Let’s say pediatric health experts think kids shouldn’t play tackle football. They end up developing a clear consensus on it — the evidence is in, and they’re sure that tackle football is a bad match for kids. What would happen next? What would be the proper way for them to communicate their findings given that youth tackle football is a really popular, ingrained part of youth sports culture?
We’re not quite at that point, but experts have nonetheless highlighted many reasons why it might not be good for young people to play tackle football. And in a commentary published last week in the New England Journal of Medicine, Kathleen E. Bachynski, a Ph.D. student at the Columbia School of Public Health, raises some interesting questions about these issues, and about the role physicians should take in the national conversation about tackle football.
Bachynski highlights a Policy Statement published in October by the American Academy of Pediatrics in which the Academy highlights a number of issues with youth football and notes that removing tackling from it would make it significantly safer. Nonetheless, the AAP writes in that statement that it “recognizes … that the removal of tackling from football would lead to a fundamental change in the way the game is played. Participants in football must decide whether the potential health risks of sustaining these injuries are outweighed by the recreational benefits associated with proper tackling.”
The statement jumps out a bit, since in a pediatric context football players aren’t quite choosing to play in the same way we think of adults as choosing something. Plus, should it matter to the AAP whether or not one of its recommendations would entail a “fundamental change” to a sport?
The AAP ended up making recommendations that focused mostly on the idea that youth tackle football should be “supervised” to ensure proper tackling form and so on. As Bachynski notes, this isn’t the first time the AAP dealt with tension between its findings and certain cultural realities about football:
In the 1950s, the AAP took a much stronger stand against tackle football for children. The focus then was primarily on orthopedic injuries. Representing the AAP at a 1953 conference on planning programs of games and sports for young children, Dr. George Maksim argued that in football and several other contact sports, “the risk of permanent bone and joint injuries is just too great.” The 44 conference delegates, who represented medical, educational, and recreational organizations, recommended excluding body-contact sports, including tackle football, from programs for children 12 years of age or younger. In 1957, the AAP Committee on School Health issued a policy statement on competitive athletics for children in that age group, similarly concluding that “body-contact sports, particularly tackle football and boxing, are considered to have no place in programs for children of this age.”
Yet as youth football grew in popularity, such medical objections were largely overshadowed by broader cultural trends favoring the expansion of competitive collision sports for children. The belief that careful supervision by coaches, athletic trainers, and doctors on the sidelines was the key to making youth tackle football safer increasingly predominated over the ensuing decades.
In addition, long-standing beliefs about the social value of youth football strongly shaped medical advice. For example, in 1956, Allan Ryan, chair of the American Medical Association’s Committee on Sports Injuries, wrote that the association was working with educators and coaches to highlight “the character-building advantages of football” while minimizing the risks. Ryan portrayed football as a healthy sport that helped build boys’ bodies and promote teamwork but one that could be dangerous, even “a killer and a maimer,” without medical supervision. He advocated regular physical examinations of players conducted by physicians, properly fitting uniforms, and pre-play warm-ups as effective means of preserving the benefits of the “wholesome and valuable” sport.
There’s some clear uneasiness here: When scientific findings cast negative light on an American pastime, there’s naturally some incentive to communicate this fact in a way that isn’t quite full-throated. The main question is whether and to what extent an organization like the AAP should soften its recommendations based on its read of where society is at with regard to a popular, somewhat dangerous activity.
Bachynski has a clear stance on this:
It is understandable that the AAP has promulgated policy recommendations that seek to minimize the harm of tackle football as it is currently played, given the cultural prominence of football in the United States. But physicians also have a role to play in shifting the culture when it results in harm to children’s longterm health. Recommendations that prioritize children’s health should extend beyond supervision of risky activities to include counseling against them. Stronger recommendations against tackling would deepen public appreciation of the severity of the risks associated with repetitive brain trauma and would promote broader discussion about whether these are tolerable risks for children to undertake.
It’s interesting to imagine how this would go over in some of the more football-crazy towns scattered around America. Science isn’t always popular.