Bicycle Helmets Reduce Social Cost Essay

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The third controllable cost is storage and delivery, which depends on program scope independent of which professional educates the consumer.

d. Unrecoverable expenses if the activity is not implemented include the cost of preventable traumatic head injuries borne by the total health care insurance consumer pool whether cyclists are insured or not; the direct ER costs attempting to prevent one traumatic head injury from becoming catastrophic (death); the foregone potential earnings that would be generated were one child not killed before they could finish their career, and the public cost from obesity prevented by cycling. As with variable costs, the actual savings will depend on the variable factors discussed above. Likewise, without predicting exactly how many traumatic head injuries would be prevented by helmet use or not, this budget estimates what those savings would be if one catastrophic head injury were prevented in such a way.

3. We estimate the benefits in foregone treatment cost for a hypothetical, benchmark emergency room where traumatic head injuries constitute 1 out of 10 presentations, with one catastrophic, fatal head injury per 100 injury presentations. We exclude the treatment cost of the minor injuries which, while they may be expensive, are not preventable with helmet use. Nor do they cause death like head trauma would, however. Traumatic care costs include ongoing, longer-term care costs and catastrophic costs include lifesaving treatments that are usually the most expensive treatments available. Situations of failure where those most-expensive life-saving resources could be applied treating so many other injuries, added to the human cost of the life of a child, create a tragic loss the costs of which can not all be expressed on the spreadsheet. We estimate returns to public health from investing in helmets as the direct savings from preventing 10 traumatic head injuries and 1 death per 1000 presentations, using doctors or nurses to administer the program, because these figures mirror many of those found in several hundred state and not-for-profit hospitals. We then consider potential savings from prevented obesity and loss of earnings from the preventable death of a child.

Table 2. Morbidity, mortality and cost

Morbidity (per 1000)

Injury Level

Minor

Traumatic (head injury)

10

Catastrophic

1

Average cost per injury

Minor

€ 1,000

NOT INCLUDED

Traumatic (head injury)

€ 100,000

Catastrophic

€ 200,000

Cost per injury per 1000

Minor

€ 100,000

NOT INCLUDED

Traumatic (head injury)

€ 1,000,000

Catastrophic

€ 200,000

Total (per thousand)

€ 1,200,000

Foregone obesity cost

€ 1,000

€ 1,000,000

Foregone earnings

€ 1,000,000

x Catastrophic / 1000

€ 1,000,000

Total per thousand

€ 3,200,000

Savings 1000 helmets

€ 3,200,000

2000 helmets

€ 6,400,000

3000 helmets

€ 9,600,000

Technically, we would have to discount the obesity savings and earnings back to present value, but this would also imply adjusting future prices for possible inflation; exchange rates etc. We have foregone this level of complexity perhaps at a cost of the accuracy of our budget to predict exact costs and savings, but if we consider the results "if this amount of savings were achieved," the placeholder is useful to demonstrate the scope of possible, if not the exact and precise level of, return on investment in cycling injury prevention.

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Table 3: Costs per helmet price from table 1.

# helmets

2000

Costs

Doctors

Low helmet price

€ 10,763

€ 21,026

€ 31,288

Mid helmet price

€ 15,763

€ 31,026

€ 46,288

High helmet price

€ 25,763

€ 51,026

€ 76,288

Nurses

Low helmet price

€ 10,578

€ 20,741

€ 30,903

Mid helmet price

€ 15,578

€ 30,741

€ 45,903

High helmet price

€ 25,578

€ 50,741

€ 75,903

Table 4: Savings per thousands of helmets

2000

Doctors

Low helmet price

€ 3,189,237

€ 6,378,974

€ 9,568,712

Mid helmet price

€ 3,184,237

€ 6,368,974

€ 9,553,712

High helmet price

€ 3,174,237

€ 6,348,974

€ 9,523,712

Nurses

Low helmet price

€ 3,189,422

€ 6,379,259

€ 9,569,097

Mid helmet price

€ 3,184,422

€ 6,369,259

€ 9,554,097

High helmet price

€ 3,174,422

€ 6,349,259

€ 9,524,097

Without the obesity and foregone earnings savings:

Table 5: Savings per thousands of helmets, not including preventable obesity and lost productivity

Savings per helmets (Shorter term: no earnings cost or obesity savings)

2000

Doctors

Low helmet price

€ 1,189,237

€ 1,178,974

€ 1,168,712

Mid helmet price

€ 1,184,237

€ 1,168,974

€ 1,153,712

High helmet price

€ 1,174,237

€ 1,148,974

€ 1,123,712

Nurses

Low helmet price

€ 1,189,422

€ 1,179,259

€ 1,169,097

Mid helmet price

€ 1,184,422

€ 1,169,259

€ 1,154,097

High helmet price

€ 1,174,422

€ 1,149,259

€ 1,124,097

4. Based on this cost-benefit analysis, the question is not whether we should implement the program or not, but at what level we can afford to distribute bicycle helmets to children seeking physical examinations to get into school. The answer is clear if we save only one life per thousand, even if we rule out savings from prevented obesity and the lost contribution from a lifetime of earnings. We should enact this program, using nurses, attempting to gain lowest possible prices, up to the point where savings equal zero. This analysis demonstrates that that break-even point is far enough away such that even not considering obesity savings or earnings, that we would have to give away many thousands of helmets before returns would equal costs. While the returns slowly fall the more we spend on helmets and the more we buy and distribute, the return on investment is in the range of a thousand times every euro spent. If we consider the public health savings from foregone obesity and lost productivity, this factor effectively triples. We can safely say that offering helmets to low-income consumers' children "dominates" the policy of standing by and letting them die (Owens,….....

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