Level of Implementation

According to Michigan Government on 2017, helmets decrease the

severity of injury, the likelihood of death, and the overall cost of medical care.

They're designed to cushion and protect riders' heads from the impact of a

crash. Just like safety belts in cars, helmets can't provide total protection

against head injury or death, but they do reduce the incidence of both. Studies

show helmets are about 29 percent effective in preventing motorcyclist deaths.

A rider who does not wear a helmet is 40 percent more likely to suffer a

fatal head injury and 15 percent more likely to incur a nonfatal head injury

than a helmeted motorcyclist, the National Highway Traffic Safety

Administration (NHTSA) estimates. Helmets are even more effective in

preventing brain injuries. NHTSA estimates helmets are 67 percent effective in

preventing this injury type

Claims have been made that helmets increase the risk of neck injuries

and reduce peripheral vision and hearing, but there's no credible evidence to

support these arguments. A study by J.P. Goldstein is often cited by helmet

opponents as evidence that helmets cause neck injuries, allegedly by adding to

head mass in a crash. More than a dozen studies have refuted Goldstein's

findings. A study reported in the Annals of Emergency Medicine in 2007

analyzed 1,153 motorcycle crashes in four mid-western states and determined

that "helmets reduce head injuries without an increased occurrence of spinal

injuries in motorcycle trauma."

 Regarding claims that helmets obstruct vision, studies show full-

coverage helmets provide only minor restrictions in horizontal peripheral vision

less than 3 percent from that of an unhelmeted rider. A 1995 study by James

McKnight analyzed the effects of motorcycle helmet use on seeing and hearing.

The study found that wearing helmets "restricts neither the ability to hear horn

signals nor the likelihood of visually detecting a vehicle in an adjacent lane

prior to initiating a lane change."

To compensate for any restrictions in lateral vision, riders increased their

head rotation prior to a lane change. Subjects in the hearing study showed no

differences in hearing thresholds under three helmet conditions: no helmet,

partial coverage, and full coverage. The noise generated by a motorcycle is such

that any reduction in hearing capability that may result from wearing a helmet

is inconsequential. Sound loud enough to be heard above the engine can be

heard within a helmet, a NHTSA study concluded.

Historically, in the United States, before 1967, only three states had

motorcycle helmet use laws. The federal government in 1967 began requiring

states to enact motorcycle helmet use laws in order to qualify for certain federal

safety program and highway construction funds.

Thirty-seven states enacted helmet use laws between 1967 and 1969. By

1975, all but three states mandated helmets for all motorcyclists.
  As the Department of Transportation in 1976 moved to assess financial

penalties on states without helmet laws, Congress responded to state pressure

by revoking the department's authority to assess penalties for noncompliance.

Between 1976 and 1978, 19 states weakened their helmet use laws to apply

only to young riders, usually under age 18. Seven states repealed helmet use

requirements for all motorcyclists.

 Then, in the 1980s and early 1990s, several states reinstated laws

applying to all riders. Congress in the 1991 Intermodal Surface Transportation

Efficiency Act created incentives for states to enact helmet use and safety belt

use laws. States with both laws were eligible for special safety grants, but

states without them by October 1993 had up to 3 percent of their federal

highway allotment redirected to highway safety programs.

Four years after establishing the incentives, Congress again reversed

itself. In the fall of 1995, Congress lifted federal sanctions against states

without helmet use laws, paving the way for state legislatures to repeal helmet

laws. As of January 1, 1996, 25 states and the District of Columbia have

helmet laws covering all riders, and 22 states have laws covering some riders,

usually those under 18. Colorado, Illinois, and Iowa don't have helmet laws.

In the states that either reinstated or enacted a motorcycle helmet law in

the past decade, helmet use has dramatically increased, and motorcyclist

deaths and injuries have decreased:

 California's use law covering all riders took effect January 1, 1992.

Helmet use jumped from about 50 percent prior to the law to 99 percent

afterward. During the same period, the number of motorcycle fatalities

decreased 38 percent, from 523 in 1991 to 327 in 1992.

Nebraska reinstated a helmet law January 1, 1989 after repealing an

earlier law in 1977. As a result, the state saw a 20 percent reduction in

motorcyclist head injuries.

Texas from 1968 to 1977 had a universal helmet use law estimated to

have saved 650 lives, but the law was amended in 1977 to apply only to riders

younger than 18.

The weakened law coincided with a 35 percent increase in motorcyclist

fatalities. Texas reinstated its helmet law for all motorcyclists in September

1989. The month before the law took effect, the helmet use rate was 41

percent. The rate jumped to 90 percent during the first month of the law and

had risen to 98 percent by June 1990. Serious injury crashes per registered

cycle decreased 11 percent.

Helmet use laws may also lead to a decline in motorcycle thefts, possibly

because some potential thieves don't have helmets, and not wearing a helmet

would attract police notice.

After Texas enacted its universal helmet law, motorcycle thefts in 19

Texas cities decreased 44 percent from 1988 to 2002, according to the Texas

Department of Public Safety. Motorcycle thefts dropped dramatically in three

European countries after the introduction of laws that fined motorcyclists for

failure to wear helmets. In London, motorcycle thefts fell 24 percent after Great

Britain enacted a helmet law in 1973. The Netherlands saw a 36 percent drop

in thefts in 1975 when its law was enacted. And in former West Germany,

where on-the-spot fines were introduced in 1980, motorcycle thefts plummeted

60 percent.

Unhelmeted riders have higher health care costs as a result of their

crash injuries, and many lack health insurance. Results of NHTSA's Crash

Outcome Data Evaluation System study released in April 1995 show average

inpatient hospital charges for unhelmeted motorcycle crash victims were 25

percent higher than for helmeted riders- $15,447 compared with $12,374. After

California introduced a helmet use law in 1992, studies show health care costs

associated with head-injured motorcyclists declined.

Average charges for head-injured motorcyclists admitted to hospitals in

San Diego County fell 32 percent from 1991 to 1992, from $53,875 to $36,744,

and average charges for all injured motorcyclists fell 17 percent. For head-

injured patients treated and released from emergency rooms, the drop was

even more substantial - 43 percent.

The total charges for head-injured motorcyclists seen in San Diego

County trauma centers fell from $9.8 million in 1991 to $5.5 million in 1992

and $5.4 million in 1993. A study of the effects of Nebraska's reinstated helmet
use law on hospital costs found the total acute medical charges for injured

motorcyclists declined 38 percent after the law was implemented.

Studies conducted in Nebraska, Washington, Massachusetts, and Texas

indicate how injured motorcyclists burden taxpayers. Forty-one percent of

motorcyclists injured in Nebraska from January 1988 to January 1990 lacked

health insurance or received Medicaid or Medicare. In Seattle, 63 percent of

trauma care for injured motorcyclists in 1985 was paid by public funds.

In Sacramento, public funds paid 82 percent of the costs to treat

orthopedic injuries sustained by motorcyclists in 1980-83. Forty-six percent of

motorcyclists treated at Massachusetts General Hospital in 1982-83 were

uninsured. At Brackenridge Hospital in Austin, Texas, 41 percent of injured

motorcyclists who were unhelmeted had no insurance, compared with 27

percent of injured helmeted riders treated between February 1985 and January

1986.

In the United States, only 19 states, along with the District of Columbia,

have universal mandatory helmet laws in place. These require that every

motorcycle rider wear a helmet every time they get on their bikes. [ CITATION

Ins17 \l 13321 ]

The majority of the rest of the states have laws that require riders below

a certain age, such as 17 or 20, to wear a helmet whenever they ride their

motorcycles. [ CITATION Pat15 \l 13321 ] And there are three states (Iowa, Illinois,

and New Hampshire), where there’s no law at all regarding the use of helmets

while you ride. All countries throughout the European Union have enacted a

law that requires helmet use for all individuals who ride motorcycles.

Therefore Pathway (2017) concluded, anywhere in the EU, there’s simply

no escaping this law and absolutely one must have the appropriate protective

headgear on whenever one head out on the road, whether someone goes for a

relaxing backcountry ride or some heading to work in the city. All of the

helmets that are worn on roads throughout the United Kingdom must also

meet specific requirements.

In the study of Bachani (2017) Head-related trauma is a significant

cause of injury and death in road traffic injuries and contributed to 88% of

deaths involving motorized two-wheeler crashes in low- and middle-income

countries (LMICs). Large-scale ecological studies have shown that increases in

helmet use when brought on by legislation or enforcement changes are

accompanied by decreases in mortality and morbidity, suggesting that helmets

represent a viable method of reducing head injuries from two-wheeled

motorized vehicle crashes. 

In a global evaluation, Abbas (2015) found that helmet non-use was the

most significant factor affecting a motorcyclists death rate in a RTI and that

helmets reduce the risk of death in a crash. A 2009 Cochrane systematic

review concluded that motorcycle helmets reduced the risk of death and injury
in motorcycle riders who crash. Helmet wearing among those surviving

motorcycle crashes was also found to lower hospitalization costs compared to

those without helmets in the United States.

In addition, a study in Taiwan reported motorcyclists without helmets

were four and ten times as likely to have head and brain injuries, respectively,

in a crash. Further, the use of substandard helmets and correct fastening of

helmets are additional secondary issues that are particularly relevant in

LMICs.

In Vietnam, two-wheeled motorcycle users are left vulnerable to head

injuries and fatalities resulting from RTIs. Given the proven effectiveness of

helmet use in reducing mortality, morbidity, and costs, it is crucial to assess

and improve the use of helmets across Vietnam. [ CITATION Pas10 \l 13321 ]

One effort to improve the use of helmets globally is through the Global

Road Safety Programme (GRSP) funded by Bloomberg Philanthropies.

Implemented from 2010 to 2015, the project targeted key risk factors for road

safety in nine countries with the highest burden of road traffic injuries. In

Vietnam, the GRSP focused on interventions for helmet use and drink-driving

in Ninh Binh and Ha Nam provinces.

Primary data collection in the two study areas, Ha Nam and Ninh Binh

provinces, included observational helmet wearing studies and roadside

knowledge, attitude, and perceptions (KAP) surveys on helmet use.

 Observational studies were used to determine the prevalence of helmet

use through systematically observing road users at randomly selected study

district locations. The methodology is highlighted in a prior publication.

Fourteen rounds of data collection were completed from June 2011 to

December 2014. The locations of helmet observations were predetermined

through a systematic process and held constant for every round of

observations. Study teams comprised two data collectors, and each round had

one weekday and one weekend day. During an observation day, collectors

captured data during 120-minute intervals to account for variations in traffic

volume and composition throughout the day.

Data were only recorded for vehicles traveling in one direction to avoid

double counting and ensure quality data collection. Data were recorded on

correct helmet use and substandard helmet use with stratification by age

(adult/child), gender, time of day, and time of week. Children were defined as

individuals perceived to be under 17 years of age, inclusive. The outcome of

interest is correct helmet use and was assessed as such if drivers (or

passengers) wore a helmet with protective elements, which was not a

substandard helmet and was properly fastened.

Despite the reported magnitude of road traffic injuries, various

sources suggest official figures may underestimate the number of deaths by

more than 30%. As of January 2009, 27 million vehicles were registered in

Viet Nam of which 95% are motorized two-wheelers, a figure that increased

by an average 7680 new motorcycles each day in 2008.

The effectiveness of motorcycle helmets in preventing head injuries

are well documented. Successful examples include China (Province of

Taiwan) and Thailand where reductions in head injuries of 33% and 41%

respectively were reported after the introduction and enforcement of

mandatory helmet laws.

Despite the long history of motorcycle helmet laws in Viet Nam, low

penalties and limited enforcement coverage made them largely ineffective,

resulting in approximately 30% compliance. Collaborative advocacy from

many sectors came to fruition on 29 June 2007 when the Prime Minister,

Nguyen Tan Dung passed into law a strategy that represented a dramatic

strengthening of helmet wearing requirements. Coming into effect on 15

December 2007, Viet Nam's new helmet law required all riders and

passengers to wear helmets on all roads without exceptions.

While revised standards provided a well needed boost to the public

acceptability of helmets, the quality of helmets has the potential to limit the

effectiveness of legislation. A survey in April 2008 by the Viet Nam

Standard and Consumer Association found that up to 80% of motorcycle

helmets on the market did not meet national standards. In November 2008,

the Ministry of Science and Technology introduced revised standards

(QCVN2) that strengthened quality assurance requirements to limit market

infiltration of substandard products.

 The new law substantially increased penalties for non-wearing from

20 000–40 000 Viet Nam Dong (VND) (approximately US$ 1–2) under the

2007 legislation to 100 000–200 000 VND (US$ 6–12) per offence, which

represents more than 30% of the average monthly income per capita. Data

from the traffic police indicate that in 2008 more than 680 000

infringements were issued against riders and passengers for not wearing a

helmet. Revenue from road traffic infringements are collected by the State

Treasury. [ CITATION Pas10 \l 13321 ]

The national helmet law was developed and implemented by the

NTSC on behalf of the Vietnamese Government. The NTSC work included

obtaining the clearance on the details of the helmet law, collaborating and

consulting with provincial networks to ensure nationwide implementation

and for reporting on implementation progress and any barriers to the Prime

Minister.

Meanwhile in the Philippines most residents in Dumaguete still view the

Republic Act 10054 or the Mandatory Helmet Act of 2009 as impractical and

ineffective even four years after the law was implemented in the city. The

helmet law was passed in 2010 but its Implementing Rules and Regulations

took effect only in January 2012. Dumaguete, known as the "Motorcycle

Capital of the Philippines," has been mandated to implement it since 2012, but

the Land Transportation Office (LTO) head Marliza Elesterio herself admitted

that they have difficulty implementing such, as the local government units and

several sectors are against it. [CITATION Ger16 \l 13321 ]

 Regine Bacalso, one of those who opposed the helmet law, said the

measure is impractical, since the roads in Dumaguete are narrow and short

compared to other urbanized areas like Manila and Cebu. She said the national

highway, which is only a two-lane highway, is not even congested.

In Cebu, Motorcyle-related accidents and fatalities have increased in the

province. The meaningless fatality could have been prevented if the said law is

strictly implemented. The importance of wearing standard protective helmet

should be highlighted. Motorists should wear it even in short distances said

Oyas. Records of Cebu City Traffic Office showed that a minimum of six

accidents happen every day. Some notable traffic accidents have been recorded

both occurring in the city and in the province of Cebu. [ CITATION Qui17 \l

13321 ] The World Health Organization’s road safety report showed that 1.25

million people have died globally due to road accidents, with motorcyclists

comprising 23 percent of deaths. Without action, WHO said road traffic crashes

are predicted to rise to become the seventh leading cause of death by 2030.

WHO said wearing a motorcycle helmet correctly can reduce the risk of death

by almost 40 percent and the risk of severe injury by over 70 percent. 

The director of the Land Transportation Office-Region-1 said as of press

time 250 violators of the Motorcycle Helmet Acts of 2009 were nabbed and

fined after the city government implemented an ordinance on the non-wearing

of helmet in Dagupan. [ CITATION Ort \l 13321 ]

 In addition, David (2012) stated that over the past week, thousands of

motorcycle riders throughout the country descended on the offices of the

Department of Trade and Industry seeking a small sticker for their helmets.

Like recruits for a ragtag army waiting to have their weapons inspected before

marching to war, they waited for harried DTI personnel to paste an ICC sticker

on their helmets attesting to their worthiness.

Strengths and Weaknesses

 Each year about 1.2 million people die as a result of road traffic

crashes, and millions more are injured or disabled. Most of the deaths are

preventable. In many low-income and middle-income countries, users of

two-wheelers - particularly motorcyclists - make up more than 50% of those

injured or killed on the roads. Head injuries are the main cause of death

and disability among motorcycle users, and the costs of head injuries are

high because they frequently require specialized medical care or long-term

rehabilitation.

Wearing a helmet is the single most effective way of reducing head

injuries and fatalities resulting from motorcycle and bicycle crashes.

Wearing a helmet has been shown to decrease the risk and severity of

injuries among motorcyclists by about 70%, the likelihood of death by

almost 40%, and to substantially reduce the costs of health care associated

with such crashes.

The World Health Organization (WHO) is intensifying efforts to

support governments, particularly those in low-income and middle-income

countries, to increase helmet use through a new publication, Helmets: a

road safety manual for decision-makers and practitioners.[ CITATION Smi06 \l

13321 ]

The manual is a follow-up to the World report on road traffic injury

prevention, published in 2004 by WHO and the World Bank, which provided

evidence that establishing and enforcing mandatory helmet use is an

effective intervention for reducing injuries and fatalities among two-wheeler

users.

The manual has been produced under the auspices of the UN road

safety collaboration, in collaboration with the Global Road Safety

Partnership, the FIA Foundation for the Automobile and Society, and the

World Bank, as one of a series of documents that aim to provide practical

advice on implementing the recommendations of the World Report.

The importance of increasing helmet use follows dramatic growth in

motorization around the world, largely from increasing use of motorized

two-wheelers, particularly in Asian countries. In China, for example,

motorcycle ownership over the last ten years has increased rapidly. In 2004
it was estimated that more than 67 million motorcycles were registered in

the country, and approximately 25% of all road traffic deaths were among

motorcyclists and their passengers.

Countries will recoup their investment in these programs many times

over through savings to their health care systems, as well as savings to

other sectors.

Many countries have succeeded in raising rates of helmet use through

adopting laws that make helmet use compulsory, enforcing these laws, and

raising public awareness about the laws, as well as the benefits of helmet

use. This new helmet manual draws on such examples.

In Thailand, for instance, 80% of the 20 million registered motorized

vehicles are motorcycles. In 1992, when helmet use was not mandatory,

90% of deaths resulting from traffic injuries were among motorcycle users,

almost all due to head injuries. Legislation passed in the north-eastern

province of Khon Kaen to make helmet use mandatory, supported by

enforcement and publicity programmes, led to a 40% reduction in head

injuries among motorcyclists and a 24% drop in motorcyclist deaths within

the two years.

Copenhagen is known far and wide as the "City of Cyclists". This is due

to its longstanding and lively cycling tradition. Cycling is a socially acceptable

means of transport and it is not uncommon to see Danish ministers or mayors

cycle to work. Bicycle traffic in Copenhagen has grown in recent years.

Currently, one out of three Copenhageners cycle to work.

The thing to notice in this video is how few bicyclists are wearing

helmets. This is the norm: bicyclists in countries with large numbers of

transportation bicyclists (Denmark, Holland, Japan) do not wear bicycle

helmets. At the same time, the bicyclist mortality rate in these countries is 6 –

11 times lower than it is in the US.

According to Austin (2013) Helmet laws are often touted as a "cheap way"

to improve bicyclist safety; however, there is no substitute for spending money

on roadway repairs and bicycle lanes, and the best way to avoid a head injury

is to not fall on your head in the first place. Education, safe facilities, defensive

biking, and educated motorists prevent head injuries, not bicycle helmets.

Helmet Laws are divisive and hurt community spirit.

Transportation bicyclists feel insulted by mandatory helmet laws (MHLs)

because such laws suggest that bicyclists are incapable of managing their own

personal safety. Furthermore, in a car-oriented city, bicyclists are already a

beleaguered minority, and MHLs represent a heavy-handed swipe at them. Far

from having the effect of "people getting used to wearing helmets" as helmet law

proponents have suggested, the 96-97 Austin MHL was controversial and

bitterly divisive for the entire 10 months it was in place. In 1997, underdog city

council candidates Bill Spelman and Willy Lewis were elected on the campaign

promise that they would repeal the helmet law. Of the minority of bicyclists
who supported the helmet law in 1996, most are now either opposed or neutral

after witnessing the negative impact it had on the community.

A lot of people get into transportation bicycling by making short

neighborhood trips to the grocery store or coffee shop. A helmet law can serve

as a barrier to these kinds of short rides on quiet neighborhood streets. Rather

than risk being stopped by the police, and not wanting to bother with a helmet,

potential bicyclists will elect to drive instead, consequently never making the

transition to substantive transportation bicycling. Nationally, increased bicycle

helmet use is correlated with an increase in head injuries.

Claims that "helmets reduce the incidence of serious head injuries by as

much as 85%" are almost all based on a series of studies that gathered data

from Seattle-area emergency rooms in the late 1980’s and early 1990’s. Even

the authors of these studies admit that these studies suffer from serious

methodological flaws.

For example, the same data can be used to show that "helmets reduce

the incidence of leg injuries by as much as 72%. Most studies like these

showing a positive impact of helmet use are hopelessly compromised by

confounding variables, such as the fact that helmeted riders tend to be more

cautious by nature than riders who refuse to wear a helmet. When writing

about the effect of MHLs, many authors fail to take into account reductions in

the number of bicyclists and other safety measures implemented at the same

time (lower speed limits, etc.). When these factors are taken into account, the

safety impact of MHLs is, at best, negligible.

 A far more reasonable way to measure the effectiveness of helmet use is

simply to look at the raw numbers on a large scale. By this measure, helmets

fair rather poorly. According to an article published in The New York

Times July 29, 2001, from 1991 to 2000 — at the same time that voluntary

helmet use in the United States went from 18% to 50% — the number of

bicyclist head injuries increased by 10%. However, during this period bicycle

use actually declined by 21%, so that the effective increase in head injuries

was 51% — a strong linear correlation between increased helmet use and

increased head injuries.

Even under the assumption that helmets are extremely effective, coercion

is not the way to encourage helmet use. Helmets must be properly fit and

correctly worn in order to have any chance of being effective at reducing the

severity of injury.

According to the study of Thompson (2009), individuals whose helmets

were reported to fit poorly had a 1.96-fold increased risk of head injury

compared with those whose helmets fit well. Improperly worn helmets result in

all the hazards outlined above with none of the protective benefits. An

individual who wears a helmet simply to avoid getting a ticket is not going to

suffer the discomfort of a properly worn helmet. The best and only

effective/appropriate way to encourage helmet use is through education.