Monday 14 March 2011

Stairs are dangerous - wear a helmet

In 2008, 716 cyclists died on the roads of the United States. It's quite a death toll - it would of course be better if there were fewer. However, by comparison, 12000 people die each year on stairs in the same country. It's much the same pattern in any country. Stairs are much more dangerous than bicycles. Nearly 17x as dangerous.

This article provides a list of helpful tips to prevent injuries from falling:

Here are some tips from the American Academy of Orthopaedic Surgeons and the National Athletic Trainers’ Association to help prevent injuries from falls.

Keep muscles and bones strong, by following an exercise regimen:

  1. Strength training with weight bearing and resistive exercise works for all age groups.
  2. Practice exercises designed to help improve balance.
  3. Exercise at least three days a week to improve strength, flexibility and balance.
  4. Choose low-impact exercises, such as yoga, tai chi and Pilates to avoid stress on joints.
  5. Stretch daily to improve flexibility and mobility.
Make your home safer with simple improvements:

  1. Good lighting, without extension cords, to eliminate dark areas.
  2. Slip-resistant walking surfaces.
  3. Grab-bars and a night light in the bathroom.
  4. Handrails on both sides of stairs extending one foot beyond last step.
  5. Remove throw rugs from doorways and hallways.
If you have fallen before, follow these recommendations:

  1. Consider a full physical evaluation and balance screen, including vision and hearing tests.
  2. Wear shoes with good support, such as lace-up oxford shoes with leather soles and rubber heels.

What's more, "The actual number is probably much larger. We believe most stair incidents are not reported". This is a scandal ! Stairs are demonstrably dangerous. So much so that they are the second largest cause of unintended injuries in the United States. When will we see national campaigns about stair safety, advocacy of helmets and special safety clothing for use of stairs ?

Why are Stannah stair lifts only marketed to the elderly ?

Children should be taught to use Stannah stair lifts. We can save lives with a campaign for this. Parents should set an example by always using a stair lift themselves.

Oh, hang on, there's a worse problem
Wait. Stairs are only the second largest cause of unintended injuries. What's the largest cause ? You'll perhaps not be surprised to hear that Motor vehicles are actually the largest cause of unintended injuries. Perhaps we should be putting our efforts on safety there.

And it gets worse. If you look not just "unintended injuries" but at "preventable causes of death" for the USA, the picture changes again. Now the 43000 deaths per year due to Traffic Collisions looks a little less significant as there are five other greater preventable causes of death. However, up there in the number two position, are 112000 deaths per year due to "overweight and obesity".

With this, cycling comes into the picture again. If the population can be convinced to take regular daily exercise as a part of their everyday lives, there is a very good chance of reducing that enormous death toll. If these people cycle instead of drive, they not only will reduce their chance of being one of 112000 dying each year due to being overweight or obese, they'll also reduce their chance of having anything to do with the 43000 deaths due to motor vehicles.

By comparison, the 716 deaths of cyclists now look a bit less significant. So why are cyclists the focus of so much "safety" campaigning ? In any case, helmets can only do so much. Of those 716 cyclists who lost their lives on American roads in 2009, only some will have died due to a head injury. Of those who died due to a head injury, only some won't have been wearing a helmet at the time of the crash. And of the non-helmet wearing cyclists who died of head injuries amongst the 716, only some might have had their lives saved by wearing a helmet. The potential gain to society by scaremongering over bicycle helmets is small. By comparison, the potential gain by encouraging people out of cars and onto bikes is enormous. Also the potential gain by re-arranging the streets to resemble those of the Netherlands is also enormous. Dutch cyclists are the safest in the world, with a death rate per km cycled 5x lower and an injury rate 27x lower than in the US, even though helmets are very rarely seen except on sport cyclists.

Note that because many of the other preventable causes of death catch up with us only as we get older, if you're an American aged between 1 and 44, the most likely preventable cause of death for you is a motor vehicle crash. For children aged between 9 and 18, it is the most common preventable cause of death worldwide.

If you want to make children safer, and cyclists safer too, then don't campaign for cycle helmets, or for improvements in stair safety either. The thing to do is to copy what has been done in the Netherlands. In particular, this campaign, and always keep an eye on the need for a high degree of subjective safety.

At present, there is a "wrong headed" attempt to make cycle helmets compulsory in Northern Ireland. The last day to sign a petition against this is today.

Update a bit later in the day: Some people in the comments are getting a bit too interested in exact statistics for how dangerous stairs are. Actually, this isn't really the point. The point is that there are many things more dangerous than cycling, however you count them. This post is about keeping a sense of perspective about different risks. There is simply too much scaremongering about cycling.

Note that exercise is listed as one of the things that improves your chances when climbing stairs. Cycling is also low impact exercise, so ride a bike and you're safer there too. In the photo at the top, Judy risks climbing the stairs of a local lookout tower - without wearing a helmet. I'll end on a serious note: Hold the rail when you walk on stairs. It might save your life.


Gary said...

Excellent post David. Really puts the actual risks into perspective. Have you considered running for PM in Australia? You'd get my vote for sure.

Piet said...

While I fully agree with the thrust of your post, you make no allowance for "exposure" to risk. I would imagine the exposure to the risk of stair injury is much larger than the exposure to the risk of a bicycle head injury. To compare apples to apples requires allowances for exposure. Nevertheless thanks for a great post and please keep up the good work in advocating sensible approaches to bicycle infrastructure.

David Hembrow said...

Actually, Piet, I think the exposure by cycling is greater. For instance, if you were to express the figures per km travelled, or per minute exposure. I use the stairs at home several times a day, but I don't spend anything like as long on them as I do on my bike.

Mostly, though, the post is supposed to point out how ludicrous it is to go on about the "danger" of cycling, and how helmets are somehow needed to keep cyclists safe. There are far bigger problems facing the population as a whole, and far more effective measures to make cyclists safer than slapping a plastic hat on their heads.

Paul Martin said...

Excellent post, David.

...and here I was thinking that running up and down stairs is good exercise (to improve strength to avoid falling down stairs)!! ;-)

Re: Exposure risk
It always frustrates me that the exposure to risk, when comparing cars to bicycles, is expressed as a 'per kilometre' figure. Surely this means that the fastest means of travel will appear safer.

'Risk Exposure' to me implies how long I am exposed to a given risk. Cycling is safe compared to driving in Australia yet car drivers aren't compelled to wear helmets, paint their cars fluorescent yellow (all of them) and have little flags on their aerials!

Going by the 'per kilometre' reference point, to quote Mikael Colville-Anderson: "Space travel is remarkably safe per kilometre travelled... until you realise that 5% of all astronauts have been killed in space..."

Irishman said...

I can't find any sources for that figure of 12,000 stair deaths - is there a report or a statistic (not a random web page) that quotes it?

Irishman said...

PS all I've found so far is and which both site 1,307, far lower than 12,000.

I'm in full agreement that cycling is not as dangerous as can be made out, but I'd like to get my facts straight and up-to-date.

David Hembrow said...

Irishman: My reference is linked to from the blog itself. I can't explain the difference between the figure you've found and their figure. It is quite possible that they measure something different. The number quoted in the article looks suspiciously similar to deaths from falls overall, but you could perhaps classify some of the other falls as also being connected with stairs (e.g. "Other fall from one level to another").

dr2chase said...

One obvious reason for the focus on cycling safety is a sort of bikes-are-toys paternalism; clearly, anyone riding a bike isn't really thinking things through (else they would drive a car, right?) thus we must teach them about safety.

Another likely reason is that "normal people" don't go around hurting other people unnecessarily, and since in America, "normal people" drive cars, when a is cyclist is crashed into, the problem cannot be with the car or its "normal" driver. So it must be the cyclist.

Anonymous said...

Like Piet, I agree strongly with the thrust of this post, but I don't think you have fully rebutted his point regarding the amount of exposure to risk.

While it is true that *an individual* might spend more time cycling per day than using the stairs, I imagine pretty much everyone in the US uses stairs at some point every day. However, I doubt more than 1-2% (generously) of US citizens use a bike every day.

So the exposure to risk on stairs might be greater than you suggest.

That said, of course, even if it turns out that the risk of a head injury when using stairs is slightly less than that of using a bicycle, we will never see campaigns for helmets for people using stairs, even though thousands of people die on them every year. That shows you how muddled our thinking is on 'safety' regarding bicycles.

Ladia-skladaci-kola said...

Do not forgot to wear a helmet while stepping on stairs :-)

David Hembrow said...

aseasyasridingabike: It was really not meant to be put to such scrutiny. However, one of the links that Irishman provides gives an interesting perspective. The Netherlands seemingly is number 7 for stair deaths, with 175 per year. That's almost exactly the same number as that for cyclist deaths each year. This is a country where both stairs and bikes are used by a large proportion of the population every day.

Something I find very interesting about those stair death statistics is the huge variations between countries. Does it really seem likely that, for instance, Germany with an 82 million population has 941 stair deaths per year while the UK with a 65 million population has just 52 and Argentina with 40 million (half the population of Germany) has just 8 ?

I think not. I suspect these huge variations come about due to different ways of counting, and different way of classifying what a stair death is.

rigtenzin said...

I know you did not intend for this to be a discussion about the details of the statistics. I agree with your overall point.

Anyway, the number of deaths attributed to falling down steps was a surprise to me so I read the comments here for more details and I found the following information provided by a quick search:

They call them "Unintentional fall deaths" which takes in more types of accidents than just falling down steps.

I apologize for nitpicking because I like your blog and read it regularly.

Son of Shaft said...

The Dutch stair deaths could also be relatively high because of tourists/expats in old city centres where the stairs are steep and narrow compared to most (north american) stair designs. There are several youtube vids of foreign students/tourists/expats having a tumble.

Handrails aren't mandatory in parts of Europe. The comment by Simon is telling.

cocosolis said...

There's very little one can dispute about your arguments - if the world was ruled by logic. Alas, old prejudices and vested interests mascarading as 'common sense' are always getting in the way. I hope reason prevails in NI.

Micheal Blue said...

Dave, this is a very good article.
As to the politians trying to make helmet wearing mandatory, I think that many politians are some of the most clueless people around and they do what seems to look good and earns them glamorous points. It's very easy to say that "helmets save lives and prevent injuries"; it doesn't need to be defended much = easy points.
People who cannot think intelligently quickly agree with these superficial slogans/ideas.
It takes intelligence and guts to look into something deeply and then to stand by the revealed truth.
BTW, even though it's more a question of syntax than overall validity, it's incorrect to say that stairs are dangerous or that stairs cause injuries, or that an earthquake kills people, etc. It's walking up/down stairs without awareness and/or in poor physical shape that makes people fall and get injured/killed. It's falling things that kill people in earthquakes, not the quake by itself; if everything would be properly designed and attached to withstand event the strongest earthquake, nobody would get killed.

Kim said...

"Exercise at least three days a week to improve strength, flexibility and balance."

Hummm, what sort of exercise would be use full in achieving this? I know, riding a bicycle...

Marcus said...

Very well written piece of text David! There are some horrible number you present there.112000 deaths by overweight, that's a third of my hometown (Malmö, Sweden) each year! And a simple bike could fix this in a jiffy!

For daily exercises I would recommend everybody to look the name Hans Kraus up. The first one to connect exercise and health together. There is a very inspiring book about him called "Into the unknown".

Eric said...

"Exercise at least three days a week to improve strength, flexibility and balance."

Does working out on a stair climbing machine reduce your risk by making you more fit, or increase it by increasing your exposure to stairs?

Doug McLaren said...

Ahh yes, the "X times as many people die doing Y than Z, so Y is X times more dangerous than Z" argument.

Once again, skydiving and Russian Roulette beat stairs and bicycling handily in the safety through statistics department!

David Hembrow said...

Doug: I did sky-diving in a previous post.

Doug McLaren said...

Claiming that skydiving is safe is butchering the statistics there too. One death per 122,000 trips, where each trip lasts only a few minutes and covers perhaps three miles? Well, part of the trip is going up, let's say ten miles (Not that the distance really matters for our purposes here.)

Cars are a whole lot safer than that. If you estimate that the average person makes three trips per day, and 40,000 die per year, and here's 300,000,000 people in the US -- that's one death per 8,212,500 trips. Assuming the trips are somehow comparable, that makes skydiving 67 times more "dangerous" per trip.

But most people don't go skydiving, and not several times a day, so the overall deaths are low. Even fewer people play Russian Roulette, but the odds are about 1 in 9 that each round will kill you (done properly, the odds of a bullet are 1 in 6, but it doesn't always kill.)

But using your reasoning, both of these activities are orders of magnitude safer than using stairs and riding a bicycle.

Anonymous said...

"Some people in the comments are getting a bit too interested in exact statistics for how dangerous stairs are. Actually, this isn't really the point."

Sorry David. I thought I had made it clear that I agreed with the general thrust of your argument - it was just a minor statistical quibble.

Apologies for the diversion!

David Hembrow said...

Doug: You've missed the point. In fact, you've somehow turned it complete around on its head.

Cycling is not dangerous. Even here where it is something that the masses do every day, cycling still accounts for only a minority of deaths.

What's more, despite the world's safest roads, it is still true that motor vehicles are the biggest shorteners of life for younger people: "the cause of death of the 'younger than 40' is often a traffic accident. The average age of a road death is 42 years. The number of years of life lost (YLL) as a result of a road crash is large in comparison with other causes of death".

David Hembrow said...

aseasyasridingabike: I didn't particularly have you, or anyone else, in mind when I wrote that. In itself, I quite enjoy the discussion. However, none of it is really the point.

Motor vehicles kill 1.2 million people per year, injure 50 million and damage the health of rather more again due to the pollution they create. This danger is way out of proportion to any danger due to bikes, yet it is cyclists who are targeted with "safety" campaigns.

The risk due to cycling is incredibly small, including here in the Netherlands where everyone cycles. Exposure really has nothing to do with it. Bikes simply aren't (often) lethal devices.

Steve said...

Your implication that stairs aren't being regulated as heavily as bicycles even though the risk of injury is greater isn't really accurate.

Every building code regulates the size of stair landings, stair width, clear head height, riser height, tread depth, nosing size, handrail height, handrail location, handrail diameter, opening size allowed in handrails, extension of the handrail beyond the top and bottom of a flight of stairs, allowable variations in riser and tread in a flight of stairs, types of glass allowed in windows near stairs and landings, and those are just the ones I can think of off the top of my head.

Robert said...

Last year I fell down some steel steps when my company was inspecting the progress of a structural steel fabrication. So it doesn't surprise me that stairs are the second largest cause of unintended injuries. I do think you go too far, though: if you think about how many people use stairs each day (usually more than once) compared to how many people use bicycles each day, it becomes less surprising. I would be interested to know which one, percentage wise (# of accidents / use), would come out higher.

Poiuyt Man said...

I am disappointed by the bias and statistical accuracy in this article. As pointed out by others, the figure for stair falls is likely misquoted, being the figure for falls in general. Additionally, there is sampling bias in that being "nearly 17x as dangerous" does not account for the large difference in number of people that use stairs everyday vs. number of people that ride a bike everyday.

I understand that the statistics aren't really the point, but if so then they shouldn't have been put first and foremost in the article. For me, and I'd guess many other readers, the first paragraph was the main draw because it's filled with several shocking statistics, and was a large part of why I recommended that others read it (before returning later myself and perusing the comments). Finding out that the real statistics are likely, much, much less shocking, I feel a bit deceived.

David Hembrow said...

Poiuyt Man: There is no statistical inaccuracy in the article. At no point does the article attempt to tell you anything which isn't true.

It's really very simple: According to the source that I used in the article, in the USA, 17x as many people are killed by stairs as by bicycles. However, in the same country, there is a virtual hysteria over the "need" to wear a helmet while cycling, while hardly anyone is aware of the number of deaths which result from using stairs.

The article is about this hysteria, not about the numbers.

Meanwhile, over here in the Netherlands, where everyone cycles, but not everyone has stairs in their home, stairs and bicycles account for about the same number of deaths as each other and people wear helmets for neither of these activities.

Ian Brett Cooper said...

Stairs already come with safety equipment that's mandated by law here in the US. It's called a bannister and all stairs over (IIRC) 6 steps are supposed to have them.

So the idea that safety equipment for bicycle riding is unnecessary because safety equipment is not required to use stairs is, frankly, nonsense. It's a straw man.

David Hembrow said...

Ian: Bicycles also come as standard with mandated safety equipment. Brakes, for instance. In most jurisdictions you must have two independent systems because brakes are essential for safety. These are the near equivalent of banisters for bikes.

However, no-one is suggesting that climbing of stairs should require safety clothing.

Incidentally, in the Netherlands it is legal to have just one brake on a bike if it is a back-pedal brake. With this type of brake, the form of propulsion is closely tied to the brake. A broken chain means you can neither go nor stop, making the safety implications of failure not nearly so large as with cable operated brakes.

Unknown said...

I think the whole helmet thing comes out of the bicycle racing scene. Cultures outside of NL probably dont make a distinction between racing and utilitarian cycling. The utilitarian approach can be very clearly seen in the upright design of typical dutch bikes which arent suited for racing at all. Slow speeds dont necessitate helmet usage. Higher speed cycling with a more horizontal attitude of the torso makes falling forward a risk in the case of accidents. Helmet usage in this scenario is relevant.

David Hembrow said...

An3z: Actually, the faster you go, the less helmetsmake sscene. They're desied to absorb energy from impacts up to about 12 km/h. The amount of energy to be observed is a square law so at double tat speed the helmet can absorb just a quarter of the energy and at four times the speed, only a sixteenth.

While racers use helmets, they actually don't gain much safety from them.

Cycle racing isn't nearly as dangerous as people think. The Tour de France is over a hundred years old now. Just three riders have died. One of them from a head injury. One of the unfortunate risers died on a rest day (jellyfish sting when he swam), making rest days statistically more dangerous than racing days.

Unknown said...

I posted my last comment out of personal experience. I flipped over forwards once on a racing bike during a collision (the spokes of my front wheel got caught on someones back axle fun and very dangerous)I landed with my forehead on the asphalt. I agree bicycle helmets dont protect much but I could have used some kind of protection! Didnt get a concussion (or worse)though. Lucky me:)

David Hembrow said...

an3z: Do you realise you're justifying helmets on the basis of one anecdote in which your injury was just a scratch and you were not further harmed. That's how the human body correctly responds to small injuries. No real harm done, but it reminds you not to repeat the experience.

Unknown said...

I wasnt looking to justify helmet usage at all. What i was trying to get at is that certain models of bicycles are safer than others. People should do a risk assessment before purchasing any vehicle. Im of the opinion that racing models are not the safest choice.

David Hembrow said...

an3z: Then we're completely in agreement. However I think we have to also agree that even less safe types of bikes such as racing bikes aren't really that dangerous.

I get my racing bike out on sunny sundays sometimes for the fun of it. There's something special about the feel of riding on high pressure narrow tyres while staring at the ground. Actual speed over distance is easier to come by with the more streamlined form of a recumbent, in more comfort and certainly more safety due to having a shorter distance to fall and going feet first.

Unknown said...

Forgot one thing: I think bicycle helmets are all flawed as they really only protect the top of your head.

p.s. I dont think i should have gotten involved in this thread living in NL. I understand some countries make it mandatory to use a helmet. This is utterly stupid as, like you pointed out, other things are far more dangerous. Anyway, you can delete my comment if want. This discussion isnt really my business.

Unknown said...

Are racing bikes dangerous? Not if you grew up with cycling. Ive seen a lot of immigrants learning to cycle for the first time as adults. It doesnt look pretty. I think racing bikes are safe for experienced cyclists but maybe not a good idea for everybody. I do still think youre more vulnerable going 'head first' on a racing model certainly in congested bike traffic. The accident i mentioned earlier happen in congested bike traffic.

Unknown said...

What youre dealing with, with the helmet issue, is the culture of each different country involved. NL has a very liberal attitude with respect to, amongst other things, personal safety so helmets arent mandatory. Its more of personal responsibility thing. Other cultures may have a completely different mindset. Even if you look at canals in urban areas in NL, you rarely see fences protecting people from falling in, which does happen on rare occasions(drunk people) but you dont hear anybody screaming for fencing along the canals because its perfectly safe if you take responsibility for your own safety. Im prone to thinking other countries, or at least their govs might, if they had canals, choose to have fencing along city canals as a standard safety measure because the culture facilitates such an attitude from their gov. An open-ended comment I guess...

Multiparty Democracy Today said...

Regardless of how safe helmets might make you in a collision, the thing that really saves lives is not having the collision at all. After all, your head might be fine in a collision with a truck but your heart and lungs might be directly under the wheels without proper means of avoiding a right hook collision. And of course head injuries cannot occur if the collisions themselves do not occur.