Wednesday 2 May 2012

Challenges to growth in cycling in the Netherlands. Older people cycle more than ever before but their injury rate is rising.

One graph can never show the multitude of factors behind the cycling modal share of a nation.

In this post, I'll point out how the usual chart which shows how cycling has grown in the Netherlands since the 1970s hides some major demographic factors which influence cycling, not all of them positive.

In addition, we've recently been told that for the first time in nearly ten years, cyclist deaths rose in the Netherlands last year compared with the year before. What's this all about, and is it somehow related to the modal share ? Read on...

First challenge: Immigration
Each year, the Netherlands loses about 30000 more people due to emigration than arrive as new immigrants. Many people who emigrate were born overseas and are returning to their land of birth, but also many Dutch people emigrate. This number, you'll notice, is smaller than that of births vs. deaths.

Nevertheless, by 2010, this exchange of people between countries resulted in 11% of people living in the Netherlands having been born in other countries. Because all other countries have a lower cycling modal share than the Netherlands, this of course implies that immigrants were born in countries where it is normal to cycle less than in the Netherlands.

Immigrants to the Netherlands try hard to integrate well with the local population and this includes their cycling habits. Immigrants living in the Netherlands cycle about as much as they would had they been born in and still lived in Finland or Germany. i.e. less on average than the native Dutch, but as much as people from other leading cycling nations. Clearly, though, we can't state that growth in cycling is due to immigration.

Second challenge: Ageing
Between the 1970s and now, the population of the Netherlands grew from 13 million to 16.5 million people. As we've seen, this is not due to immigration. It is also not due to a high birth rate. As is normal for developed nations, the Total Fertility Rate of the Netherlands (how many children are born on average to each woman) has been less than 2 for some time. In the Netherlands, the TFR has been less than two since 1973.

Births still outnumber deaths in the Netherlands by almost 50000 people per year, and this is what has lead to population growth. Deaths are lagging behind births because of the increase in life expectancy and resulting increase in the average age of the population. Men can now expect to live 7 years longer than in the early 1970s and women 5 years longer. Women still live slightly longer on average than do men.

Meeting these challenges
Neither older people nor recent immigrants from countries with lower cycling rates are the easiest people to convince to cycle.

Immigrants are encouraged to cycle. A successful initiative called Fiets Vriendinnen ("Cycling Girlfriends") is the only organisation that I'm aware of which cycle training for adults. Specifically, they offer cycle training and support for women new to the Netherlands, performing a useful function of helping people to integrate into Dutch society.

However, something else has happened which many people may find surprising. Elderly people in the Netherlands now cycle nearly three times as much as they did in the 1980s. It is the rise in the number of retired people cycling which has driven the growth in electric bicycle sales in the Netherlands.
A group of older people who passed us a couple of Sunday afternoons ago. It is not at all unusual to see groups of retired people cycling for pleasure in the countryside.
Other growth has come from specific areas. For instance, cycling to railway stations, where literally hundreds of thousands of extra cycle parking spaces have been built in an attempt to keep up with growth in usage in the last few years (40% of train passengers now arrive at railway stations by bicycle). Many Dutch towns have seen increases in cycling alongside improvements to infrastructure. This is true of the capital, Amsterdam, of the top cycling city in the Netherlands, Groningen, and also of the small town of Assen, where we live.

What about that rise in transport related deaths ?
Obviously any rise in deaths is something that has to be taken seriously. First some context. Overall, roads and cycle-paths in the Netherlands are amongst the safest in the world. They are much safer than they were in the early 1970s.

The improvement in safety have come in large part from following the principles of sustainable safety. Different modes are separated, keeping cyclists away from the danger from motorized vehicles even when you might not think this was happening.

While 2011 was a slight increase over 2010, this is clearly a
downward trend over time. It is not an imaginary trend.
Sadly, for the first time in several years, 2011 saw the number of deaths on Dutch roads increase. This has seen alarming commentary from some quarters about how the roads are becoming more dangerous, but I do not believe this to be the case. Rather, this is a bump on a graph which still depicts a downward trend. The rise was small, 3.3%, and 2011 was still safer than 2009. Perhaps the same sorts of comments concerning a "rise" were made when this last happened, in 2003.

In 2011, there were 661 deaths compared with 640 in 2010 (these figures are for all road users, not just cyclists). December 2011 was a particularly deadly month with 81 people losing their lives in that month alone. Without this unusual one month peak, the figures could have been lower than for 2010.

There is always "noise" in figures of this nature. It's important not to take too much notice of year on year changes as they can be so misleading. While one cannot make any prediction based on the graph, it looks more like the continuation of a steady downward trend than the beginning of an increasing trend, and we should note that the December figures which particularly made a difference last year are likely to be due to particularly unhelpful weather.

Demographics of road casualties
Of the 661 deaths last year, 40% or 269 were of people over the age of 65. Nearly 1 in five, 126 people, were aged over 80. This is a reflection of how active older people remain the Netherlands and also of how vulnerable older people can be in crashes which might cause less serious injuries in younger people.

We see the same if we look just at cycling casualties.

Over 65s cycle around 12% of the total kilometres cycled each year in the Netherlands. However, almost 2/3rds of the cyclists who died in the Netherlands last year were of people aged over 65.

In total, 200 cyclists died in the Netherlands last year, a rise of 38 over the year before. This is quite a sharp rise in one year. It compares with 185 in 2009, which makes for a less dramatic change. It is still part of a downward trend, and the Netherlands remains the safest country in the world for cyclists.

Why are older people falling victim more often ?
It is an unfortunate fact that as you get older, you also become more delicate. Injuries which might cause nothing more than a little discomfort when you are young can cause a broken bone when you are older. Those which might have resulted in a broken bone can result in death.

The rise in electric bicycles has been blamed for older people suffering more injuries and deaths. One study claims that while electric bikes are not much different in safety to non assisted bikes for younger people, there is a relationship between an assisted bike and a higher rate of injury amongst older people. Such bicycles are sold almost exclusively to retired people, and for this age-group they result in being able to ride faster and further than before, without improving the rider's reaction time or strength.

New figures from 2013 show that women over 60 with
electric assisted bikes (solid red line) are especially
at risk of injury. Two possible explanations are offered.
1. More fragile people tend to buy electric bikes.
2. Electric bikes lead to higher danger for this group
In either case, extra investigation is needed.
However, it would appear that the main reason why older people are falling victim more often is that they are cycling more often. Between 2000 and 2010, the number of kilometres ridden each year by over 65s more than doubled. Over 65s now cycle nearly three times so much as they did in the 1980s.

In the Netherlands, cycling suffers from the "Golf effect". Just as regular gentle exercise by cycling extends life-expectancy, golf has been shown to do the same. However, a surprisingly high number of people die of heart attacks when playing golf. It's not the game that kills them, as golf has few risks, however the combination of an aged demographic and that playing golf can take quite a long time means that there is a fair risk that regular players will die when they are playing golf. Many older Dutch people spend a considerable amount of time cycling, and the same will be observed.

None of this is new
In 2005, a study showed that the number of visits to hospital by older cyclists had risen by 55% between 2005 and 2009. The total distance cycled by this group had also risen by 50% over the same period.

In 2010, a study showed that elderly cyclists ran 3.2 times the risk of injury than younger cyclists, and that this was due not to having more crashes, but due to the relative fragility of older people. It also showed that 10% of total cycled kilometres in the Netherlands are ridden by the over 65s, and a link was shown (again) between improvements to cycling infrastructure, an increased rate of cycling, and lower risks for all cyclists.

What about the future ?
Average number of bike rides per day for Dutch
population separated into different age groups
It is expected that the ageing population will eventually reduce the cycling modal share because older people in the Netherlands cycle less than younger people.

In 2007, a study suggested that ageing of the population could be expected to slowly reduce the rate of cycling in the Netherlands. It also predicted a rise in serious bicycle crashes of 10% over 20 years for much the reasons that we have seen start to occur. This study also showed that immigration was thought unlikely to have a very large effect because the number of immigrants remains small.

That same study includes an interesting table which shows the percentage of cycle trips by over 65s in 2005 for each local government area, compared to what it is expected to be by 2025. In Assen, for example, 12% of cycle journeys were made by over 65s in 2005, and this is expected to grow to 16% of cycle journeys being made by over 65s in 2025. This is about average for the whole country.

Of course, the Netherlands isn't standing still. A new organisation, the National Investigation into Cycling Safety has begun to work on improving future safety for cyclists in the Netherlands.

It is important that standards for cycling infrastructure continue to improve. Only with improvements in standards can the cycling modal share be preserved despite the challenges of demographic change.

All three types of safety are important.

About comparing sensible figures
Last week, British politicians compared Dutch and British cycle safety figures in rather a confusing and perhaps even deceitful manner by referring only to the absolute number of deaths in both countries.

It is of course true that the Netherlands has a higher rate of cycling injury per hundred thousand people. However, this is because while everyone cycles in the Netherlands, and as we see above, this covers a very wide range of demographic groups, only a minority cycle in the UK and they're largely young adult males.

Comparing per km cycled, even though the Dutch cyclists include far higher levels of more vulnerable groups (not only older people, but also children and people with disabilities), the figures are very much better for the Netherlands than the UK, even taking into account the increase last year. Several people blogged about this, but I refer you to "(Drawing) rings around the world" for accurate figures.

Someone quipped that by the same logic as used by the British Transport Ministers, Switzerland could perhaps learn a lot from the UK's good record on skiing safety, and it's a valid comparison.

Any British politician who wants to know what the difference really is between cycling in the Netherlands and cycling in the UK only has to ask us to find out. We do tours specifically for this reason, but not one British politician has yet come to see for themselves.

2014 update
Traffic safety figures in the Netherlands have continued to improve despite the upward tick in 2011. The total number of deaths in 2012 was 650, roughly the same as 2011 but this improved in 2013 to 570. That's the lowest figure ever. 184 cyclists lost their lives in 2013, only five of whom were under 15 years old. 124 of the cyclist deaths were of people aged over 60. Over 2/3rds of the total and  continuing the trend of their being the most vulnerable people being injured in single-sided crashes.

Investigations into the cause of the rise in injuries and deaths continue. If the person who made the quip about skiing safety reads this, let me know and I'll link to you.


Don said...

David - I think you are being most diplomatic when you describe our minister's comments as "perhaps even deceitful"!

Sadly, spin and deceit seem to infect much of the debate around cycling and so-called 'road safety' in the UK.

Thank the Lord you are still here, providing a balanced and level-headed examination of figures, which have inevitably been mis-represented by some in this country. Thankyou.

Frits B said...

An article I read on this subject stated that one of the reasons why elderly people in particular were more prone to "one-sided accidents" is their growing lack of balancing agility. What they need, said the author, is more stability so it would perhaps be a good idea to promote threewheelers. But the author agreed that this might be a futile suggestion as most seniors would rather die than be seen on a vehicle for the handicapped (David will understand that this is a literal translation from Dutch). And of course he blamed the obstinate refusal of elderly people to wear helmets - forgetting that most fractures involved were on arms, hips and legs, which then heal very slowly.

Paul Martin said...

It is good to see facts presented properly, in context. Thanks, David.

I'm becoming increasingly frustrated here in Australia over the Government's deceptive mis-interpretation of data... and even more frustrated over the population's ability to swallow it without question.



Martin said...

Sadly many policy and law makers will always look at the fatality statistics that IRAD publishes from year to year and compare the cycle fatalities per 100 000 inhabitants. While your could compare Australian cycle fatalities around 30-40 each year like you say its like comparing skiing statistics with Switzerland and UK. It also could be like comparing Aus. drowning statistics with other countries I'd be interested to know the Dutch statistics on this. Australia's drowning stats for 2011 was 315 which includes the devastating Queensland Floods.
Also in Aus a road death is not counted in the official road toll if that person died of a medical condition rather than the accident itself. Is this the case for cycle accidents in the Netherlands with 2/3 deaths over 65.
The argument could be given as to how many lives could have been saved in the Netherlands by bicycle helmets and sadly that's where the debate continues and not the amount of people that cycle and the heath benefits of the society that it generates.

kfg said...

"elderly . . . their growing lack of balancing agility."

This is begging the question, as the idea that the elderly loose balancing agility is a crude inference from the observation that they fall down more often.

More careful observation suggests that what they need is strength and flexibility training, as the source of their disability is simply disuse atrophy.

Ben said...

You are very thorough! I must read all of this, although I'm feeling overwhelmed!

Gareth said...

David, somewhat of an odd request perhaps. I occasionally encounter misinformed commentary, usually from the VC types, who are dismissive of NL and try to imply that cyclists are banned from roads. This is obviously false and we needn't go into that.

But I've tried to think of what grain of truth they may be clinging on to in order to justify this belief. Other than the obvious, roads with minimum speed limits (Snelweg and Autoweg, 80 and 60 Kph respectively, unless that has changed), all I can think of is the technicality of some cycle paths being verplicht as opposed to onverplicht, marked as a round blue sign with a white bicycle in the middle for the former, and the more conventional blue rectangle with 'Fietspad' in white text for the latter.
I was wondering if you could clarify the difference between the two, not so much as intended meaning of the distinction, but also where you are more likely to encounter one over the over.

If possible, are there any statistics over what proportion of bicycle paths are verplicht as opposed to onverplicht?

I grew up in NL and lived just outside Utrecht (Driebergen-Ziest area), and whilst I did my basis school bicycle training, and even sat my drivers theory there, I was content to just obey the signs with no real thought to design and such. I've since lived in the UK for 12 years and really need to get back to NL more often.

BG said...

Fascinating: the total number of deaths for ALL road users in the NL is very close to the number for cyclists alone in the USA -- and I'm pretty sure that cyclists in the NL outnumber cyclists in the USA:

David Hembrow said...

Don: I've got to be a bit diplomatic. I still hope one day to actually see government ministers take a real interest.

Frits: Yes, I completely forgot to include the fact that many of these injuries are the result of crashes without anyone else being involved. Trikes unfortunately have an image problem. It's a shame, as they are quite fun to ride.

Paul: Change won't come unless people question what the government feeds them.

Martin: Drowning is an interesting case. As I recall, people who can swim are statistically far more likely to drown than non-swimmers. The reason is obvious, of course, in that non-swimmers have the good sense to stay out of the water ! The Dutch appear to be more keen swimmers than the English, so quite possibly drown more often (I don't have stats for this, nor for relative to Australia).

Any discussion about helmets in the Netherlands cannot be allowed to stand alone. Dutch cyclists are the safest in the world without safety equipment and even though they number amongst themselves the more fragile members of society. This demonstrates quite well that better infrastructure, and in particular being kept away from the dangers of automobiles, is the most important way to increase safety.

kfg: Would such training help older people to be less affected by the sort of injuries that the young would simply laugh off ? So far as I am aware, this increased frailness something that awaits all of us, and it is not possible to exercise ones way out of it. Many Dutch people are active with cycling through their entire lives, so it isn't a lack of cycling.

Ben: Sorry. It's difficult to make it more concise, and as it is I've missed some things out.

passingby: People who claim to be interested in promoting cycling, but who dismiss the achievements of the world's leading cycling nation, are seriously missing the point.

I don't have statistics for compulsory vs. non compulsory cycle-paths. If I see them somewhere, I'll blog about it. In practice, as you know, this simply isn't a problem for cyclists.

BG: Your hunch is correct. The Netherlands is small, but Dutch people make about as many cycle journeys as the entire English speaking world put together.

Frits B said...

@kfg: I'm 73, I know the feeling. When you grow older, your reflexes become slower and your body becomes stiffer. There is also inevitably some degeneration in the balance organ in the ear and both eyes and ears don't work as well as they did earlier in life. And as cyclists balance on two rather small patches of rubber, the risk of falling increases with age. It's not a general rule, of course. Some people last longer.
Anecdote: some decades ago we had a prime minister, Dries van Agt, who was a fanatic road racer. Even moved cabinet meetings in order to be able to attend stages in the Tour de France. He is 81 now but remained active on his bike in actual races until his mid 70s. He no longer rides because of hip replacements. Simple mechanical wear.

Slow Factory said...

Just some formal comments:

* Perhaps some "British" politicians will come visit if you call them Scottish or Welsh?

* "English-speaking world"? Do you include India, Liberia, Nigeria... etc?

Richard said...

I'm confused. You say 661 deaths in the Netherlands, but then you say 200 cyclist died?

> In 2011, there were 661 deaths


> In total, 200 cyclists died

David Hembrow said...

Richard: Yes, that's correct. 661 deaths overall, 200 of whom were riding a bike.

27% of all journeys in the Netherlands are by bike, and about the same proportion of deaths when making journeys are also associated with cycling.

In other countries, cycling is more dangerous than this per journey or per km travelled. However, the total number of people who die when cycling is very much lower because far fewer people cycle.

Richard said...

The slightly decreasing share in the UK is maybe a good indication of estimating the impact of immigration and aging of society wrt cycling.

That means that the constant or slightly increasing share in NL is actually an increase of app 20%.

Which is not small.