A good amount of discussion about NFL players health has been going on again due to Will Smith’s most recent movie Concussion. This provides an opportunity to revisit a sporadically reoccurring theme of this site: When it comes to the body, pretty much whenever you gain something, you lose something, and vice versa.
In college I had a professor ask the class to define health. It turns out to be a tough thing to do. It’s hard to give a broad definition for something so context dependent.
The current discourse about NFL players is centered on brain health, to the exclusion of pretty much everything else. But brain health is one aspect of health. In fact, most everyday people are far more worried about other aspects. Heart, diabetes, cancer, being the big ones.
The below chart is from a paper looking at football players who played at least five seasons from 1959 to 1988. What was the underlying or contributing cause of their death? Looking at the current hot topic:
We can’t look at CTE -chronic traumatic encephalopathy- because it wasn’t / hasn’t been recognized as a cause of death, but neurodegeneration along with dementia / Alzheimer’s is close enough. (Some researchers are arguing over whether a true distinction exists. Histologically it seems to; clinically? ehhh.)
The standardized mortality ratio, SMR, is the rate compared to the general U.S. population. At 1.80, NFL players have dementia / Alzheimer as an underlying cause of death at 1.8 times the general population. For neurodegenerative causes of death, NFL players are at 2.83, nearly three times the U.S. population.
These numbers seem pretty high, but examining what the relative number, 2.83, comes out to, it’s only 10 causes of death out of 334. Since this was 2.83 times the general population-
- 10 / 2.83 = 3.53
While NFL players had 10 deaths from neurodegenerative issues in this time period, the general population would have had about 4. The percentage difference is fairly large, but the number of deaths difference is quite small.
Total deaths were 334.
- 10 / 334 = 0.030 -> NFL neurodegenerative death rate
- 3.53 / 334 = 0.011 -> Compared to U.S. neurodegenerative death rate
3% risk up from 1.1%. We’ve entered the world of “meh” caring.
Yet while 10 guys died of neurodegenerative issues, a whopping 126 died from cardiovascular issues, and another 85 from cancer. Over 200 compared to 10! 211 out of 334!
This is what we’re more worried about from a general population perspective as well. Yellow is cardiovascular and cancer, while green is our neurodegenerative category:
Even if we include suicides as part of the neurodegenerative category, we’re talking 1.4 million deaths for the yellow compared to 126,000 for the green. (Other neurodegenerative issues would barely influence this difference. Despite the ice bucket challenge, ALS is not a public health concern. (Of course it’s an individual one.).) If we’re worried about premature death, prolonging life, or trying to prevent death, the yellow is what we’re most concerned with. For the general population and NFL players.
Playing in the NFL can make you less likely to die from the most common causes of death:
Notice for cancer the SMR is 0.58. Meaning the risk was less for football players. Nearly half. For cardiovascular diseases, it was reduced by 32%. NFL players nearly halved their total risk of dying!
What does health mean to you?
While I didn’t play in the NFL, I played football for 15 years. The research discoveries on players brains has sporadically scared the shit out of me. The way the media has gone after the brain issues has only added to that. If you follow football, every month it’s something else about this topic and the health of football players. Something negative.
-> Lost in the popularity of the NFL in the United States is most of the country does not watch football. Even if 30 million people watch a Sunday night game, that’s not even 10% of the population. When ~100 million watch the Super Bowl, that means two thirds of the country isn’t. (And half the 100 million is probably for the social aspect, not for the game.)
Along with that, it’s common in American culture for football players to not only be very popular, but maligned. The whole jock vs nerd thing does exist. I went to a very academic college. The student body hated the football players.
I wonder how much of the attack on the NFL is being done by people who were picked on by players in high school, or jealous of them, giving a distorted view of what’s really going on.
If we’re going to vilify football for what it does to the brain, we need to concurrently celebrate what it does for the rest of the body. So the story continues, when you lose something, you gain something. If we were to take these numbers to a bunch of parents and said look, we can cut your children’s risk of death in half compared to the general population. In exchange for that though, we’ll increase the odds they die from a neurological disorder from 1.1% to 3%. This is an exchange many would take.
-> Especially if you’re someone who has a family lineage of males seemingly always getting heart attacks by 50. (If you have a family history with a bunch of dementia in it, then maybe not!)
Sure, you could likely get the benefits of playing football without the detriments through playing another sport, or just being active in general. But maybe not. For some of us in high school and college, football was the only sport we wanted to play. Without it, some teammates I had would not have been active at all. In fact, many of my old teammates became drastically less active since they stopped playing. It wasn’t until they saw a sport could give a violence outlet that they even cared about sports.
And perhaps there is something beneficial from football not found in other sports. Maybe there is something physiological to be said for being able to let your aggression out in a way very few other avenues can offer. Maybe this is why football players have less deaths from violence.
Due to the violence, football has a level of teammate bonding not found in many other sports or activities. Along with the style of the game, few activities are so reliant on so many people. How many sports have 53 guys on their roster? A single player can take over pretty much any sport, but football. Tom Brady can’t do anything if five guys don’t block for him and one guy drops the ball. He needs six guys every play, minimum. Sure, in business you’re often reliant on others. But if one guy screw up you don’t risk getting knocked unconscious.
We know being lonely increases your likelihood of heart issues. So maybe football is providing benefits that can’t simply be replicated by being active. Benefits that aren’t easy to replicate period.
Perhaps this can give other former players some solace. “Hey, maybe I have a higher chance of dementia, but it doesn’t seem to be that much higher of a chance, and meanwhile I’ve made myself less likely to die from the most common killers. Overall, it may have actually been a decent / worthwhile / I’d do it again tradeoff.”
No, I still wouldn’t want my kid playing football. But given the alternative of it’s either football or they’re sedentary? Considering our family history is very good neurodegenerative wise? Considering the males have a history of a temperament that could really use an outlet when testosterone is at its peak?
I was in college a decade ago. If anything, defining health has only gotten harder.
After writing this I came across this solid article, which hits some of the above points and more.