Helmets and health care

Did you see this story in yesterday’s New York Times? It’s about bike-sharing programs in cities around the world—existing ones in Amsterdam, Dublin, Melbourne, Minneapolis, and Paris, and the upcoming one in New York—and the effect that helmet rules have on their success. The basic thrust of the article is that forcing riders to wear helmets discourages the use of bikes in these programs and that whatever safety benefits helmets provide are negated, in terms of overall public health, by the higher rates of obesity and heart disease in populations that don’t do as much bike riding.

I won’t argue the value of helmets one way or the other, because I haven’t seen the accident statistics. I will say, though, that I was surprised to see no mention in the story of either mandatory seatbelt laws or national health care programs.

It’s not that I think seatbelt laws are truly analogous to bike helmet laws. There are certainly similarities: both seatbelts and helmets are safety devices that do nothing to prevent accidents but lessen the severity of injury during accidents; and both are devices that one would advise every individual to use. But advising an individual and advising society are two very different things. Seatbelt laws don’t discourage driving,1 and even if they did, less driving doesn’t make people less healthy. Bike helmet laws, on the other hand, do discourage riding—among adults, anyway—and less riding makes for a more sedentary, less heathy population. So there’s a distinct health tradeoff with bike helmet laws that doesn’t exist with seatbelt laws.

The more puzzling omission is that of national health care. The cities with successful bike sharing programs do not require helmets and most of them—Minneapolis and Washington being the exceptions—are in countries with national health care, which flies in the face of the “nanny state” stereotype many Americans associate with socialized medicine. Is it because these cities have weighed the costs and benefits and made a cold, rational decision that lots of helmetless riding is better for the health of the citizenry (and is therefore less expensive to the national health care program) than a little helmeted riding? This is ultimate practical application of cost/benefit analysis, and the article is utterly silent on it.2

Health care in the United States, what it costs, how it gets paid for, and future restrictions that may be imposed, has been the subject of a continuing argument here for years. It’s a prominent issue in the presidential campaign and will certainly be addressed in this week’s debate. This the kind of story that could show that national health care involves more than just hospitals and insurance companies and government bureaucrats. But it didn’t. A missed opportunity.

  1. Has anyone ever given up driving because he was forced to wear a seatbelt? If so, we’re all better off with him off the road. 

  2. The story does include quotes from a researcher in Australia whose studies suggest that the benefits of increased riding that come when helmets are not required outweigh the risks by 20 to 1. But there’s no indication that his work had any effect on the rules of any bike sharing program.