In the heyday of population health, healthcare providers are exercising muscles that previously went unused. They are forging partnerships with nonprofits, public health organizations and businesses in their communities to improve health and well-being. But how much of population health involves not only endorsing what can improve our health, but also rejecting what hurts it?
Repeated concussions can be devastating. The average helmet-to-helmet collision in the NFL lasts just 15 milliseconds. But players today are so strong, and so fast, that the head receiving the hit moves at an average of 14 mph in the opposite direction. One scientist describes it as the literal equivalent of a sledgehammer blow. Players below the professional level may not experience hits as severe as those in the NFL, but the sheer volume of impacts they absorb is staggering. The average high school football player receives up to 1,500 subconcussive hits per year.
None of this information is new. The risks football poses to brain health have been widely studied and discussed, particularly since NFL Commissioner Roger Goodell testified before Congress in 2009. But what is becoming more pronounced is the link between the football, societal health and even healthcare costs. Earlier this month, Patrick Hruby wrote a painstakingly detailed piece for The Atlantic about the NFL's proposed (and loophole-rich) settlement with more than 4,500 former players who claimed hits received during their years in the league left them physically and mentally impaired.
The proposed $765 million settlement caps payouts for conditions such as dementia ($3 million), Parkinson's and Alzheimer's ($3.5 million) and chronic traumatic encephalopathy, which is only diagnosed after death ($4 million). After accounting for a series of reductions built into settlement terms and legal fees, Lester Munson with ESPN found a player who faced dementia after age 60 might end up collecting about $375,000 from the league. It's also worth noting that current and future NFL players are not eligible for cash awards under the settlement, regardless of what neurological conditions they might develop or already have.
"Why is this significant? Because brain damage isn't cheap," Hruby wrote. "Retirees who can't hold down jobs or keep their families together cost money. Retirees who need feeding tubes and ventilators cost even more money." The report cites an estimate from Frank Neuhauser, executive director of the Center for the Study of Social Insurance at the University of California, Berkeley, who told the Los Angeles Times that dementia and Alzheimer's patients can involve up to 30 years of medical care and income support.
Population health is a broad concept, so talk about the NFL might seem trite. After all, the pool of current and former NFL players is a tiny fraction of the general population. But the league's cultural influence is deeply ingrained into American culture.
Football is the No. 1 participation sport in high schools across the country, according to the the most recent data from the National Federation of State High School Associations. More than 1 million high schoolers played football on a team in the 2013-14 school year. (This isn't counting younger players or programs that aren't affiliated with schools, such as Pop Warner leagues.)
A significant number of these kids are ending up in hospital ERs from the sport, too. The nonprofit advocacy group Safe Kids Worldwide analyzed 2012 emergency room data, finding football resulted in both the highest number of all pediatric injuries for players ages 12 to 17. For players under age 19, the sport also resulted in the most injuries and concussions seen in the emergency room.
Football is problematic to population health for its cognitive risks, but the NFL has sent mixed messages, at best, about social and mental health in recent weeks. Conversations about population health get hard when it comes time to identify who is most responsible for solving health problems, especially if they extend beyond the medical arena. Addressing issues of domestic violence and child abuse are not the sole responsibility of hospitals or health systems, but the current NFL crisis — and the attention thus lent to more sensitive health topics — leaves ample opportunity for healthcare providers to do some good. One place hospitals might want to start seems relatively obvious: They might want to reconsider their sponsorship deals with NFL teams.
None of the NFL's national corporate sponsors have pulled their deals so far, although some have voiced their disappointment. Nike has suspended its endorsements of players in question, and other local team sponsors have pulled out, such as Radisson, which suspended its sponsorship of the Minnesota Vikings over Adrian Peterson's indictment for child abuse. It's interesting that child abuse, irrefutably a health issue, prompted a hotel chain to pull its contract while some of Minnesota's children's hospitals with sponsorship and promotional deals have been relatively silent on the issue.
Some of the biggest names in healthcare are corporate sponsors or partners with NFL teams. The way in which these relationships are worded ("the official hospital of the team") might leave the public thinking the health system provides medical care for the athletes — but sponsorship contracts are separate from medical care provision. A team can have one health system provide medical care while still accepting corporate sponsorships from other hospitals, for instance.
Tampa-based Florida Hospital recently launched a "Bucs Fever" campaign with the Tampa Bay Buccaneers after debuting its Bucs Babies program during the NFL draft this spring. All babies born at Florida Hospital during the football season receive Bucs Babies t-shirts. Earlier this year, Cleveland-based University Hospitals signed onto a deal to provide medical care for players on the Cleveland Browns in addition to a sponsorship deal through 2024. That sponsorship will leave the health system with "extensive signage at the stadium and other advertising opportunities." (Cleveland Clinic was the former healthcare provider for the Browns.) Virginia Mason sponsored the Seattle Seahawks' 200,000-square-foot athletic center, but that deal was back in 2008. Judging by the Seahawk's homepage, though, Virginia Mason is still a corporate sponsor, listed at the bottom alongside Nike, Bud Light and Verizon.
The social issues raised by the current NFL crisis only compound the known health effects of the game. There is something inconsistent about hospitals and healthcare providers — so often self-described as the anchors of health in their communities — continuing to feed the NFL money machine. Does it not seem strange that hospital executives continually push messages about lowering healthcare spending and improving population health while writing checks for a game where men intentionally deliver the most severe physical blows they can?
Population health is leaving many organizations, not only hospitals, adjusting their policies for consistency even if it hurts their bottom lines. (CVS isn't making more money by halting cigarette sales, for example.) Maybe it's time healthcare providers re-examine the messages they're sending, and do the same.
Speaking of cigarettes. The NFL's handling of brain injuries is often compared to the decades-long debate over the health hazards of tobacco. If we extend that analogy, we see nearly 4,000 hospitals have adopted 100 percent smoke-free campuses today. Will there be a day when health systems take that much of a pronounced stance against the dangers of football? And if so, what will that look like?