Is cycling in the Netherlands without a helmet safer than cycling with a helmet in the USA?

Question

We moved to Netherlands and no one seems to wear a helmet. My teenage child did have a helmet but said she lost it. When my wife wanted buy her a new helmet, my daughter said she will refuse to wear it. This ended up in some family drama between them.

My daughter ended up saying that it is safer to cycle without a helmet in the Netherlands, then with a helmet in USA. To end the crisis, we agreed that she does not have to wear a helmet if this is true. (My wife expects it to be false) But I am not sure, as I read once that the safety of a helmet is generally overestimated (and there is also some risk-compensation). Hence my question is:

Is it true that cycling in the Netherlands without a helmet is safer, then cycling with a helmet in the USA?

Apart from that my daughter claimed that the health befits of cycling outweigh the risk by far. Is this true?

Please give scientific evidence if possible.

Answer 1

There's a simple answer to the question you didn't actually ask: in the Netherlands cyclists who wear helmets are much more likely to be hospitalised than those who don't

Although the Netherlands is probably the safest country in the world for cycling, helmet wearing among Dutch cyclists is rare. It has been estimated that only about 0.5 percent of cyclists in the Netherlands are helmeted.

However, according to Dutch Government data (Rijkswaterstaat, 2008), 13.3 percent of cyclists admitted to hospital were wearing helmets when they were injured. Why does wearing a helmet appear to increase the risk of being injured so substantially?

The answer is probably related to another statistic. Of the injured cyclists wearing helmets, 50 percent were riding mountain bikes and 46 percent were riding racing bikes (Rijkswaterstaat, 2008). In other words, most helmeted cyclists in the Netherlands are engaged in a competitive activity, with very few making utility trips on the traditional style of Dutch bicycle.

I can't find a useful answer because of that. I couldn't find statistics that answer "of the less than 1% of utility cyclists who wear helmets, how many were killed or injured"?

Of course, having so many people riding bikes on the roads also means that of the people killed on the roads, a high proportion are cyclists (about one third). The Netherlands is also the safest place in Europe to use the roads (45 deaths/million pop, cf 145 in Greece which is the worst in Europe and 147 in the USA).

What that means is that in The Netherlands about 185 cyclists die every year compared to 700-odd in the USA (~4x as many, thanks whatsisname). There are more than twenty times as many people in the USA... but more trips by bicycle in the Netherlands. You're still safer there than any inhabited part of the USA. You're safer on a bike in The Netherlands than in a car in the USA, even just looking at immediate crash danger rather than life expectancy (the lifetime risk of death remains 100%, obviously).

There are some amusing results of that:

• After a recent decline in the murder rate, you are now fractionally more likely to die while biking than to be murdered in the Netherlands!

• In Amsterdam, you're still more likely to be murdered, though.

• You're also more likely to die by murder in the U.S. as a whole than by biking in the Netherlands.

• You are also more likely to drown here than either die biking or be murdered, especially if you are a child.

My suggestion is to look at it the other way: if you-the-parents insist that your daughter wear a helmet while cycling, will she keep cycling? Will she be unhappy that her mother would prefer her be socially ostracised than even try to fit into the new culture? Will she just observe that her parents are failing to assimilate and reject them, rather than everyone she knows?

Also try flipping it - how would your wife deal with someone who moved to rural USA and didn't want their daughter to learn to drive? Or insisted that she only travel in the Smart car, since that's the safest small car and it's what her parents had back home in the Netherlands?

Answer 2

No matter how to frame it, shopping for the answer you want does not change the facts, which largely fall into irrelevance when coming to an agreement with a teenager. Your daughter will be able to shop for the answer she wants, and you get to the same stalemate you are now at. The society you now live in in support her position, as teenager, that's more than enough proof she is right to any reasonable person (in her mind) - ergo - to her you are being unreasonable

You daughter won't ride a bike if she has to wear a helmet. If you try to force it, she will choose to not ride a bike, or remove her helmet as soon as she is out of sight. If you succeed in forcing her, its unlikely it will have no cost to your relationship with her.

In this situation, express your disapproval, explain you logic to her, let her know its "because we love you" (hopefully this is not a control issue), but let her make her own choice. Its one of those battles you cannot win, and more importantly - its not important to win it.

As far as "Scientific Evidence" - you won't easily find any reliable data because all the easy to access research is published to either prove the point one way, or with the research that is fact based the difference is below the margin of error or the research is not holistic (e.g. fewer riding mean more heart disease...) The exception to this is for young under about 10 yo children where helmets have been shown to improve safety outcomes (sorry, no time to look up reference).

Answer 3

We have regular debates in Australia regarding our mandatory helmet laws. Pretty much all such laws did was to divert attention away from strategies that actually make cycling safer, significantly reduce the cycling participation rates (they more than halved after the laws were introduced) and further marginalised cycling and cyclists in the eyes of general Joe Public road user.

As part of those debates I did some research and read various papers on the topic. Interestingly there was a correlation between fatality rates and helmet usage in developed nations - see the chart below. That's not to suggest a causative relationship though.

There is also an inverse correlation between fatality rates and cycling participation rates - which does imply that the more cyclists there are, the safer it is.

One would presume that more cyclists means the infrastructure is cycling friendly and conducive to greater participation and that other road users are far more attuned to cyclists and cycling (far more likely to be a cyclist themselves).

Answer 4

I will try to elaborate on what I wrote originally below to avoid it being isolated to a one off incident/urban myth or anecdote. What I wrote below is not unique to me as other experienced riders have similar stories that follow a similar narrative (i.e. I'll skip the helmet and then they have a crash where a helmet could have helped mitigate injuries). For completeness sake I will also state that there are incidents of riders as well who attribute walking away from a crash without major injury because they had a helmet. The last bullet point provides a link to a study supporting that qualitative claim. Below are some points that summarize the dialog in this discussion and hopefully clean up this answer a bit.

• Most normal people do not plan when or if they will crash on a bike.
• Some if not most people who suffered an injury because they chose not to wear some protective equipment probably would not repeat that mistake again. Certainly, there may be some people who might I suppose.
• I think a helmet protecting your brain is not totally the same as let's say knee/elbow pads as full recovery from complex fractures is more likely vs. from traumatic brain injuries.
• Wearing a helmet is a choice and some people are fine taking the risk without one based on how they ride. However, it is worth pointing out that thinking you can maintain absolute control during low speed crashes to avoid your head hitting the ground is false. I have seen people fall with clipless pedals not moving and their head made contact with rocks on the side of the road. In this case, they were wearing a helmet that had a dent it, but they suffered no injuries. Had they not had on a helmet certainly at least a cut and gnarly bruise would have occurred.
• It is a false equivalency to say people die walking and getting into a bath tub therefore if we do not wear a helmet there, we certainly don't need one when biking.
• This question is going to illicit controversy and attempts to frame any scientific study with some conditional situation since we are trying to effectively compare/normalize data for two things that are different for very complex and nonindependent reasons (i.e. safety of riding in the US with a helmet vs. riding in the Netherlands without one). Furthermore, the original post fails to clarify what we are defining as "safer". I will say things like better traffic discipline, bike lanes, and a culture where cycling is prevalent make it less probable that there are cycle and motor vehicle crashes. However, that does not mean that if for another reason you end up wrecking on a bike, which is possible that you will be "safer" than someone who is wearing a helmet. In fact, you could be worse off according to the studies in the next bullet.
• A bike helmet is not perfect. It is an extra piece of gear, makes your hair look bad, for some may be uncomfortable, and some may say does not make you look cool, etc. Also, I know that with a severe enough crash a helmet may not make a difference between life and death, but in survivable crashes involving head trauma a well built bike helmet (e.g. MIPS helmet - https://mipsprotection.com/, https://www.helmet.beam.vt.edu/bicycle-helmet-ratings.html, https://www.irideup.com/is-mips-worth-it/) will absorb impact forces that otherwise would be transferred to your brain.

"According to a US study in 2016, helmets cut the risks of severe traumatic brain injury by half, when riders suffer a brain injury. The report, in the American Journal of Surgery, also concluded that riders with helmets were 44% less likely to die from their injury. Also, they were 31% less likely to break facial bones." Link : https://www.americanjournalofsurgery.com/article/S0002-9610(16)30366-X/abstract

---------- Archived Original Response and 1st Comment Clarification Below ------------

-----Original Answer -------

No, don't forget you can have a crash due to bad terrain like a crack in the road, ice/rain, or gravel. Even at slow speeds a crash like that can lead your head to hit pavement, which science has determined is not good.

----I'll Address the Comments Below Here ----

My answer above is based on assumption that perhaps one might say it is safer in the Netherlands to bike without a helmet because there are things like better traffic discipline, more bikes, bike lanes, etc (i.e. "a bike safe country").

While those things make it safer than perhaps the US for a bike + car crash, people can still crash on a bike due to unforeseen things like road condition including rain/ice, another bicyclist, or possibly even a mechanical failure on a bike.

I regularly ride in US traffic at some reasonably fast speeds (25 MPH+) on roads I know well and on a bike I maintain well. However, my only crash was on a casual ride where I thought I did not need a helmet because I was going to be going slow (<15MPH). I ended up hitting a crack on a road I never rode before. Despite having several thousand miles on a road bike by that point, I still wiped out.

Furthermore, despite going slow and thinking that made it safe, my head did make slight contact with the ground. So the notion that you can react quick enough if you go slow, to not hit the ground is false.

I would advocate for always wearing a helmet because even a slow boring ride can lead to a crash. A helmet at least provides some protection from even things like cuts and abrasions. Furthermore, it will always absorb some forces if you head makes contact with the ground and that certainly makes it safer than your head hitting pavement directly.

With that said, people always have a choice and can chose to not wear a helmet.

Unfortunately, trauma after a crash is not really reversible after the fact. Some people get lucky by never crashing and some get lucky to have a close enough call to learn their lesson.

I fall in that second category.

Answer 5

I also have a teen daughter, she is 15, and we kept the helmet for awhile, until she was 11! It was impressive. Then I looked around, nobody was wearing a helmet not even kids, I had never worn a helmet. My other daughters had stopped wearing one at 9 and 8. So when they were both 15 and 17, so there was never an argument. My daughter had mentioned that she wanted to bike bareheaded to school. I asked parents and it is so much safer from research and other parent input. They are so much safer with traffic. There are so much more biking so they are safer. I have lived in Amsterdam for 14 years. So yes, it is safer technically. I think that she is a teen so you just have to let it go. My daughter just turned 13. I hope you find this helpful!

Answer 6

On average, every Dutch person makes a trip by bicycle 5.6 times per week. This works out as an average across the whole population of 2.5 km cycled every day. That's the highest figure for any population in the world. If we assume that people cycle every day of their lives to the age of 80, and that they cycle that 2.5 km every day of their life, they will ride a bike for a total of 73000 km during their lifetime. Divide it into 6.5 million and you find a figure that a typical Dutch cyclist can expect a "head/brain injury" once every 90 lifetimes

Note that it doesn't say how serious the injuries have to be in order to be included. However, it does give total numbers of head/brain injuries per year as 550 + 1600 = 2150 which is more than ten times the total deaths of cyclists per year from all types of injuries. For the sake of making the maths easy, let's lazily (and very inaccurately) assume that every death when cycling is due to a head injury. We then find that the risk of death due to head or brain injury when cycling is actually around once per 900 lifetimes.

I have a teenager daughter too, and I understand being what it is like being a mom. I also understand what it is like to live in America, I always thought that anyone under 18 should wear a helmet. (Even though I never wore a helmet on a bike) I did make my daughter wear a helmet until she was 8, and then I started to teach how to safelt ride a bike, and then by the time she was about 9, she threw away her helmet and I felt confident about it. She bikes every day to school, which is 4 kilometers each way, and I feel 100 perecent comfident that she is safe and that feels good. then I really started to understand the safety, I bike about 6 kilometers every day, and not once have I fallen off a bike, the thing is that there are no potholes, and the Netherlands was designed for cyclists Another thing is before she takes that helmet off you need to teach her how to ride the bike safely, because without that teaching then she is 5 percent more likely to fall.

Answer 7

I feel like this is really going to come down to the specifics. For example is it safer to ride a bike in the middle of a field with no one around in the Netherlands than it is to ride down a main road in Los Angeles? Yes. Is it safer to ride on an empty beach of North Carolina than amongst traffic in the Netherlands? Yes.

So it is really circumstantial. I would not be surprised to find that the Netherlands are more bicycle friendly than the US, as much of Europe is. I however would not say that it is ever safer to ride without a helmet than it is with one. While they can result in neck injuries if you land on your head i would venture to say that is still better than a fractured skull 90% of the time.

I really think that it depends on what form of cycling she is doing, the distance, her age, location and a multitude of other factors. You may take this time to teach her to use her best judgment and leave a little responsibility in her hands (depending on age). As I honestly don't wear a helmet if I'm just taking a couple laps in my neighborhood, but if I'm going a distance or trail riding i always do. I also do not have children so i can't really speak on how you should parent your child. This is just my 2 cents on the matter and was too long for a comment.

Maybe you should speak with your daughter and change the pertinent questions to where you lived before vs. where you live now rather than considering the entire country, Because if you used to live in down town New York and now you live on 15 acres, or vice versa, that changes things a bit.

Answer 8

To cut it short, just wear a helmet wherever you are cycling. Accidents can happen anywhere at anytime, you might be a safe country but it only takes a driver to accidentally nudge your rear and will send you flying. Other scenario where your bike hit a hole or something which send you flying forward and landing your head first.

Answer 9

Is it true that cycling in the Netherlands without a helmet is safer, then cycling with a helmet in the USA?

Most likely it is, given the status of cycling in those countries and the ridiculously weak helmet standards.

Cycling has safety in numbers: the more cyclists there are, the safer every one of them is. Netherlands has a lot of cyclists.

Also the risk of cycling one kilometer is about the same as the risk of walking one kilometer as a pedestrian. If you consider a country dominated by the automobile, to get anywhere from the suburban area you have to ride a huge distance. If you consider a country dominated by cycling, the distances to get to places of interest are probably much shorter. Thus, I assume a random trip in Netherlands is probably much shorter than a random trip in USA.

The additional risk of cycling compared to risk of walking comes from the possibility to cycle far longer distances than it is reasonable to walk.

It is not a surprise that cycling is not more dangerous than walking is. Both are means of transport where the head is at about the same height and there's a danger of falling.

About the head height: helmet tests are done with a severed head. If we consider a cyclist or pedestrian, the head is at about 1.8 meter height. However, when falling, relatively more energy is in the head which moves fastest than your toes have. The toes when falling won't move much, but the head is moving at a great speed. Thus, falling is not comparable to dropping a severed head at 1.8 meter height. When considering the physics of a falling cyclist, it can be modeled as a rod 1.8 meters long rotating about one end. Solving the equations, one finds that the head of the rod hits the ground with as much speed it would have if a severed head was dropped from 1.5 times its height, i.e. 2.7 meter height instead of 1.8 meter height.

So, we can establish that a good helmet test drops a severed head from 2.7 meters height. Let's take a look at the helmet tests:

• The EU test (EN 1078) drops a severed head from 1.5 meter height
• The USA test (CPSC) drops a severed head from 2.0 meter height
• The best test (Snell) drops a severed head from 2.2 meter height

Not a single test drops a severed head from 2.7 meter height.

A cyclist on the road faces two threats:

• The cyclist's head can hit an oncoming motor vehicle. The speed of this impact is so large that no helmet can protect from it.
• The cyclist can fall and the head can impact pavement. This is the impact that has the same energy as a severed head dropped from 2.7 meter height. The existing helmet standards are inadequate for protecting against this.

Based on this, we can expect that helmets do not do much to improve the safety of cyclist. The difficulty of assessing whether helmets prevent head injuries is that severe head injuries are so rare that the only reasonable form of test is a whole-population test where a mandatory helmet law is suddenly enacted and enforced, so that the rate of helmet wearing suddenly goes from negligible to significant. Then we need some measure of severe injuries. As any measure of "severe head injury" is very hard to define, the easiest measure is to count the number of cyclists dead resulting from accidents and assume that the rate of severe head injury is proportional to this.

Such a mandatory helmet law has been at least enacted and enforced in New Zealand. By looking at the statistics, one can see that it can be the case helmets reduced fatalities. However, the argument is more against helmet laws than for helmets, because of two reasons:

1. The reduction of fatalities is nowhere comparable to the reduction of fatalities due to for example car seatbelts. Often times, a helmet is compared to car seatbelts, claiming that both are very effective safety devices. This is false: only one of them is a very effective safety device.

2. Due to the mandatory helmet laws, cycling decreased so it is possible that the fatalities divided by number of active cyclists actually stayed the same.

It is a good question whether a helmet could be made that bicyclists are willing to wear and that at the same time is good enough to be an effective safety device. Bicyclists need ventilation unlike motorcyclists that produce their power in an internal combustion engine. Bicyclists are limited in power so aerodynamics and light weight are important. Thus, bicycle helmet must be lightweight, aerodynamic and keep the cyclist's head cool. These design features are at odds with the safety features of a helmet.

In addition to these whole-population tests for which we can thank New Zealand at least, there are scientific studies where cyclists seeking healthcare services are assessed for head injuries. The problem is that to get a large enough sample size for head injuries, the term "head injury" must be defined such that a simple bleeding wound in the head is a head injury. (Then the result is obviously that helmets protect against head injuries if a "head injury" is a bleeding wound.) Also, there is fundamental flaw in this test that the cyclists more worried for their safety (and thus wear a helmet) visit healthcare due to even minor suspicions, whereas the cyclists that aren't worried for their safety (and thus won't wear a helmet) visit healthcare only if they truly have a serious head injury. (Then the result is obviously that helmets appear to protect against head injuries but that result was only due to a flawed scientific study.)