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Injuries to the head and neck are the main causes of death, severe injury and disability among users of motorcycles and bicycles. In some countries head injuries are estimated to account for up to 88% of such fatalities.

Motorcycle and bicycle use is widespread throughout the world. Daily, millions of people use motorcycles and bicycles for transportation and for recreation. Particularly in Asia motorcycles are a very important part of the traffic fleet, in several countries they are the dominant vehicles. Of the 11-12 million motorised vehicles in Viet Nam 90% is motorcycles. Motorcyclists are involved in more than half of the fatal accidents in some Asian countries. It is expected that motorcycle growth is expected to increase and so will the number of head injuries and number of fatalities. This low-cost and vulnerable motorized vehicle could conceivably accelerate the motorization in the Asian region. See below some statistics for Malaysia - one of the 'better' (in road safety terms) Asian countries.


  • Motorcycles represent 49.6% of traffic
  • Motorcycles involved in 60 - 67 % of crashes
  • Motorcyclists represent 50 - 57 % of deaths
  • 33% of motorcyclists are involved in weaving
  • 30% of helmet users not wearing helmet properly
  • Only 24% of children are using a safety helmet
  • Problem of motorcycle racing on public highway

From presentation by Kulan K. C. Mani, Road Safety Research Centre, University of Putra Malaysia, at ASEAN Seminar, Viet Nam, March 2004.


Helmets provide the best protection from head injury for cyclist and motorcyclists involved in traffic crashes. Non-use of helmets increases the risk of head injury for motorised two-wheeler riders by a factor of three, and helmets reduce fatal and serious head injuries by between 20% and 45%. Motorcycle fatalities in the US rose 13 percent between 2004 and 2005 to 4,553. Almost half of the people who died were not wearing a helmet at the time of a crash, reflecting looser state helmet laws. Wearing rates are however high in many high income countries, being virtually universal in the United Kingdom for example. In middle income and low income countries where two-wheeler traffic has increased rapidly, wearing rates may be close to zero, or almost 100% if laws on helmet use are in place and enforced. Even where the rider wears a helmet, passengers may not do so, and children in particular are often unprotected. Cyclists are also at risk from head injury, but legislation on cycle helmet wearing is much less common than for motorcyclists. Where legislation is not in place, wearing rates are often as low as 10%. Bicycle helmets have been shown to reduce head injuries by between 63% and 88%. Read full publication.

In Thailand the high rate of death and serious injuries involving motorcyclists in Khon Kaen prompted the authorities in the Province to take action to cut the death and injury toll by introducing legislation to make helmet wearing compulsory. In the year following the enforcement of the law, helmet use increased five-fold. The introduction of the legislation was coupled with an intensive public education and police enforcement programme, the combined effects of which achieved a helmet wearing rate of over 90%, a 40% reduction in head injury and a 24% reduction in mortality in motorcycle injuries over a one year period (1996).

The introduction of helmet use laws for all motorcycle riders and passengers combined with enforcement is the most effective method of increasing helmet use. Motorcycle helmet wearing can, if correctly legislated and enforced, reduce the severity of motorcycle accidents. Legislation must provide for the compulsory wearing of helmets while riding a motorcycle of any size and speed; this must be backed by enforcement. However, helmet design and construction must relate to a suitable minimum legal standard that will offer the wearer an appropriate amount of protection in the event of a crash. Traffic police using motorcycles must be seen to wear the correct helmet type, have the helmet fastened, and to enforce their correct usage. Helmets should also be worn by pillion passengers. Regulations concerning the size and speed of motorcycles should also be considered, along with the use of graded licenses based upon age and experience.

One of the objectives of a helmet programme is usually to raise the quality of the helmets being used. This is best achieved by ensuring that all helmets meet a recognized safety standard - one that has been demonstrated as being effective in reducing head injuries. The standard should also provide quality assurances for the user. It must, of course, be suitable for the traffic and other conditions of the country, and it should be flexible enough to enable manufacturers to produce a range of approved models and styles. A number of standards exist for different countries. The most wide spread has been developed by the Transport Division of the United Nations Economic Commission for Europe (UNECE): UNECE Regulation No. 22. The latest revision of this regulation came into force in February 2002, and is applied by 36 UNECE Member States as well as New Zealand.

Lack of helmet use was recognized by the World report on road traffic injury prevention in 2004 as one of the most important 'risk factors' that contribute to road crashes and injury severity. Based on the findings of the report, the UN Road Safety Collaboration has recommended priority action in five key areas: lack of helmet use; seat belt non compliance; drink driving; excessive speed; and poor infrastructure design. The World Bank, WHO, FIA Foundation and GRSP are co-ordinating the production of a series of good practice guides covering these key recommendations.

The good practice guide for "helmets" was published in August 2006, and activities to implement and enforce helmet campaigns have been initiated. The manual is targeting decision-makers and practitioners and provides advice on how to increase the use of helmets within country and draws on experience from countries that have succeeded in achieving and sustaining high levels of helmet use. It provides the necessary evidence that will be needed to start a helmet use programme, and takes the user through the steps needed to assess the helmet situation in a country. It explains the steps needed to design and implement a programme, including: setting up a working group; developing an action plan; introducing and enforcing mandatory helmet laws; creating appropriate standards for helmet production; effectively marketing helmets to the public; educating children and young people on helmet use; and consideration of the capacity for an appropriate medical response to be provided following a crash. Finally, the last section in the manual guides the user on planning and implementing an evaluation of the programme, such that results are fed back into programme design. For each of these activities, the document outlines in a practical way the various steps that need to be taken.