The Ethics of Bike Shares: Some Tough Distributive Justice Questions about Helmets, Fatalities, and Obesity/Heart Disease

Boston recently followed many other world cities in implementing a bike share program. As the New York Times recently reported, North American cities face a dilemma: if the European experience is any guide, for bike shares to take off the city must do away with the helmet requirement. That turns out to be not a health versus leisure trade-off, but a complex health vs. health trade-off. As the New York Times puts it:

In the United States the notion that bike helmets promote health and safety by preventing head injuries is taken as pretty near God’s truth. Un-helmeted cyclists are regarded as irresponsible, like people who smoke. Cities are aggressive in helmet promotion. But many European health experts have taken a very different view: Yes, there are studies that show that if you fall off a bicycle at a certain speed and hit your head, a helmet can reduce your risk of serious head injury. But such falls off bikes are rare — exceedingly so in mature urban cycling systems. On the other hand, many researchers say, if you force or pressure people to wear helmets, you discourage them from riding bicycles. That means more obesity, heart disease and diabetes. And — Catch-22 — a result is fewer ordinary cyclists on the road, which makes it harder to develop a safe bicycling network.

Suppose hypothetically we came to the conclusion that more life years would be lost to obesity/heart disease related injuries from forbidding helmet laws than would be saved from putting helmets in place, would that justify doing away with our helmet laws? Does it matter that the injuries cause immediate death/injury in the un-helmeted case but are gradual to accumulate as to obesity and heart disease in the helmet case? That might in turn depend on whether we believe in the “rule of rescue” and whether we think of it as merely a rule about allocating aid versus preventing harm in the first place. If most bicyclists who are injured are younger, given the typical profile of the city biker, is there a dimension of age-weighting that might be relevant. Or, in fact, given that those who do not use bikes now due to the helmet laws will be older when they suffer from obesity/heart disease give us a reason to think age-weighting is inappropriate in this domain. This is somewhat similar to the arguments offered in the Age Discrimination in Employment Act (ADEA) context, that unlike Title VII or the ADA we will ALL (if things go well) eventually be old, so protection for the old benefits everyone. However, those who get hit by cars without helmets will likely die young. Finally, what role for choice, responsibility, resistance to the nanny state, etc?

    6 thoughts on “The Ethics of Bike Shares: Some Tough Distributive Justice Questions about Helmets, Fatalities, and Obesity/Heart Disease

    1. A difference not considered above is the TYPE of cycling. Most US cycling is on either 10-speed style road bikes or mountain bikes, while a significant portion of European cycling is on upright city bikes. There is a difference in the types of injuries and whether or not a helmet would make a substantial difference in the outcome. If a cyclist on a city bike (which all of the bike share bikes I’ve seen are) crashes it’s more likely to be a low-speed fall over (few opportunity for head injuries) or a motor vehicle accident where a helmet is unlikely to help much. As a life long rider, I know I wear a helmet when I take my road and touring bikes out, but rarely use one if I’m on my city bike, for the reasons I’ve stated.

    2. Bravo Joel.

      The author has a very myopic view of this. Health isn’t the only reason to want easy risk-free cycling in a city. What kind of city do you want: one with more or fewer slow, normal-looking, everyday pedestrian-plus cyclists? Helmet laws don’t mean “everyone helmets”: they mean “only those who happily helmet, cycle”. Big difference.

      City cycling is only about health in the same way walking is about health. Sure, there are power-walkers and hikers, and we’re all supposed to move around a bit more than we do. But to focus on that aspect alone is missing the point. Streets with people in them are popular streets: the tourist destinations, the shopping destinations, the high real estate values. The places you take visitors, to show off your city. Cities where children and old people can cycle are just nicer cities.

      City cycling isn’t a sport, in fact it’s the opposite of a sport. You’re sitting down and travelling further with every “step”. Everyone who can walk can ride a bike. If they don’t it’s either because of a choice-restricting mis-investment of their tax dollars in infrastructure for a single mode; or it’s because of silly hat laws.

    3. Joel — thanks for the helpful information on different types of bikes.
      James — thanks for the comments. I am not sure if by “the author” you meant me or the NY Times author whose article I was quoting from, but if it was me let me be clear: I did not suggest or mean to suggest that the obesity/heart disease v. fatality trade-off was the only relevant question for deciding what to do about helmets and bike shares. Far from it. Instead I am zoning in on one element of the social planning decision particularly pertinent for this blog, health vs. health trade-offs.
      One of the nice things your post highlights, though, is the difficulty (especially for CBA types) of trying to extend further to health vs. non-health trade-offs that (on some views) may involve less commensurable goods. How many heart attacks or bike fatalities equal how much improvement in tourism or street “niceness”? This is a very difficult problem for a social planner to try to resolve even if the health v. health trade-off is a little more tractable. Still I appreciate the comment.

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    5. I’d be surprised to see good data supporting Joel’s theory about different kinds of accidents on different kinds of bikes, controlling for riding style. It may be that different riding styles cause different sorts of injuries, and that particular sorts of bikes are associated with those different sorts of riding styles. (Obviously the average road bike is going faster than the average comfort bike.)

      • If there are no data that focus on different types of bikes and riding conditions, it would be nice to get it. There may be a trade-off here. But in Melbourne, where they refused to waive the helmet rule, a free-market solution arose: convenience stores, always open and usually near the bike stands, sell helmets for $5. Possibly there is a subsidy in there somewhere, but possibly a win-win