The Cost of Football, Heading and Brain Injury to Health Services

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The Need for a Preventative Sport and Dementia Strategy and The Societal Costs of Heading a Football

Definition of Dementia

It is the progressive deterioration of intellectual functions, such as memory, that can occur while other brain functions such as those controlling movement and the senses are retained.

Introduction - The Need for a Preventative Sport and Dementia Strategy 

In the 19th century a doctor, in London, made a hypothesis and was able to trace an outbreak of cholera back to a contaminated water pump.  The closure of this water pump led to the elimination of the source of the disease. The suggestion made here is based on this outbreak of cholera.  The football industry could take action to reduce the level of dementia in former footballers.  A kick ball game could be introduced without any heading.  This action could be undertaken, without a complete understanding of the relationship between playing football and then suffering from dementia.


Scientific research would help in understanding the possible link between football and dementia.  The government needs to fund studies to this effect.  There is already a parliamentary report  which examined sport and brain injury. A strategy now needs to be formulated to reduce the impact of sport on the brain.  A preventative approach is needed, so that action can be taken before the incidence of brain damage increases.  Such a pre-emptive strategy would be similar to policy advice to reduce flooding and anti bacterial resistance


The Societal Costs of Heading a Football


A preventative approach would highlight the costs of dementia to individuals; as well as to national health and social services.  The ultimate aim would be to reduce the incidence of dementia among former sports people.  A government study would also examine what state interventions are needed to reduce the number of brain injuries.  This would entail an evaluation of different policy options such as outright prohibition, taxation or a softer marketing approach; where the risk of heading is communicated to a footballer.  

Football, Heading and the Implications for Society


The costs to the NHS are outside of the decisions made in the football industry regarding what is an acceptable level of 'football safety'.  The football industry takes action to meet its own needs. It is now common practice, for a footballer with a head injury, after competing for a ball in 'the air', to be substituted.  However, this may not prevent long-term brain injury;  particularly as a player could be passed fit to play again soon after.  There is still potentially a cost to the health service; the footballer and his family.  This is a cost which appears to be overlooked by the industry.


The National Health Service (NHS) is expected to pay for the treatment and care costs of a retired footballer, if they develop dementia from playing football.  This is similar to the costs that smoking imposes on the NHS; as the NHS is expected to pay for the treatment of smoking related illnesses.


A Solution to the Social Cost of Head Injury from Football

The argument here is that welfare of the footballer has to take precedence over the needs of all the spectators who want to watch football.  The need to protect the brain of the sportsperson has to take precedence over the sport as a spectacle.  Also the exercise benefits of football can still be achieved, using a 5 - a side game, where the ball is played on the ground.


Consequently, the sport could significantly reduce the number of head injuries by reverting to the original Football Association rules of 1863 where the game was played without any heading of the football.  The heading of the ball only emerged 12 years later.  A nominal tax could be levied on football to encourage the sport to revert back to being played using the feet only.  This would be similar to taxation on cigarettes to reduce the incidence of smoking.  Such a tax could be removed if the game returned to the original rules.  However, if the industry were to ignore future cases of dementia among former footballers, then the level of taxation could be significantly increased.


The justification of this measure is that football needs to be treated in the same way as other sectors of the economy and society.  Industries which damage wider society need to have their activities corrected.  If a factory polluted a river and the water became polluted then government intervention would be expected.  Many former professional footballers have died prematurely from dementia and this could be attributed to heading a football.  The concern is not just over premature death but also the loss of quality of life from a deterioration in the quality of life in later years. The effects of playing football could be felt for decades after the end of a playing career.  The football field is the place of work for the footballer and the industry has a duty of care to protect players from unnecessary injury. It is unacceptable for a footballer to lose consciousness due to a clash of heads when there are safer rules available which could avoid this outcome.  It is unacceptable for traumatic brain injuries to be considered as an occupational hazard.




Further research is needed into heading a football and the potential for long-term brain damage.  However, government action should be taken regardless of the need for additional investigation. The main reason for this is to avoid a clash of heads when footballers compete for the ball, in the air, particularly in and around the penalty box.  It should be possible to reduce the number of head injuries substantially although foot, ankle and leg injuries will remain.    To summarise, preventative action can be taken without a full understanding of the scale of the health problem.  This was the case with the reduction in cholera in London in the 19th Century.

YouTube Video

Other Links on Football and Head Injury on this Website

Football, Heading and Brain Injury: Time for Government Intervention

Football, Brain Injury and Dementia: Time to Stop Heading

The Cost of Football, Heading and Brain Injury to Health Services

Football and Heading: The Need to Resolve Conflicts of Interest 

A list of former UK footballers with dementia 

Discussion on the list of former footballers and ideas for research