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TMQ on Football and Mortality

In this week’s TMQ, Gregg Easterbrook revisits the debates about the effects (positive and negative) of playing football. Are the mortality rates for football high enough to warrant reconsidering whether football is dangerous? It depends on whether we care only about mortality (if so, it is not that dangerous), or care more generally about smaller injuries that add up over time (in which case this would be a different discussion). Here are Easterbrook’s thoughts.

Football and Mortality: The first consideration is that both absolute numbers of football deaths and rates of death compared to participants are in long-term decline — mirroring the decline in many forms of risk in society. Age-adjusted rates of all deaths in the United States have declined for 10 consecutive years. Auto fatalities have been declining for more than a generation. “Winning the War on War,” an important new book by Joshua Goldstein — he presents the ideas in this video — shows that despite the impression created by cable news, exposure to violence is in decline both in the United States and worldwide. Schoolteachers especially should consult Goldstein’s book and video.

If society generally is becoming safer, sports also should be becoming safer, and that is happening. Data from the National Center for Catastrophic Sport Injury Research reflects a steady decline in deaths caused by football. Table 1 of the center’s most recent report shows that in the past decade, 34 high school, three pro and two college football players have died as the direct result of games or practices, with the primary cause of deaths being heat stroke. That is entirely awful — but much lower than the rate of a generation ago. In 1968 alone, 26 high school players died as a direct result of football; last year, the number was two. Table 3 of the report shows the direct fatality rate from high school football peaked at 2.6 deaths per 100,000 players in 1969 and declined steadily to 0.13 deaths per 100,000 in 2010. That means a 1968 high school football player was 20 times more likely to die than a 2010 player. (The main reason for declining deaths was that football helmets were improved to eliminate skull fractures.)

But even if football deaths have declined, one loss of life is a tragedy. This is especially true for death due to heat stroke, which is 100 percent preventable. No athlete should die from heat stroke; coaches or trainers whose negligence allows heat-stroke death should face legal consequences. Deaths from brain swelling or undiagnosed heart defects are, by contrast, a challenge to prevent. Ridge Barden, the 16-year-old New York player who died earlier in the month, seemed fine moments before collapsing and had not been involved in any dramatic hits. Accumulating harm to his brain from many minor hits might have gone unnoticed. A conscientious coach or athletic trainer might have missed the signs.

How to compare the slight risk of a terrible football outcome to other common risks experienced by the young? Consider the risk of being in a car. About 3,000 teens die each year in car crashes. There are about 21.3 million Americans between 15 and 19 years of age. Teens average about 146 miles driven per week, roughly 150 hours per year of driving. These figures yield a roughly one in 1 million chance that a teen will die in an hour of driving. The National Federation of State High School Associations reports that 1.1 million boys (and a few girls) played high school football last academic year. A typical high school football season would include, in games and practice, perhaps 75 hours of exposure to contact. That’s about 80 million total hours of exposure to contact on the part of high school football players. The National Center for Catastrophic Sport Injury Research reports a recent average of three deaths per year directly caused by high school football. That’s a roughly one in 27 million chance of a high school player dying from an hour of football contact.

These are all rough estimates. Taking them together, a teenager has a one in 1 million chance of dying in an hour behind the wheel, compared to a one in 27 million chance of dying in an hour of football contact. Being in pads on a football field is less deadly than driving to high school for class. Many contemporary parents, especially moms, might say, “I don’t want you playing football because it’s so dangerous, but it’s fine for you to drive to the mall.” As regards mortality, this misperceives the risks.

Of course, death is only one of many risks in football. Other, more common harm, especially accumulated damage to the brain from concussions, is a greater negative to playing, since sports-caused death is very rare but sports-caused brain harm is not.

And even if the risk of any activity — whether football, driving or anything else — is low, society should work to make the risk lower. Cars are safer than a generation ago, but many safety features still could be added. Stricter enforcement of football rules, in games and in practices, would lower risk.

Risk, in turn, does not exist in a vacuum. It should be balanced against gains. The reason the chance of a crash does not stop people from jumping into cars is that automobile transportation offers many benefits. The benefits of cars almost always outweigh the risks. Benefits outweigh risks in many pursuits. Ballet dancers, for instance, might ruin their knees, but being a ballet dancer has many benefits. Bicycling is a leading cause of concussions, but bicycling also offers significant health benefits. If we thought only about risks, we’d never get out of bed. There are many rewards to playing football — exciting experiences, a sense of worth in the community, admission boosts to college being among them. Most high school football players enjoy some benefits and never experience any harm. The benefits should not be overlooked.

Deaths of young athletes shock society, as has been the case at least since this 1896 poem. Recently two middle-aged, retired NFL players, Orlando Brown of the Ravens and Kent Hull of the Bills, died before their times — Brown at age 40 from complications of diabetes, Hull at age 50 from intestinal bleeding. When former pro football players die in middle age, should this be seen as bad luck or as a sign of long-term degenerative harm from football? Last season, TMQ reviewed long-term health studies on football in this column.

Deaths of young athletes cause a second level of shock because rightly or wrongly, sports teams, especially football teams, are perceived as symbolizing the hopes of their community. Particularly in small towns or college towns, when the home team wins, this is seen as auspicious. Losses are perceived as bad signs. Deaths on the home team are the most awful signs imaginable. In August, four players from the high school football team of a New Jersey town were killed in a car crash that had nothing to do with sports. Any four students from any high school dying in a car crash would be a tragedy. But because the four deaths occurred on the football team, the community perceived the event as especially terrible. If a bicyclist dies, this does not always make the front page of newspapers, while a football death usually does.

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