Wed Sep 6

We are finally moving towards a national strategy on concussions in sport. Will the government and sports bodies now act?

Written by: Annette Greenhow, Assistant Professor, Faculty of Law, Bond University

A Senate committee has tabled a long-awaited, 187-page report ^[1] on the growing problem of concussions in sport, with 13 recommendations for action.

Senator Janet Rice, the committee chair, urged the government to take the report very seriously and quickly move to implement the recommendations. She said now is the time for the “Commonwealth to step up”.

In the past few years, we’ve heard countless heartbreaking ^[2] stories about Australian sports figures who have struggled with their mental health after suffering head injuries on the field.

Some have posthumously ^[3] been diagnosed with chronic traumatic encephalopathy (CTE), a form of dementia.

Our sports leagues have begun paying greater attention to the risks associated with concussions and mild traumatic brain injuries. The primary focus has been on the elite level, with some recent action at the community level.

It has been nearly 30 years since the National Health and Medical Research Council, the government’s public health agency, called for precautionary action on this issue. However, governments have been slow to act on repeated calls for a national strategy to what is fundamentally a public health concern.

So, will the government follow through now by implementing the Senate committee’s recommendations? And how will our sports leagues respond?

Jack Reed of the Brisbane Broncos leaves the field with a possible concussion in a National Rugby League match in 2016. Michael Chambers/AAP

Conflicting approaches to concussions

The Senate committee received 92 submissions and heard from 84 witnesses from a wide range of backgrounds, including athletes, families, medical experts, the leaders of sports organisations and other experts. (I also presented evidence, based on my expertise in this field.)

Two conflicting narratives emerged from the evidence. On the one hand, athletes, families, health care professionals and other public interest groups expressed concern that the current approach on concussions and player safety was inadequate. They argued there are too many gaps in the system and, in some cases, that sports organisations are putting self interest above player health.

On the other hand, the Australian Institute of Sport and other sports-affiliated parties argued the current approach, which allows sports organisations to self-regulate when it comes to handling head injuries, is fit for purpose. They also said player health and wellbeing was a primary concern.

In some respects, the report carefully toed the line between the two sides. Several recommendations set out a greater role for the Commonwealth government to play, but did not provide the level of specificity some might have expected for such an urgent and pressing public health concern.

Lack of reliable data on head injuries

One of the main concerns in the report was the lack of reliable and accurate data on the prevalence of concussions in sport and our general level of understanding on the health risks.

To address the data issue, the inquiry recommended the government establish a national sports injury database as a matter of urgency. This is greatly needed not only to enact better injury prevention policies and programs, but also so families can make decisions on sports for their children.

The report further recommends requiring professional sporting codes to collect this data on concussions and share it with the new database. Currently, only some sporting codes share this information publicly.

On the research front, the report recommended the government establish a new independent body (or an entity within an existing body) that would be dedicated to research into the short- and long-term effects of concussions and repeated head trauma in sport, including CTE.

Many of those submitting evidence cited concerns over the lack of coordination and direction in the current approach to research. As the committee pointedly said,

There is clear evidence of a causal link between repeated head trauma and concussions and subsequent neurodegenerative diseases such as CTE. While important research questions remain regarding the degree of causation and the nature of long-term impacts, these questions should not be used to undermine the fundamental nature of that link.

‘High level of confusion’ on return-to-play rules

Other recommendations focus on how sporting codes should change their rules or policies to mitigate the risks of head injuries.

Here, the committee also called for a greater role by government and medical experts in developing return-to-play protocols (as in, the amount of time a player should sit out after a head injury before returning to the field), which could be adapted for use across sports.

This is an important point. The report cited concern over the “high level of confusion” over how much time a player should sit out, which comes from the disparate rules across sporting codes.

And the committee noted that even with return-to-play policies in effect, compliance and enforcement remained a problem. The report again cited a greater role for government in overseeing these protocols, though it doesn’t specify how.

If the goal is to achieve uniformity and compliance, then a practical issue to consider is whether the sports and their networks have the required resources and capabilities to achieve this. And is legislation required to empower government to monitor compliance?

Ben Brown of the North Melbourne Kangaroos was concussed during an AFL match in 2017. Julian Smith/AAP

Inadequate support for athletes

The final sections of the report deal with the current lack of financial support for players who suffer concussions, including:

the exclusion of athletes from workers’ compensation schemes
the absence of a national injury insurance scheme
inadequate support provided by sporting organisations
inadequate private insurance, and
barriers to legal remedies for concussion and head trauma-related claims.

The report made clear much more could be done by sporting organisations to improve their duty of care to athletes. As a baseline, it “encourages” professional sports organisations to ensure their athletes have insurance coverage for head trauma and the removal of the exclusion of athletes from workers’ compensation regimes.

The goal here is to address the inequities in access to adequate support for professional athletes. But without crunching the numbers and doing a cost-benefit analysis across the various compensation options, it’s difficult to know whether athletes will be better off.

The lack of detail and concrete timeframes in the report make it difficult to predict what lies ahead. With sports revenue streams likely to be impacted due to the ban on sports gambling advertising ^[7], the sports organisations will be paying close attention to the costs of these recommendations.

Let’s hope the government adheres to its role as “neutral umpire” when it comes to the resistance it could now face in implementing the recommendations.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.