Harvard’s Advice for NFL Player Health and Safety
The university’s independent study compared the NFL to five other North American sports leagues and made nine recommendations on how to help preserve the future of the game
When former Dolphins Nick Buoniconti started falling, he knew something was wrong. What he and his family didn’t know was that they’d take a winding path to figuring out what.
Self-scouting is common practice in the NFL. Coaches mostly do it, but players and personnel execs do it, too. They comb through old game film to learn about their own tendencies on certain downs, in certain situations, and out of certain formations. The goal is to spot your weaknesses and make improvements.
The sport of football, in 2017, is in a state of intense self-scout. The reasons are many: self-preservation, love for the game, fear of the game, concern for the livelihood, a desire to find concrete answers to nebulous questions. Etc.
It’s in this landscape that Harvard researchers released a new report today about the health and safety practices for players at the game’s highest level. It’s part of the Football Players Health Study, a long-term project funded through the NFL Players’ Association by money set aside in the 2011 collective bargaining agreement. About a dozen research projects are ongoing; among them, a health and wellness questionnaire of more than 3,400 former players, and an investigation of a localized painkilling gel that may reduce the need for addictive prescription pills.
Today’s 255-page report comes from Harvard Law School’s Petrie-Flom Center for health law policy, biotechnology and bioethics, and it compares the NFL’s policies and practices concerning player health against five other North American sports leagues—MLB, the NBA, the NHL, MLS and the CFL. The Harvard researchers emphasize that their work is independent, and that the agreement for the funding stipulates protection from any influence by the NFLPA or the NFL. An underlying question to the research: Is enough being done to preserve the game?
It’s a tricky question, one that’s hard to answer when comparing the NFL to fundamentally different sports leagues. On one hand, the authors write that overall “the NFL’s policies concerning player health appear superior to the other leagues,” in areas such as the breadth of player benefits and the control players have over their own care. On the other hand, they present statistics highlighting higher per-game injury rates in the NFL compared to other leagues, based on available injury data.
The mean number of injuries suffered in each NFL game, per the report, is about 4.9 times the combined sum of MLB, the NBA and the NHL, and the NFL’s per-game concussion rate is about 6.9 times the combined sum of four other non-football leagues. Of course, the NFL plays far fewer games than the other Big Four leagues (NHL, NBA, MLB), so while an NFL player is more likely to suffer a concussion in a regular-season game than an NHL player, a pro hockey player is more likely to suffer a concussion over the course of a season than a pro football player. But the point, particularly when compared to non-contact sports like basketball and baseball, is this: If football is more dangerous, shouldn’t it follow that the policies are more protective? In other words, the real question for the NFL and the NFL Players Association should be: Are we doing enough for our players given our unique injury risks?
The Harvard researchers put forth nine recommendations for improvements to NFL policies. Among them: Removing the requirement that teams disclose the specific location of a player’s injury in their weekly reports, akin to the NHL, to discourage targeting of injuries; offering treatment not only for recreational drug violations but also PEDs, as the NBA does; and having neutral doctors perform preseason physicals, as is the practice in the CFL, to avoid any potential conflict of interest created by the team having financial liability for past injuries.
“We are in a moment where [because of] people’s attitudes toward football and toward the health risks of football, these conversations have to happen,” says I. Glenn Cohen, Harvard Law School professor and a co-author of the study. “And it’s also a time when the NFL is more sensitive to the public perception as well.”
A similar version of one Harvard recommendation, a short-term IR list for players who’ve suffered concussions (like the seven-day DL in MLB), is on the agenda to be voted on next week at the NFL meetings. The Washington NFL team proposed a rule change that would allow clubs to place a player who has suffered a concussion on the exempt list and be replaced by another player on a game-by-game basis, until the injured player is cleared.
Some of the other issues discussed in the report are muddied by the fundamental disparities between sports leagues in critical areas like roster size and risk of serious injury—a limitation the authors acknowledge. Take the issue of guaranteed compensation, which the Harvard study points to as a way to protect player health. Unlike the other Big Four leagues, NFL contracts are not fully guaranteed; according to data crunched in the study, only about 44% of player contracts in the NFL are guaranteed. The issue is complicated in pro football, because the injury risks create greater financial risk for teams handing out big deals, and as the study notes, player salaries could thus decrease, at least in the short term.
Also consider health care. The Harvard report stops short of recommending the NFL adopt lifelong health care while noting that the other leagues offer it. Former NFL players can only continue with the league’s health insurance plan for five years, though they also have a Health Reimbursement Account for out-of-pocket expenses after their coverage ends. The overall benefits package for NFL players is more robust than any other league, offering benefits such as severance pay, long-term care insurance and neurocognitive disability benefits—but there’s also more of a demonstrated need among former NFL players for those benefits. (Stories published at The MMQB last week detailed the frustrations of a pair of former Dolphins greats dealing with dementia, Nick Buoniconti and Jim Kiick, in navigating the administrative burdens of applying for these add-on benefits and their payout from the players’ $1 billion concussion settlement with the NFL.) Also, since the former NFL player population is larger than the retired populations of other leagues, funding lifelong health care could be burdensome, and devoting additional funding to benefits would reduce the salary pool for current players.
“If we are going to pound on the table for lifelong medical, that’s a tough hill to climb,” admits Chad Brown, a 15-year NFL vet and former union player rep who is now an advisor for the Harvard Football Players Health Study. “But information is power. Players can look at the benefits in other sports and decide what they need to fight for in the new CBA. It’s an easier fight to say to the owners, this is what hockey has done, this is what baseball has done, rather than try to invent something new.”
Whether or not this report contributes as a table-setter for the next round of labor talks remains to be seen. The current CBA expires after the 2020 season, so negotiations are just around the corner, timing that Cohen described as “fertile.” The last negotiation, in 2011, resulted in steps forward for health safety, such as rules reducing practice time and intensity and enhanced player benefits such as adding the long-term care insurance plan. How health and safety is addressed in the next labor agreement depends on what the league and the players choose to prioritize at the bargaining table.
Policy changes, such as those presented in this report, are one piece. But putting together the whole puzzle requires a comprehensive understanding of player health—specific to the sport of football—during a time when everyone in the game is being forced to confront the long-term risks more than ever before. “There is a real need for having true, reliable findings, for having actual science behind decisions people are going to have to make,” says Alvaro Pascual-Leone, a professor of neurology at Harvard Medical School and a co-director of the Football Players Health Study. “As we understand the risks—and the benefits—better, we will be able to modify the risk profile just by providing guidance on what things they should be doing to minimize those risks.”
Ultimately, there’s a gap between what’s feasible in other leagues vs. the NFL; between an academic study and the world of professional sports; and, perhaps most importantly, between what’s known now about football player health and safety and what is still to be learned.
Below is the full report.
• Question? Comment? Story idea? Let us know at firstname.lastname@example.org