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Sunday, Jan 14, 2007
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The case for compulsory helmet-wearing

K. Ganapathy

A neurosurgeon on the need for head protection among two-wheeler riders

The Madras High Court has at last admitted a writ petition challenging the non- implementation of Section 129 of the Motor Vehicles Act, which makes the wearing of protective headgear compulsory for two-wheeler riders. The only point that needs to be adjudicated upon is whether individuals have a right not to wear a helmet.

Neurosurgeons would take umbrage at the government pleader's argument that "neurosurgeons were of the opinion that helmets did not offer complete protection." This is contrary to the facts. In 1999, the Neurological Society of India impleaded itself in the Madras High Court in a writ petition filed by the Accident Victims Association. The exhibits included a certificate from the president of the World Federation of Neurosurgical Societies (representing the world's 45,000 neurosurgeons) on how a helmet could reduce the severity of a head injury. That petition has still not come up for hearing. The literature on the subject shows that additional protection to the head reduces the severity of the force transmitted to the brain and injury to it. What would otherwise be an irreversible injury could be made reversible. Wearing a helmet reduces significantly the fatality rate, the period of hospital stay, medical costs and degree of disability. Any anecdotal reports that helmets by themselves cause problems, do not have any scientific basis or statistical significance.

Head injury is the sixth most common cause of death in India. But data do not reflect the agony and misery faced by families when a breadwinner is critically injured or dies. In spite of the phenomenal number of two-wheelers on the roads, the chances of sustaining a head injury is less than 0.5 per cent. For these few who are injured, the consequences are disastrous. Any parent, widow or child of a victim will testify to this. The insurance companies doling out crores of rupees, the hospitals whose beds are occupied by head trauma cases, the disabled patients, the survivors who are working at sub-optimal levels... all will testify to this. During the last 31 years, this writer has been involved in the management of some 9,500 such cases in Chennai. About 90 per cent of them are two-wheeler drivers or pillion riders. Of the 450-odd persons who died from head injury, fewer than 10 were wearing helmets.

In one study in Chennai involving 1,500 individuals, only 11 per cent of non-users had an objection to wearing a helmet. Some 92 per cent of the non-users said they did not use helmets "because it is not compulsory." Helmets are compulsory for two-wheeler riders in Austria, Belgium, Denmark, Finland, Greece, France, Luxembourg, the Netherlands, Portugal, Sweden, the U.K., Japan, Singapore, Malaysia and Sri Lanka. In many States in India and in the U.S. it is so. Studies have shown that when helmet use is left to voluntary choice, it is used by 40 to 50 per cent; when it is compulsory the figure is almost 100 per cent.

The Supreme Court has made wearing of seat belts mandatory, though whether it is being implemented is a different story. Nobody objects to the use of seat belts in an aircraft: it is accepted as a part of safety regulations. Why then is it necessary for individuals and organisations to seek the intervention of the courts to pass a judgment so that people are compulsorily made to save their own lives? It has been suggested that the decision be left to individual judgment. But, because of the it-cannot-happen-to-me syndrome, young, healthy individuals seldom accept the fact that he or she is at a risk.

The pen is mightier than the scalpel. With a signature, a judge can save more lives in Tamil Nadu than can be saved even if all the neurosurgeons in the State spend their lifetime treating head injuries. Helicopter ambulances, state-of-the-art critical care head injury units and trained neurosurgeons in every town can at best save a few more lives.

Not enforcing the law on the grounds that individuals have a right not to wear a helmet, is a retrograde act. Making two-wheeler users wear helmets does not require funds or expertise. All that it requires is a change in mindset. How many hundreds more need to leave this world prematurely for want of a signature?

Indifference, apathy and insensitivity to traffic laws on the part of the public at large, often reflect oriental fatalism: "what is to be, will be." But, by the time realisation dawns, it is too late. Public laws are aimed to protect human beings and society. Can society exist without laws and enforcement? Enforcement is one way to demonstrate that individuals are cared for and protected. One has to be cruel to be kind.

(Prof. K. Ganapathy, a Chennai based neurosurgeon, is a former secretary and president of the Neurological Society of India. )

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