Why is it Americans appear as horrible at risk assessment as they are susceptible to manipulation by “influencers,” as those who now pull big numbers of “followers” on social media have come to be called?
Influencers have, of course, been around forever, though only recently have they been labeled such. The mainstream media used to be a major influencer but has lost significant influence due to online competition from all directions in the era of the internet.
Government, meanwhile, remains a huge influencer via propaganda labeled as “education.” Some of this is good; some is questionable; and some is bad. Americans got a big dose of propaganda at the height of the SARS-CoV-2 pandemic.
Some of it was good. Some of it was questionable. And some of it was bad.
Suggesting to older Americans – people easily identified from the start of the pandemic as those most vulnerable to being killed by the new virus – that masks made the world safe and that the new virus spread only by droplets at close range was bad.
Very bad.
SARS-CoV-2 was from the start an airborne virus capable of accumulating in enclosed spaces with poor air circulation, such as bars and restaurants. Some people figured this out early on and avoided such places. Others didn’t and ended up dead.
But enough about the pandemic. This is primarily about risk assessment, a subject that struck me when I saw several bareheaded bicyclists on Anchorage’s Chester Creek Trail ignoring the above sign suggesting to them how dangerous it is to ride a bicycle without a helmet.
I will freely admit to at that moment thinking, “you people should be wearing helmets,” because, like everyone else, I have for years been “educated” to the idea that riding a bicycle without a helmet is inherently unsafe.
This, however, got me to wondering how unsafe it really is, which led to a little research.
TBIs
Traumatic brain injuries – TBIs as they are commonly called – are an increasing cause of death in this country.
Exactly how many of these people were bicyclists is hard to determine, but at most it was a very, very small percentage. Their deaths are so few that cyclists fail to register as a group in any of the reports on causes of TBI deaths.
The latest “surveillance report” from the CDC says:
- Suicide accounted for 35.5 percent of TBI-related deaths and an average annual age-adjusted rate of 7.2 per 100,000 population.
- Unintentional falls accounted for 29.9 percent of all TBI-related deaths, with an average annual age-adjusted rate of 4.6 per 100,000 population.
- Unintentional motor vehicle crashes accounted for approximately 17 percent of all TBI-related deaths with an average annual age-adjusted rate of 3.1 per 100,000 population.
This leaves 17.6 percent of TBI deaths in other undesignated categories such as workplace accidents and sports of all sorts from football and hockey to skateboarding and skiing.
The National Safety Council reports 1,230 bicyclists died in 2021, the last year for which full data is available. But 853 of those deaths involved people being hit by motor vehicles. In many if not most of those cases, it likely made no difference as to whether the cyclist was wearing a helmet or not.
Bicycle helmets are designed to meet a crash-protection standard of 14 mph in the U.S. The Bicycle Helmet Safety Institute, which promotes helmet use, warns that this is inadequate for many current ebikes and the most powerful pedal cyclists.
These collisions happen at speeds greater than 20 mph given that there are so few places in the country with 20 mph speed limits, midblock or elsewhere. Such speeds are generally reserved for school zones and bike-friendly neighborhoods in the lower 48 states.
Alaska state guidelines call for 20 mph speed limits in business districts, but the guidelines are seldom followed. When Anchorage neighborhoods have asked about reducing speed limits to 20 mph, they’ve been dismissed with the statement that “the Russian Jack neighborhood lowered the speed limit and it did not reduce speeds through the neighborhood.”
When it comes to actual, real-world helmet use, Czechoslovakian researchers who studied the autopsies of 119 cyclists reported in a peer-reviewed study in Safety Science in 2018 that they believed 37 percent could have survived if they’d been wearing a helmet, but the study came with a huge caveat.
The real death danger when riding a bicycle clearly isn’t from falling off and suffering a TBI because you weren’t wearing a helmet. The real danger is in the risk of being hit by a motor vehicle and suffering massive, multiple injuries.
A cyclist’s best protection against that sort of danger rests in judgments made about where to ride, how to ride and what dangers to anticipate.
Marginal versus maximal gains
Some small number of people who died bicycling without helmets surely would have survived if they’d been wearing helmets, but in the bigger picture, that number easily gets lost in the statistical noise surrounding the nearly 350,000 Americans who the CDC now calculates die premature deaths every year from lack of exercise.
Exercise is medicine, but the majority in the U.S. don’t like the prescription and ignore it.
Given this reality, the gut reaction to seeing anyone on a bike (or walking) on a trail in Anchorage ought to be one of “good for them” rather than “geez, they’re not wearing a helmet.”
But I admit to being as conditioned by the helmet promoters as everyone else because when I’m on the bike there’s no reason not to wear a helmet, and if I’m riding at night, a helmet makes a great mount for a headlight/headlap.
Research into this issue of head injuries, however, can’t help but make one wonder whether the government is promoting helmets in the wrong places. Instead of lobbying for, or in some states dictating that, cyclists wear helmets, the government should be lobbying for or dictating that the elderly and motorists wear helmets.
“Falls among adults 65 and older caused over 38,000 deaths in 2021, making it the leading cause of injury death for that group,” according to the CDC. And the rate of deadly falls among the elderly rises rapidly with ages over 65.
Helmets for the elderly, as for cyclists, cannot ensure everyone who falls will survive, but if one were to apply the survival percentage from the Czech study on cyclists – that pretty conservative 37 percent – putting helmets on the elderly could save 14,060 lives per year or at least 20 times than helmets on cyclists and probably more like 25 times more.
Simply getting pedestrians over age 75 to wear helmets would save more lives than putting helmets on all cyclists young and old.
As for motor vehicle occupants, the CDC reports, that “among children from birth to 17 years the most common mechanisms of injury for TBI-related deaths were motor vehicle crashes (average annual rate of 1.0 per 100,000).”
There is no easily available comparative rate for children on bicycles, but if there was it would be well below 1.0 given that the National Safety Council reports the death rate for cyclists under age five as 0.02 per 100,000.
The rate does climb with age, but not that rapidly: 0.04 at five to nine, 0.12 at 10 to 14; and 0.19 at 15 to 20. All of these rates are well below the rate reported for childhood TBIs in motor vehicle collisions.
The data would indicate everyone is worrying about putting helmets on kids on bikes when what they really should be worrying about is putting helmets on kids in cars and trucks.
But we all know cycling is dangerous, right?
Danger is relative
It certainly feels that way if you ride on the roads of Anchorage. Scary close passes are a regular thing in Alaska’s largest city given that the Anchorage Police Department ignores the municipal ordinance requiring that drivers of motor vehicles “overtaking a vulnerable road user…shall pass to the left at a safe distance, not less than three feet, and shall not return to drive on the right side of the roadway until safely clear of the overtaken vulnerable road user.”
The APD has never ticketed anyone for violating this law, which has been on the books for years, and I can personally testify to having been passed by an APD-labeled vehicle that was closer than three feet.
And stories about distracted motorists running down cyclists from behind make the news with scary regularity, the latest coming out of Texas late last month.
The data, however, tells a somewhat different story. The Safety Council puts the odds of a bicyclist dying at 1 in 3,162, which move leaves cycling just behind choking on food – odds ratio 1 in 2,482 – in the Council’s ranking of odds on what will kill you.
Suicide was number seven at 1 in 87. “Depression is the most common condition associated with suicide,” according to the American Foundation for Suicide Prevention.
It is also a very cheap treatment and a healthy way to self-medicate. Thus the exercise benefits of cycling need to be factored into any discussion of “safety” because where risks go up in one category they go down in many others.
There is no doubt it is more dangerous to be on the road on a bicycle or in the bike lane along a road on a bicycle (where too many bicyclists get hit) than on the road in a motor vehicle, especially a big, heavy tank of a motor vehicle.
And even without factoring in the health benefit of getting out from behind the wheel to walk or pedal, your average cyclist is probably still at a greater risk of dying while in a motor vehicle than from being hit by a motor vehicle given that most American cyclists spend more time in motor vehicles than on bikes.
Most of modern America has been designed around the automobile, and it’s hard to live in such places without driving. The number of people living close enough to work and shopping to use a bike or bikes as their only means of transportation is small.
As someone who is on the bike a lot – eight to 15 hours per week for 120 to 225 miles or more – I ran the numbers just to see how dangerous biking is for me, and on the basis of miles/kilometers driven, driving remained near as dangerous because of the increased exposure to risk.
It also parallels the data for U.S. motor vehicle fatalities compared to those of other countries. This country obviously has more than its share of bad drivers. The death rate for U.S. drivers is 8.3 per billion kilometers, which is almost double the 4.2 per billion kilometers of Germany, home of the high-speed autobahns, and almost triple the 3.0 per billion of Norway.
A billion is 10 times 100 million, so the comparable rates for U.S. cycling and motor vehicle deaths would be six per billion for cycling and 0.83 per billion for driving, making cycling about 7.3 times as dangerous per kilometer as driving.
Still, if your driving miles exceed your biking miles by 7.4 times or more, you remain statistically more likely to die beyond the wheel than at the handlebars. The Federal Highway Administration says the average driver now racks up 13,476 miles per year.
So if the average driver who also cycles is pedaling less than 1,846 miles per year, or about 35.5 miles per week or around five miles per day, he or she remains at greater risk of dying in a collision between motor vehicles than in a motor vehicle versus bike crash.
Real dangers
If you’re a cyclist, you might also want to consider this: being on a bicycle is nothing compared to the danger of being on a motorcycle.
Part of this can be attributed to the behavior of motorcyclists. Twenty-eight percent of those who died were found to be alcohol-impaired versus 24 percent or less for those in passenger cars, light trucks and large trucks, the Council reported, and 43 percent of the motorcyclists who died as a result of crashing their bikes sans a collision with any other vehicle were likewise alcohol-impaired.
But even if you correct for these deaths, motorcyclists were still about 18 times more likely to be killed on American roads than the drivers or passengers in cars and trucks and more than three times more likely to be killed than pedal cyclists.
Helmet use on the part of motorcyclists has been credited with saving the lives of thousands but not all. According to the National Highway Traffic Safety Administration, motorcycle helmets are 37 percent effective in preventing fatalities to motorcycle riders and 41 percent for motorcycle passengers.
Motorcycle helmets are much more protective than bicycle helmets, but they are also much bigger and heavier and impractical to wear while pedaling because they lack ventilation. On a hot day, a cyclist in a bike helmet could easily die from hyperthermia, which the U.S. Department of Health and Social Services says killed 2,302 Americans last year.
That’s more than six times the 377 cyclists who died in crashes not involving a motor vehicle, which would make heat appear more dangerous than cycling somewhere other than near a roadway.
Heat might even be a bigger danger than riding a bike along or near a roadway, but it is on or near roads in this country that it is becoming ever more dangerous to be one of those so-called vulnerable road users. Their deaths are steadily increasing in the U.S. while falling in much of the Western world.
Part of this is likely due to the rise of mobile, electronic media.
In London at Christmas, you had to stay alert just walking the streets because so many people had their faces in their phones so they could text or watch videos or do whatever it was they were doing. And I’ve had near collisions with both cyclists and pedestrians similarly preoccupied with texting, Facebooking, Xing, TikToking or whatever while on paved multi-use trails in Anchorage.
The good thing is that if you collide with a pedestrian or cyclist who has his or her eyes in a phone, you’re unlikely to die. The same is not true when drivers of motor vehicles are involved.
The Governors Highway Safety Association reports pedestrian deaths are now 77 percent above the 2010 level. How much of this is due to phones, the Association doesn’t say, but electronic devices are surely playing a part.
The Association’s analysis of current deaths also reported “some troubling trends regarding people on foot being killed at night, where there aren’t sidewalks, and by SUVs and pickups.”
A lack of sidewalks plus high numbers of SUVs and pickups pretty much defines most of Alaska as does another observation made by the Association:
“A combination of factors creates this deadly situation for people walking on U.S. roadways. A steep drop in traffic enforcement across the country since 2020 has enabled dangerous driving behaviors – including speeding and driving impaired – to flourish.
“At the same time, roads are largely designed to prioritize fast-moving vehicle traffic instead of slower speeds that are safer for people walking. Many parts of the country lack infrastructure – such as sidewalks, crosswalks and lighting – that help protect people on foot. The U.S. vehicle fleet is increasingly dominated by larger, heavier vehicles that are more likely to injure or kill people walking.”
All of which helps explain why American urban areas – the country’s kill zones – are becoming less and less safe for so-called vulnerable road users. Eighty-four percent of pedestrian deaths now take place in urban areas, according to the National Safety Council.
That number climbs to 85 percent for cyclists, according to the Highway Safety Administration, which reports a significant rise from 69 percent in 2011. The NTSB has repeatedly suggested that lowering speed limits in urban areas is the quickest and easiest way to save the lives of not just cyclists and pedestrians but motorists as well but nobody appears to be listening.
The agency has made it clear that if communities are truly interested in saving lives, the way to do so is to slow down traffic in those places where the most deaths are occurring. The evidence makes it clear that this would do far more to save the lives of cyclists and pedestrians than ranting about helmets.
The cycle-helmet issue could pretty easily be viewed as a “red herring,” something that distracts from the real issue, and a herring which, sadly, plays well with the poorly educated mainstream media in the U.S.
Often a helmet, or lack thereof, is the only thing mentioned in stories reporting on the deaths of cyclists, although there was a little more in a story covering the demise of 83-year-old Juan Yhanes in St. Petersburg, Fla., just a couple of days ago.
Whether the driver had the green light is irrelevant. A green light doesn’t give a driver permission to run over anyone while making a turn.
In simple language here, Yhanes was in a crosswalk acting on the belief a green light made it safe for him to cross the road when a sport-utility-vehicle made a turn and ran him over. Whether a helmet would have done anything for Yhanes is wholly unknown. Often in these kinds of accidents vulnerable road users are knocked over and then crushed under the front of the vehicle as nearly happened in Tallahassee just days ago.
This is another undeniable reason for why the roads are getting less and less safe for vulnerable road users.
U.S. politicians, however, have generally been reluctant to go there for fear of alienating their motocentric constituents. This also helps to explain why Anchorage has a variety of roads where it is not unusual to have traffic flying along at 50 to 55 mph immediately adjacent to sidewalks.
That these sidewalks are little used is no big surprise. It’s scary to walk on them. Municipal politicians could fix this, but you shouldn’t expect them to do so. Road deaths of all kinds are the acceptable collateral damage for American motorists always in a hurry for little reason other than that people are now always in a hurry.
And nobody seems to care that this is killing people.
The U.S. Surgeon General has declared firearm violence “a public health crisis” because gun homicides resulted in the death of just short of 20,000 people in 2022, according to the CDC. Traffic crashes killed twice as many innocent people in the same year, according to the highway traffic safety agency, but the Surgeon General has said nothing about this.
This is not to argue that the U.S. is free of communities wherein gun violence is a public health crisis. The homicide death rate of 54 per 100,000 among black males – with black males ages 10 to 24 dying at a rate of 172 per 100,000 – is a national tragedy even without comparing it to the 2.1 per 100,000 rate among white females, which is less than a sixth the national rate of 12.8 per 100,000 for deaths in traffic as reported by the Insurance Institute for Highway Safety.
Unfortunately, politics more than data drives public policy in the U.S. Guns are bad. Motor vehicles are good. Helmets might not save all lives, but if even one life is saved….
If Anchorage really wanted to save one life or more, it would start handing out free helmets to the homeless, who are vastly over-represented in the death counts of both pedestrians and bicyclists killed in Alaska’s largest city. Or, if their lives mattered, the municipality would slow down traffic in those areas where the homeless roadkill count tops that for roadkill moose.
But the road deaths of the homeless, even more than the average pedestrian or cyclist, is generally viewed as the acceptable collateral damage required to keep the traffic flowing as fast as possible because….
Well, who knows why? Just because.
And this is the scariest part of what is happening in the U.S. at this time with the risks for vulnerable road users – pedestrians being the most at risk among them – steadily rising even as they decline in most of the rest of the Western world.
But if you’re a driver in Anchorage, don’t worry. If you kill someone, stay at the scene, and cooperate with APD, and aren’t intoxicated, the worst that’s likely to happen is that $100 ticket. And if you are intoxicated and choose to flee, you probably won’t be caught.
Sometimes, in fact, APD doesn’t even bother to look for hit-and-run drivers.
And despite all this, I’ll keep pedaling. Why? Because the overall benefits of exercise as medicine still exceed the risks of being killed by an incompetent driver no matter how hard society in general is working to normalize bad driving as an acceptable behavior.
Categories: Commentary, News
Coincidentally, this just came up:
Systematic study of the effects of 30 km/h speed limits in European cities:
🚗⬇️ 23% in nr. of road crashes
⚰️⬇️ 37% nr. of fatalities
🩸⬇️ 38% nr. of injuries
🌫️⬇️ 18% in emissions
⛽️⬇️ 7% less fuel
🔉⬇️ 2.5dB noise reduction
Source: https://nrso.ntua.gr/review-of-city-wide-30-kmh-speed…/
And it tracks previous studies. The evidence that lowering urban speed limits produces big benefits at many levels is overwhelming and yet….
It’s impossible to ignore even for someone like me whose dream driving is on the Autobahns of Germany or the Italian Autostrade with their 130kph limit.
A superb analysis of everything that is wrong with helmet promotion and legislation. The only proven effect of helmet laws and propaganda is a reduction in the number of cyclists, who then lose the overwhelming health benefits, so the net effect is large and negative. One thing you didn’t mention is that the entire case for cycle helmet rests on disproved research, the infamous Thompson, Rivara and Thompson paper of 1989, A case-control study of the effectiveness of bicycle safety helmets, which found that helmets prevented 85% of cyclists deaths https://www.cyclehelmets.org/1068.html.
There is plenty of evidence which shows that helmets reduce the death rate of cyclists, but it is all small scale, short term with known methodological short-comings and is much less reliable than the large scale (frequently whole population) long term, highly reliable studies, which show either no reduction with helmet wearing, or an increase. The helmet-obsessed media will report the first ad nauseum, but never mention the latter. In the UK, the biggest media organisation, the BBC, has led a 35 year campaign promoting cycle helmets, and despite breaking their own Editorial Guidelines many times, their attitude and reporting has not changed.
What we should be looking at, as you do in the article, is what reduces the death rate of cyclists and pedestrians, which consists almost entirely of controlling the behaviour of drivers, but since the law-makers are drivers, nothing happens.
Congratulations on a truly excellent article, and I hope you don’t mind, but I’ve just posted a link on FB.
Do you have any info on the amount of protection afforded by different types of bike helmets? For example, a BMX, full ear coverage style, versus the perched on top style most often used.
No, but I can lead you to some: https://www.helmet.beam.vt.edu/bicycle-helmet-ratings.html
The tracking there is interesting to me in that what looks like it might provide the best protection doesn’t always score so well. But the VT testing tech sounds pretty sound. It convinced me to invest in a MIPS helmet. It seemed to make some sense that if I was going to wear a helmet, it only made sense to wear one with the best protection.
Great article!!!!
Been riding a bike since a child.
Never had a wreck of any significance. Never was interested in a helmet.
Basically have hit my head doing everything except cycling.
Fell off a few ladders ect wished i had a helmet.
Sounds almost like we should all put a helmet on before we get out of bed .
A really really good helmet would be needed to reduce suicide deaths but it would probably bring down the percentage.
My experience has been that all my concussions came while wearing a helmet: football, hockey and snowmachines. The latter was a behavioral issue. I finally figured out my riding style was a lot more out there, let us say, when wearing a helmet than wearing a fur hat, which I guess would have qualified as a helmet way back when.