Report No. 053-12

TO:  Chair and Members of the Board of Health
FROM:  Graham L. Pollett, MD, FRCPC, Medical Officer of Health
DATE:  2012 April 19

Proposed All-Ages Bike Helmet Legislation for the 2012 Association of Local Public Health Agencies Annual Meeting

Recommendations

It is recommended:

1.   That the Board of Health endorse the resolution related to provincial all-ages bike helmet legislation attached as Appendix A to Report No. 053-12; and further

2.   That the resolution be forwarded to the Association of Local Public Health Agencies (alPHa) for consideration at the 2012 alPHa Annual Meeting.

Background

Unintentional injuries are the leading cause of death for young Canadians. Cycling injuries are one of the most common injuries incurred from summer sports and recreational activity. Seventy-eight percent of those hospitalized nationally with a cycling head injury were not wearing a helmet.  In Ontario, more than 1200 injured cyclists are admitted to hospital each year, thousands more present for medical care in the emergency department.

Cycling injuries are listed as the fourth leading cause of unintentional injuries for emergency visits; fifth leading cause of hospitalization; and eighth leading cause of deaths in Middlesex-London. There are 12.7 hospitalizations and 263.8 emergency visits per 100,000 population in Middlesex-London.  As well, Middlesex-London children and adults (ages 1 to 64) have a higher number of emergency visits due to cycling injuries than fro the province as a whole.

Head injuries are a common result of cycling incidents and represent a significant economic burden to society. Costs associated with cycling head injuries include hospital-related costs, rehabilitation costs, and support services costs for brain damaged individuals. It is estimated that each dollar invested in a helmet saves approximately $30 dollars in societal costs. A properly fitted helmet can decrease the risk of serious head injury by as much as 85 per cent.

Current Legislation

Current helmet legislation in Ontario requires only children under the age of 18 years to wear an approved bicycle helmet when cycling on a roadway or sidewalk.  However, all cyclists, both adults and children, are at risk for head injury. The Canadian Paediatric Society, Ontario Medical Association and Safe Kids Canada recommend Ontario amend its current bicycle helmet legislation to include all age groups.

To date, four provinces have enacted all-ages helmet legislation: New Brunswick, Nova Scotia, Prince Edward Island and British Columbia.  Research from provinces with bicycle helmet legislation demonstrates that helmet use has increased dramatically since the laws came into effect.

The national average for helmet use is 36.5%, whereas Ontario's helmet use is 34.4%. In comparison, provinces with all-ages helmet legislation have rates well above the national average with Nova Scotia at 66.4%, British Columbia at 58.8%, New Brunswick at 51.4 %, and Prince Edward Island at 51.1%.  

A research study in 2010 found that 81% of parents support all-ages helmet legislation. The call for universal all-ages helmet legislation is also supported by studies that draw attention to the positive relationship between adult helmet use and child helmet use. Studies have shown that in those areas where legislation only applies to those under the age of 18 years, helmet use compliance is decreased. As well, a study in Toronto, found that children were one hundred times more likely to own and use a bicycle helmet if their parents used a bicycle helmet themselves.

In addition, bike helmet legislation that applies to all ages eliminates the additional enforcement challenge of determining a cyclist's age without stopping them.

Opponents of bicycle helmet legislation have argued that legislation reduces ridership and may discourage individuals from using this 'green' form of transportation. Currently, there is no evidence to support this claim. Recent studies demonstrate evidence to support that implementation of helmet legislation is not associated with changes in recreational or commuting bicycle use among youth or adults. Another study also found that average cycling levels for children were actually higher than the year prior to the legislation being introduced.

Conclusion

Unintentional injuries are a public health issue.  Head injuries related to cycling without a helmet have significant economic cost to society and the health care system.  The use of a certified bike helmet in all-ages has been demonstrated to prevent head injuries.   Therefore, it makes good public health sense to have Ontario all-ages bicycle helmet legislation for the protection of all cyclists young and old.  To that end, staff members recommend that the Board of Health endorse the attached resolution (Appendix A(PDF 28.3KB)) and forward it to the Association of Local Public Health Agencies for consideration at the 2012 Annual Meeting in June.

A summary of key background information is attached as Appendix B(PDF 38.4KB).

This report was written by Ms. Megan Georgieff, Public Health Nurse, and Ms. Mary Lou Albanese, Manager, Healthy Communities and Injury Prevention Team.

Graham L. Pollett, MD, FRCPC

Medical Officer of Health

This report addresses the following requirement(s) of the Ontario Public Health Standards:

Prevention of Injury and Substance Misuse Requirement 2, 4 and 5