Helmet Laws In Congress Old Reports

HELMET LAWS IN THE CONGRESS ONCE AGAIN
In May 1989, against a backdrop of 34 states' adoption of mandatory automobile seat belt laws, Senator John Chafee (R-RI) held a news conference to announce he was introducing a bill—the National Highway Fatality and Injury Reduction Act of 1989—that would empower the US Department of Transportation to withhold up to 10% of federal highway aid from any state that did not require motorcyclists to wear helmets and front-seat automobile passengers to wear seat belts.48 The conference was strategically held during a meeting of the American Trauma Society.49
A hearing on the bill that was held by the Senate Committee on Environment and Public Works in October 1989 provided yet one more opportunity to engage (in a federal forum) the argument about the potential benefits that would result from the enactment of mandatory helmet laws and the deep philosophical issues such laws raised.50 As had others before him, Senator Daniel Patrick Moynihan (D-NY) sought to compare the imposition of helmet requirements with the public health justification for compulsory immunization.51 Senator James Jeffords (R-VT) responded with an invocation of the antipaternalistic argument so resonant in American political culture.
Would you urge us then, at the Federal level, to mandate diets and to investigate homes as far as diets are concerned? We would save a lot more money if we had good nutrition in this country. Do you think that is a proper role of the government? . . . I think there is a vast difference in vaccination, where you are subjecting others to a health problem, . . . where you are trying to protect the individual health of someone who is in a sense endangering himself and not the public. I grant the arguments are there on cost, but the arguments are there on cost in nutrition, as well. I have a hard time, philosophically, accepting that the role of the government is to tell us how to lead our lives. Why don't we have motorcycle riders wear armored suits? Where do you draw the line? It is my understanding that the largest percentage of injuries are not by head, but are injuries to the chest and the abdominal areas and things like that. So where do you stop?52
Senator Jeffords' comments were echoed by Robert Ford, chairman of Massachusetts Freedom First, an auto group that had led a successful campaign to repeal the state's seat belt law. Ford did not quibble with statistics that showed seat belts make people safer. Instead, he argued that the issue was about fundamental individual liberty.
We do not want to be told how to behave in matters of personal safety. We do not want to be forced to wear seat belts or helmets because others think that it is good for us. We do not want to be forced to eat certain diets because some think that it too may be good for us, reduce deaths and medical costs, and make us more productive citizens. We do not want to be forced to give up certain pastimes simply because some may feel they entail any amount of unnecessary risk.53
Instead of confronting the moral arguments made by opponents of helmet laws, proponents of such measures sought once again to marshal the compelling force of evidence. In 1991, at the request of Senator Moynihan, the General Accounting Office issued a comprehensive report that documented the toll. The report reviewed 46 studies and found that they overwhelmingly showed helmet use rose and fatalities and serious injuries plummeted after enactment of mandatory universal helmet laws.54
Despite the fierce opposition of motorcycle groups, Senator Chafee ultimately succeeded in getting the motorcycle helmet law and seat belt law provisions added to a major highway funding bill that was passed in December 1991. Under the law—which was far less punitive than what Senator Chafee had originally proposed—states that failed to pass helmet laws would have 3% of their highway funds withheld.55

REENACTMENT AND REPEAL
In 1991, the momentum seemed to be turning in favor of state motorcycle helmet laws. For the first time in its history, California enacted a universal mandatory helmet law, which took effect on January 1, 199256; however, this brief moment of public health optimism was short-lived. In 1995, after the "Gingrich Revolution," in which conservative Republicans took control of Congress, the national motorcycle lobby succeeded in getting the federal 3% highway safety fund penalties repealed.57 In 1997, after pressure from state-level motorcycle activists, Arkansas and Texas repealed their universal helmet laws and instead required helmets only for riders aged younger than 21 years. These repeals were followed by similar actions in Kentucky (1998), Louisiana (1999), Florida (2000), and Pennsylvania (2003). In a move that gave credence to the well-worn claim about the social costs of private choice, several of the new laws required riders to have $10 000 of medical insurance coverage policy before they could ride helmetless.
This new round of repeals of motorcycle helmet laws produced a predictable series of studies, with all too predictable results: in Arkansas and Texas, helmet use decreased significantly, head injuries increased, and fatalities rose by 21% and 31%, respectively.58 In 2003, a study of Louisiana and Kentucky fatalities found that after repeal of helmet laws, there was a 50% increase in fatalities in Kentucky and a 100% increase in fatalities in Louisiana. In 2005, the Insurance Institute for Highway Safety released a study that showed Florida's helmet law repeal had led to a 25% increase in fatalities in 2001 and 2002 compared with the 2 years before the repeal.59

CONCLUSIONS
Over the past 30 years, helmet law advocates have gathered a mountain of evidence to support their claims that helmet laws reduce motorcycle accident fatalities and severe injuries. Thanks to the rounds of helmet law repeals, advocates have been able to conclusively prove the converse as well: helmet law repeals increase fatalities and the severity of injuries. But the antihelmet law activists have had 3 decades of experience fighting helmet laws, and they have learned that their strategy of tirelessly lobbying state legislators can work. As one activist wrote, "I learned that the world is run by those who bother to show up to run it."60 More important, they have learned a lesson about how persuasive unadorned appeals to libertarian values can be.
This history of motorcycle helmet laws in the United States illustrates the profound impact of individualism on American culture and the manner in which this ideological perspective can have a crippling impact on the practice of public health. Although the opponents of motorcycle helmet laws seek to shape evidence to buttress their claims, abundant evidence makes it clear—and has done so for almost 3 decades—that in the absence of mandatory motorcycle helmet laws, preventable deaths and great suffering will continue to occur. The NHTSA estimated that 10 838 additional lives could have been saved between 1984 and 2004 had all riders and passengers worn helmets.61 The success of those who oppose such statutes shows the limits of evidence in shaping policy when strongly held ideological commitments are at stake.
Early on in the battles over helmet laws, advocates for mandatory measures placed great stress on the social costs of riding helmetless. The courts, too, have often adopted claims about such costs as they upheld the constitutionality of statutes that impose helmet requirements. Whatever the merit of such a perspective, it clearly involved a transparent attempt to mask the extent to which concerns for the welfare of cyclists themselves were the central motivation for helmet laws. The inability to successfully and consistently defend these measures for what they were—acts of public health paternalism—was an all but fatal limitation.
The recent trend toward motorcycle helmet laws that cover minors, however, shows that legislators and some antihelmet law forces have accepted a role for paternalism in this debate. The need for a law that governs minors shows a tacit acknowledgment that (1) motorcycle helmets reduce deaths and injuries and (2) the state has a role in protecting vulnerable members of society from misjudgments about motorcycle safety. Ironically, then, it is the states within which the motorcycle lobby has been most effective that have most directly engaged paternalist concerns.
The challenge for public health is to expand on this base of justified paternalism and to forthrightly argue in the legislative arena that adults and adolescents need to be protected from their poor judgments about motorcycle helmet use. In doing so, public health officials might well point to the fact that paternalistic protective legislation is part of the warp and woof of public health practice in America. Certainly, a host of legislation—from seat belt laws to increasingly restrictive tobacco measures—is aimed at protecting the people from self-imposed injuries and avoidable harm.
With the latest round of helmet law repeals, motorcycle helmet use has dropped precipitately to 58% nationwide, and fatalities have risen.62 Need anything more be said to show that motorcyclists have not been able to make sound safety decisions on their own and that mandatory helmet laws are needed to ensure their own safety?
Acknowledgments
The authors acknowledge the faculty and students of the Center for History and Ethics of Public Health at the Mailman School of Public Health and colleagues in the Department of Sociomedical Sciences who reviewed this article.
Human Participant Protection
No protocol approval was needed for this study.