Dementia in football: the latest on the risks and campaign for change

For the last few years, I’ve looked into the (mis)management of brain injury in sport, and especially in football.  Until a few years ago, I hadn’t appreciated the serious link between brain injury and football.  The more I looked into this, the more it became clear that the evidence has been there for a long time, without any substantive change.

Of course, this issue has been ongoing for far longer than my coverage on it. Dawn Astle, daughter of Jeff Astle, has been one of the most prominent figures campaigning for change since her father’s death in 2002.  Jeff died aged 59, “from chronic traumatic encephalopathy (CTE), a progressive, degenerative brain disease found in individuals (usually athletes) with a history of head injury, often as a result of multiple concussions. In Jeff Astle’s case, it was the repeated, low level brain trauma believed to have been caused from the repeated heading of footballs.”  The Jeff Astle Foundation was set up in 2015 to raise awareness of brain injury in sport, to offer support and to campaign for changes.

Since my latest blog on this subject, there’s been a lot in the media, and sadly, more deaths of former professional footballers from neurodegenerative disease.  However, I’ve also noticed that the same few misconceptions seem to arise when the topic is discussed.  Some of these even come from former footballers themselves…

I thought it would be helpful to recap some of the key issues in this matter where we are now:

• In October 2019, the results of the FIELD Football’s InfluencE on Lifelong health and Dementia risk) research study were published.  This was a commissioned by the FA and PFA in 2017 and led by Dr Willie Stewart and his team at the University of Glasgow’s Brain Injury Group.  The research revealed that former professional footballers, when compared to the general public, were:
  • 5 times more likely to suffer from dementia
  • 5 times more likely to have Alzheimer’s
  • 4 times more likely to have motor neurone disease
  • Twice as likely to have Parkinson’s

• In October 2019, UEFA launched their campaign on concussion awareness.  This included raising more awareness amongst players, coaches and staff regarding the dangers of concussion, increased monitoring for injuries on the pitch and a call for temporary concussion substitutes.  Over a year later, temporary concussion substitutes have still not been implemented.  We’ve been told a trial “may” commence in January 2021.

• In February 2020, the FA updated its guidance on heading in children – with no heading during training for primary school children, and limitations to heading for older children.  No changes to heading in matches.  The Irish and Scottish FA advised they would follow suit.

• In July 2020, Jack Charlton died.  He had dementia and lymphoma.  In October 2020, Nobby Stiles died.  He had dementia and prostate cancer.  Jack and Nobby were amongst five players from England’s World Cup winning squad to have dementia.

• In October 2020, the Coroner’s inquest review hearing into the death of Alan Jarvis found that he had died from Alzheimers, which the Coroner concluded was “caused by his occupation”.  This is the second Coroner to link the death of a former professional footballer to an industrial disease (i.e. an injury caused by their employment), following the inquest review in 2002 into Jeff Astle’s death.

• In November 2020, it was reported that former footballers were pursuing legal action.  Whilst the details have not been disclosed, it’s likely that this relates to a class action in respect of neurodegenerative disease which, the footballers will argue, was caused because football’s governing bodies failed to take appropriate measures to safeguard them from the risk.

• A campaign to have dementia listed as an industrial disease is ongoing

Having had a look at some of the key issues, I wanted to give my views about some of the above.

• Despite the overwhelming evidence that football puts players at increased risk of neurodegenerative disease, no changes have been made to professional football in seeking to safeguard players.  No changes whatsoever.  I find that shocking.  What is the point in the FA and PFA commissioning research if, once they have the results, nothing is done?  What are they waiting for?

• Whilst the FIELD research study didn’t pinpoint which exact aspect of football was the major problem, we know that:

• It’s not to do with the argument that the balls back in the day were heavier than the current, modern ones.  This is an incorrect misconception and one which Dr Willie Stewart has debunked many times.  In brief, the old leather footballs and the new synthetic footballs both weight around 15oz.  Whilst it’s accepted that the older balls were heavier when wet, this would also mean that they would have been slower which would have meant they had less of an impact when hitting a player’s head.  In brief, the same risks are evidence now as they were back in the 60’s, 70’s and 80’s.

• Subconcussive hits are thought to be a huge culprit.  These are hits to the head which don’t cause concussion but still have an impact on the brain.  So when are players most at risk of subconcussive hits?  Most people agree that this happens during practising heading over and over during training.  This kind of training can take place daily, sometimes for long periods of time.

• If we know it’s not the weight of the balls and previous studies have excluded the benefits of things like using a helmet or mouth guard, what more information or evidence do we need to adapt changes?  Why can’t some change be made now?

• No one wants to take away heading in football.  However, most researchers and campaigners agree that restricting the amount of heading during training would have a significant impact on reducing the risk of neurodegenerative disease.  Whilst players head the ball during matches, this is far less than they do during practice.  Limiting how much can be done during practice will truly help.  If this becomes a rule change, then everyone will be bound by it – meaning no one player or club is at an unfair advantage, everyone will be following the same limitations.  Of course, there’s then some argument of being at an unfair disadvantage when playing international tournaments against players who are not under the same rules, but this is such a minor issue to consider in the big picture of saving someone’s life.

• The listing of dementia as an industrial disease would be a huge step and formal recognition of the evidence identified.  It would allow those affected, where eligible, for financial aid via the Industrial Injuries Disablement Benefit.  This is not the same financial assistance as compensation secured in a legal claim, where compensation is assessed by identifying the individual’s specific injuries, needs and financial losses.  Rather, it offers a payment depending on the extent of disability suffered and the person’s age.  Currently, the highest amount payable is £182 a week.  This can be given for life, or a fixed period.  It also is a ‘no fault’ scheme, with payments coming from the Department for Work and Pensions rather than football’s governing bodies or the club.

• In order to win a legal claim for compensation, the following will need to be determined:
  • A Defendant.  Who is it that you’re saying is liable for the damage?  Is it the club?  The FA?  The Premier League?  IFAB?
  • Breach of duty: you need to be able to prove that the actions (or lack of action) taken at the time was legally unacceptable.  In respect of football, you would need to be able to show that the Defendant failed to take appropriate measures.  What’s appropriate will be determined by what was known, or ought to have been known, at the time.  This will need to be specify what steps should have been taken and when.
  • Causation: you need to be able to prove that had the steps above been taken, this would have prevented (or lessened) the injury you suffered.  This means quantifying how much of the injury was caused because of what you say was negligent and how much would have been there in any event because of the accepted risks of the sport and the general population risk of dementia.  Independent medical evidence will be needed for this.

There is a lot to consider, but this is a subject that is not going to go away.  I am surprised and confused by football’s stance, which so far has been to turn a blind eye and refuse to make any changes to safeguard professional players.  Aside from a moral standpoint of protecting a player’s health and life, there’s also a business element to this.  An employer who ignores evidence which notes a known risk in the course of employment is putting itself at risk of legal action for failing to protect its employees.  This has little to do about football, and more to do about basic employment laws.  Every employer is under a duty to take reasonable steps to safeguard its employees from known risks.  Ignoring the needed changes is not going to help anyone – certainly not the players, nor the governing bodies and their finances.