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It makes sense that kids wear helmets on bikes because they can fall. But I see no reason for helmets for adults who know how to ride a bike. What’s the point? – Jim, Toronto

No matter how old you are, wearing a bike helmet is a no-brainer, says a Toronto emergency physician.

“There’s overwhelming evidence that helmets reduce the risk of head injury by somewhere between 60 and 90 per cent,” said Dr. Eric Letovsky, chief of emergency medicine at Trillium Health Partners. “Cyclists are very vulnerable to catastrophic injuries.”

Letovsky wrote a 2015 Canadian Association of Emergency Physicians (CAEP) position statement calling for mandatory helmet laws across Canada.

Six years later, CAEP’s position hasn’t changed, Letovsky said.

“As Canadian emergency physicians, we feel strongly about this,” Letovsky said. “We see the impact of people not wearing helmets all the time.”

Four provinces – British Columbia, New Brunswick, Prince Edward Island and Nova Scotia – require all cyclists to wear a helmet.

Three more – Alberta, Manitoba and Ontario – require helmets for cyclists under 18.

The other provinces don’t require helmets. There’s an exception for e-bikes, though – most provinces require anyone on an e-bike to wear a helmet, regardless of age.

Some cycling advocates are, well, hard-headed when it comes to helmet laws.

They argue that helmet laws discourage people from riding bikes.

“We support and encourage the use of helmets by cyclists of all ages, but also recognize an adult’s right to make their own choice,” said Keagan Garz, executive director of Cycle Toronto. “More people will choose not to ride if they must wear a helmet.”

But, most research shows that any reluctance to ride a bike because of helmet laws is short-lived, Letovsky said.

“It’s not associated with a change in ridership,” Letovsky said. “And there’s overwhelming evidence that people are more likely to wear a helmet once there’s legislation.”

Helmet laws applied unfairly?

There are also concerns that helmet laws may be enforced “inequitably,” said Kay Teschke, professor emeritus in the school of population and public health at the University of British Columbia (UBC).

In Seattle, an analysis of 1,667 helmet infractions issued between 2003 and 2020 found that Black cyclists got tickets over three times more often than white cyclists.

That’s led to calls in Seattle to scrap the helmet law, which comes with a US$30 fine.

Some critics of helmet laws say the biggest problem is that they don’t solve the real cause of injuries – roads that aren’t safe for cyclists.

In a 2015 UBC study looking at hospitalization rates for cyclists from 2007 to 2011, the number of brain, head and face injuries wasn’t lower in provinces with helmet laws.

UBC’s Teschke, the lead author in that study, said she wishes emergency physicians would focus on “safe bike routes that both lower injury risk and welcome people to use this healthy and safe mode of transport.”

That means separated bike lanes and lower speed limits, Teschke said.

“In countries like the Netherlands where helmet use is rare but bike infrastructure is well designed, biking injury and fatality rates are much lower than here,” Teschke said.

CAEP’s Letovsky said evidence shows that building better infrastructure is “probably the most important” means to reduce crash injuries for cyclists.

But all cyclists should still be wearing helmets, he said.

“It’s important to remember that bike helmets are just one component of improving cyclist safety,” Letovsky said. “But they do reduce serious injuries.”

Some critics of helmet laws “bend the science,” Letovsky said.

“People get very ideological,” Letovsky said. “People say these laws infringe on their rights, but they said that about seat belt laws as well.”

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