The Swedish Bicycle Helmet Initiative. Population 9,4 million Counties 20 Municipalities km2

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1 The Swedish Bicycle Helmet Initiative Population 9,4 million Counties 20 Municipalities 290 Area km2

2 The Swedish Bicycle Helmet Initiative Robert Ekman, Associate Professor The Swedish Civil Contingencies Agency, MSB

3 Background The Swedish Bicycle Helmet Initiative 1990 WHO initiative was launched to increase helmet-wearing by two-wheel riders around the world. The initiative was taken up by a group of WHO Collaborating Centres, including the Karolinska Institutet in Stockholm Collaborating Centre on Community Safety Promotion.

4 The Swedish Bicycle Helmet Initiative Sweden s National Insitute of Public Health initiated the implementation of strategies for promoting the use of bicycle helmets as part of its National Safety Promotion and Injury Prevention Programme and as a strategy regarding physical activity. An intersectoral approach was adopted to include all agencies involved in safety promotion.

5 The Swedish Bicycle Helmet Initiative A steering group (roundtable) The Helmet Initiative Group - was formed and initially consisted of Karolinska Institutet The National Institute of Public Health The National Road Administration The National Board for Consumer Policies The National Board of Occupational Safety The Road and Traffic Research Institute The Childrens Ombudsman

6 The Swedish Bicycle Helmet Initiative Stockholm County Council, Västerbotten County Council, Skaraborg County Council and Götene Municipality (host of secretariat) National Society of Road Safety National Police Board Linköping University Swedish Cycle Society Swedish Cycling Promotion

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8 The Swedish Bicycle Helmet Initiative The steering committee met twice a year and a number of working (national)- and taskforce groups (expert and regional) were formed. A key programme strategy implemented to coordinate activities between participating organizations.

9 The Swedish Bicycle Helmet Initiative Some process-oriented targets were to: improve and share knowledge related to helmet use, examine on-going work in Sweden and abroad, and participate in international work within the framework of WHO Collaborating Centers. The Group s principal strategy was to work through existing organizations.

10 The Swedish Bicycle Helmet Initiative A special task group was formed to liaise with the Swedish Ministry of Transportation to promote helmet use legislation. Two National Helmet Conferences were held with more than 350 participants including other Nordic countries.

11 The Swedish Bicycle Helmet Initiative Investigation of public attitudes Several focus groups were established, consisting of nine school classes (ages 12-14). Other knowledge came from a online community inquiry, Lunarstorm, where as about responded.

12 The Swedish Bicycle Helmet Initiative Extensive efforts were made to extend the network of safe-cycle lanes and to implement safety promoting changes in transport structure, particulary in high-risk rural areas. Some examples of national and regional efforts: school- and design competitions advertising in media-/on milkcartons-/cinema commercials-/ikea-/on helmet discounts-/on roadside billboards information-/commercials on national TV-channels and information on the represented authorities offical websites.

13 The Skaraborg Helmet with a Helmet prescription A 25 year old concept. Every family with a one year old child and-or a three year old child gets a helmet prescription at child health clinics. Parents can buy a subsidized helmet for 11 Euro at NTF Skaraborg office or at the Insurence company Länsförsäkringar local offices in Skövde, Lidköping, Mariestad and Falköping. Helmet price without a prescription: 17 Euro

14 Skaraborg Helmet Prescription The nurses systematic safety work have resulted in at least contacts with families the last 25 years The programme covers children/year

15 The Swedish Bicycle Helmet Initiative The Swedish Parliament, through the Zero Vision Strategy, has adopted the goal of mandatory helmet-wearing, but has left it to the government to decide when this should be adopted. The Helmet Initiative Group were active for a decade and they have seen that helmet use have been increasing, however not at that rate they hoped for.

16 The Swedish Bicycle Helmet Initiative Mandatory helmet wearing is still an important strategy at the national level. Regional and local based efforts still need to be more comprehensive new target groups, such as immigrants, vulnerable social groups and teenagers must be approached. An analysis of more then 15 years of regional and national programmes on bicycle helmet promotion demonstrates positive developments for various programme components child health care, staff and parental information-/education helmet-discount schemes and general community safety programmes.

17 World Bicycle Champs 1

18 Bicycle injuries in Sweden Some results from an ongoing study By Jan Schyllander, Investigator Robert Ekman, Associate Professor The Swedish Civil Contingencies Agency, MSB, Karlstad, Sweden & Diana Stark Ekman, Ph.D., University West. Trollhättan, Sweden 2

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20 Background About new bicycles are sold per year in Sweden Sales increased 8 % this year compared with 7 % last year About 30 % use a bicycle every week. During winter time almost 20 % bicycle at least one day a week. 4

21 During , more bicyclists were hospitalised for traffic-related injuries each year ( average 3516) than the combined totals of all hospitalised car drivers and passengers (average 3472). 5

22 Bicycle helmet use in Sweden Children 10 residen.al Children 6-15 (school) Adults workplace Children and Adults cycle paths 6

23 Antal döda cyklister Number of bicyclists killed Antal dödade cyklister enligt polisen under perioden Källa: Transportstyrelsen. 7

24 Antal svårt skadade cyklister Number of severely injured bicyclists Transport Agency Antal svårt skadade cyklister enligt polisen under perioden Källa: Transportstyrelsen. 8

25 Number of hospitalized bicyclists Antal slutenvårdade cyklister under perioden Källa: Patientregistret, Socialstyrelsen. 9

26 Age distribution Cirka personer söker akutsjukhus Ytterligare cirka i andra miljöer än väg Procentuell fördelning av skadade cyklister efter åldersgrupp och kön. Medelvärden för Källa: IDB Sverige, Socialstyrelsen. 10

27 Month of injury Procentuell fördelning av skadade cyklister efter skademånad. Medelvärden för Källa: IDB Sverige, Socialstyrelsen. 11

28 Trends for age groups and injuries, hospitalizations hospitalization 0 hospitali 14 år år Enstaka dödsfall de senaste åren Ett till två döda per år de senaste fem åren år år Två till fyra döda under de senaste fem åren 12 Fem till tio döda per år under de senaste fem åren

29 Trends for age groups and injuries, hospitalizations 65 + år Tio och femton döda under de senaste fem åren. 13

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31 Trends for age groups and bicycle-injury related concussions, hospitalization / Antal slutenvårdade cyklister per invånare med hjärnskakning efter åldersgrupp under perioden Källa: Patientregistret, Socialstyrelsen. 15

32 Trends for all concussions in Sweden for age group 0-14, number of hospitalizations / Antal slutenvårdade 0 14 åringar per invånare med hjärnskakning som huvuddiagnos under perioden Källa: Patientregistret, Socialstyrelsen. 16

33 Total hospitalisations for concussions have decreased, due in part to new diagnostic measures, including CT scans, for all external causes. The total rates of hospitalisations due to concussion in children 0-14 have decreased by 30 percent between 1998 and 2011, for all external causes. The associated decrease in hospitalisation rates for children with cycle-related concussions is about 50 percent. 17

34 Discussion points Hospitalisations for cyclists have increased from 1987 through At the same time, the number of hospital beds have decreased dramatically, due in part to changes in health care, CT diagnosing, and new policies. This may mean that the total number of injured cyclists has increased even more than we report here. The increases in hospitalized cyclists have increased in every age category but the youngest, children up to ages 15. In this group we see a decrease in the number of hospitalisations. Decreases in this group began long before the mandatory helmet law was instituted in

35 Because the total number of hospitalisations due to concussions have decreased over time, it is not possible to completely explain the associated reduction in hospitalisations due to concussion for children 0-14 as simply due to helmet use BUT The decreases in hospitalisations due to concussions have decreased faster for children who were injured while cycling, compared to hospitalisations for children who suffered concussions due to other external causes, which points convincingly to the effectiveness of helmet use. 19

36 Use of cycle helmets is shown to reduce head injuries in cyclists

37 Thank You for your attention! 21