead to such injuries.
e. The appeal to fear is probably designed to provoke a “prudent” response; however, the response is not relevant to the fear raised. It might be reasonable to discuss fire victims in a campaign to promote smoke alarms, where there is a reasonable chance that use of the product might mitigate the problem and prevent the injury. In this case it is most implausible that cycle helmets could prevent massive trauma in road traffic crashes.
4. By implying that helmets have a substantive effect in collisions involving motor traffic, the advert risks causing harm.
a. Efficacy is so grossly overstated as to actively discourage the caution appropriate to the strictly limited protection afforded by helmets, as detailed by the manufacturers in the documentation supplied with those helmets and by the relevant Standards.
b. If the response to the advert is to wear a helmet rather than address lack of skill, poor maintenance, unsafe practice (such as playing on busy or fast roads) or local issues of speeding or poor road layout, then this would in fact be a highly imprudent response, giving the impression that risk has been managed when it has not. By focusing on the intervention which is probably least likely to prevent this injury, alternative, probably more effective interventions are swept aside.
c. Researchers have documented increased willingness to take risk in children when wearing cycle helmets (Mok et. al., 2004), and Adams and Hillman also documented this “risk compensation” behaviour in cyclists (Adams & Hillman, 2001). This possibility must be allowed for. The advert does not allow for this and indeed makes it more likely by inflating the claims of benefit.
5. The advert exploits the credulity of children.
a. It encourages children into a wholly unrealistic idea of the efficacy of cycle helmets.
b. It implies that this might reflect a real or likely incident. I know of no case where two children have been hit by a car in the same crash and experienced the different outcomes detailed. I know of no incident which is sufficiently close to that described, to justify its use in this context. Even if such a case existed it could hardly be described as anything other than a freak incident: for one child to be injured to that degree and the other to suffer no injury whatever would, if true, be quite astonishing. An audience of children is much less likely to appreciate this.
c. It implies that road traffic crashes of this type are frequent. Injuries of this severity are rare, as stated above (actually I would be faintly surprised if the advertisers could produce any documented cases where the skull has been laid open and brain matter spread on the pavement as described); there were just ten fatal child cyclist head injuries in England and Wales in 2003, and figures have been falling year on year for some time.
6. The advert implies that this kind of injury is a dominant cause of severe injury and death; this is misleading.
a. The story focuses on linear impact leading to skull fracture as a source of permanent intellectual disablement or death. This is a controversial view - the theory that such “coup / contre-coup” injuries are the dominant source of serious brain injury is based on some controversial research on monkeys and is now widely considered to be out of date or even discredited. Current thinking is that rotational or torsional forces leading to diffuse axonal injury is at least as significant if not more so, especially in the more serious cases (e.g. Curnow, 2003 & 2005). Cycle helmets do not mitigate these forces – this is one of the possible explanations for their failure to reduce recorded head injuries in real populations of cyclists.
b. Diffuse axonal injury is of particularly concern in road traffic collisions, due to the high accelerations involved. Rotational injury is one of the major focuses for current research, and is the driving force behind the development of side airbag curtains in cars.
c. The advert also ignores spinal injury, which is a source of “head injury” disability and death beyond the capacity of helmets to mitigate.
d. Overall, and given that around half of fatalities are not head fatalities to start with, it seems very unlikely that blunt trauma to the cranium is responsible for more than a minority of fatal or permanently disabling head injuries in cyclists.
7. The advert risks encouraging or condoning unsafe practices by both cyclists and other road users.
a. The dominant factor in determining survivability of a car v. bike collision is almost certainly the speed of the car (e.g. Joksch, 1993). Drivers hearing the advert may believe that their obligation to moderate their speed around children is subsidiary to the children’s obligation to wear helmets. This would be dangerous even if helmets did provide meaningful protection, as around half of child cyclist fatalities result from injuries to other parts of the body.
b. It risks
encouraging cyclists to use the footway instead of the road, to avoid the potential for motor impact. International research shows that pavement riding can be up to ten times more dangerous than road riding due to conflicts at junctions, loss of priority etc. It is also illegal.
c. It offers an excuse for drivers and traffic engineers to evade their responsibilities, and draws attention away from effective primary safety initiatives such as cycle training. A survey of doctors by the BMA and a report by TRL have both concluded that of a range of possible interventions to improve cyclist safety, helmets are the least effective, with TRL according cycle helmets and bicycle construction changes combined only 1% of a possible 27% cyclist injuries potentially saved by all interventions (TRRL, 1986; BMA, 2001); yet of 28 publicly funded “cycle safety” interventions recorded in 2003, 25 were helmet campaigns (DTi HASS/LASS 2003). This diversion away from more proven interventions is a source of great concern to cycle safety analysts.
d. It gives the misleading impression that head injuries are the only cause of concern. As mentioned above, of the 19 children killed cycling in 2003, nine (47%) did not die of head injury, and of the remaining 53% an unknown proportion would have had other mortal injuries as well as fatal head injuries. The largest single cause of cyclist fatality is crushing by left-turning goods vehicles, usually resulting in massive abdominal trauma. To focus on head injury in this way encourages both drivers and cyclists to assume that once a helmet is worn, the cyclist is effectively protected from all likely harm.
e. It implies that children killed or injured while cycling have only themselves to blame, a belief which is widely held and results in cyclists being blamed just for being there even when drivers are convicted of driving offences. But most sources consider cyclists the least likely of all road users to be at fault in collisions resulting in their own serious injury or death, making cycling arguably the least appropriate of all possible focuses for road safety campaigns. Still, the typical penalty for negligently killing a child cyclist currently runs at less than £500 fine and six penalty points: society is sending a clear message, which this advert reinforces, that the burden of care lies with cyclists, rather than those who pose danger to them. In 2001 an insurer initiated legal action against the parent of a child injured by one of its insured, who was wholly to blame for the crash, on the grounds that the child was riding unsupervised on the road without a cycle helmet. The action was withdrawn after substantial pressure from cyclists, but the Cyclists’ Defence Fund, set up in response to this case, is still fighting cases where cyclists are falsely blamed for their own demise. The authority will remember that in reality cyclists, like all non-motorised traffic, have a right to use the road, while motorists use it only under strict licence.
f. In implying that cycling is a major source of serious or fatal injury, the advert obscures both the danger posed by negligent motorists, and the parallel risk experienced by child pedestrians. Involvement of motor traffic is the largest single indicator for serious and fatal injury in children: around one in ten injury admissions to hospital are from road traffic injuries, but they account for half of all fatalities. The great majority of these are not cyclists. Injury rates and severity ratios for cycling away from traffic are much lower – possibly up to an order of magnitude lower, indicating that it is not cycling per se which is dangerous, but motor traffic, and the risk for child pedestrians is as high or higher. Thus it is possible that the advert may cause parents to instruct children to travel on foot instead of by bicycle, with no reduction to their chances of injury, or may take them by car, which increases overall road danger.
8. By singling out cycling in this way, the broadcast falsely implies that cycling is unusually dangerous or unusually productive of head injury. This is misleading and irresponsible.
a. In comparing hospital admission data for children in England and Wales over a seven year period up to 2003, I found no evidence that children were significantly more at risk of head injury when cycling than when engaging in other comparable activities. Trips and falls are the major source of child head injury. The proportion of hospitalisations due to head injury in child cyclists is about average for all child accidents, and the proportion of head injuries in child cyclists in collisions with motor traffic is similar to that for child pedestrians.
b. All studies comparing the levels of health and fitness of cyclists with non-cyclists are in agreement that cycling is more likely to lengthen your life than to shorten it. This result is hardly consistent with the idea that cycling is unusually dangerous and requiring special safety equipment
c. Amid widespread public concern regarding the effects of sedentary lifestyle on children's long-term health, campaigns highlighting the dangers rather than the benefits of cycling are likely to cause more harm than good.
d. It singles out one group for intervention when the intervention, if effective, would be of equal or greater benefit to other groups. Motor traffic risk applies equally to child pedestrians, whose head injury rate is comparable with that of child cyclists injured in similar circumstances - and over four times as many child pedestrians are seriously injured and killed on the roads each year. It is a smokescreen to obscure the real problem. I invite the Authority to draw the comparison with a campaign which might be focused on a particular racial group, when the majority (in this case pedestrians, a near-universal group) exhibits comparable attributes. The principle of relevant difference should surely apply.
9. The advertisement fails to make it clear that there exists a significant division of informed opinion regarding cycle helmets
a. Doctors, road safety practitioners and cycling experts disagree strongly regarding the efficacy of cycle helmets. This division of informed opinion is not reflected in the emphasis of the advert or in its content
b. The advert portrays the issue as entirely black and white; having read several hundred research documents I can state with some confidence that this is not so.
c. No court in the UK of which I am aware has thus far held that a cycle helmet would have made the difference in any case of cyclist injury involving motor traffic (Fullbrook, 2004).
10. The statement “accidents can happen any time” implies that nothing can be done by the individual cyclist to mitigate this problem. This is false.
a. There is agreement among cycle safety practitioners that a few simple roadcraft techniques can dramatically reduce the likelihood of being hit by a car.
b. Being hit from behind is a rare type of crash, occurring more often on rural roads (where children rarely cycle); urban cycle crashes are more likely to result from sources such as failures to observe and conflicts of priority where cycle tracks meet roads. Adequate training can reduce the likelihood of collision in these circumstances.
c. The majority of road traffic collisions are not accidents. According to police, around 90% are due to negligence. The word accident is considered contentious by many.
11. The advertisement shows undue partiality in the context of an ongoing political controversy regarding the promotion of cycle helmets.
a. In 2004 there was a failed Bill before Parliament to compel children to wear cycle helmets when riding on the road, in playgrounds and other public open spaces. The issue is still live and was raised by the Bill’s sponsor in Parliament during debate on the Road Safety Bill in March 2005.
b. Several Early Day Motions have been tabled on the issue of cycle helmets, their promotion, and compulsory use. There has been at least one Ten Minute Rule bill on the same subject.
c. The National Cycling Strategy Board, official advisers to the Government on cycling matters, expressed great caution regarding helmets and said that as a matter of public policy it should be left to the individual.
d. Moves for compulsion are primarily founded in the main on claims of efficacy as a road safety measure and falsely vivid and unrepresentative cases like that in the advert. |