Since rugby union became a professional sport in 1995, its popularity has increased to such a height that the Six Nations Championship in 2014 had a higher average attendance per game than either the UEFA Euro Cup 2012 or the FIFA World Cup 2014. Now with the Rugby World Cup in full swing, there’s more attention being paid to the game than ever. But is it safe?
The UK government has selected rugby union and rugby league as two of five sports it will focus on to increase the prominence of competitive sport in schools in England.
The health secretary, Jeremy Hunt, has promised to “work with sports such as football, cricket, rugby union, rugby league, and tennis to establish at least 6,000 partnerships between schools and local sports clubs by 2017”. The government hopes to put 1,300 links in place between schools and rugby union organisations, and 1,000 links with rugby league.
Rugby is a high-impact collision sport, in which players have to exert extreme force in order to acquire and maintain possession of the ball. Injuries are frequent – the probabilty of a player being injured in a season can be as high as 90% in some studies, depending on the definition used. The majority of injuries, at least 75%, occur during contact or collision, such as the tackle and the scrum. Two-thirds of all concussions occur during the tackle. With one head injury or concussion per match in the community game, and concussion common in the children’s game, traumatic and repetitive brain injury is a routine occurrence.
A link has been found between repeat concussions and mild cognitive impairment in young adult male rugby players and an association with depression, memory loss and poorer verbal fluency.
Researchers have also found evidence of a link between repeat concussions and chronic traumatic encephalopathy – a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma. There is an association with Parkinson’s disease and other neurological conditions. The degeneration can bring with it memory loss, confusion, impaired judgement, impulse control problems, aggression, depression and, eventually, dementia.
Given that children are more susceptible to injuries such as concussion and often take longer to recover, the government’s plan to increase participation in rugby in schools, in the absence of a comprehensive system for injury surveillance and prevention (including tertiary prevention and rehabilitation), is worrying.
Many countries, including the UK, have inadequate child injury surveillance systems. Under the United Nations Convention on the Rights of the Child governments have a duty to inform and protect children from risks of injury. As a signatory to the convention, the UK government should ensure the safety and effectiveness of sports – particularly that injury surveillance and prevention strategies are established, before proceeding with its plans to target funding and increase participation in a high-risk collision sport such as rugby.
A catastrophic risk
Against the backdrop of growing evidence on rugby injuries, the UK government could find itself at the wrong end of legal actions. It would do well to follow New Zealand’s example – as the only country in the world to have a comprehensive national dataset of rugby injuries, collected since April 1974 by the government’s Accident Compensation Corporation (ACC).
The ACC has a statutory duty to prevent injury, which means it must monitor injuries and work on prevention strategies with relevant parties. The New Zealand system provides financial compensation and support to anyone who suffers an injury irrespective of proof of blame and citizenship.
To ensure that legal responsibility for rugby injuries remains with the state, rugby officials have to report any injury to the head or neck that happens on their watch – or any injury requiring hospital admission or an absence from play of eight weeks or more. Nothing of comparable sophistication exists in the UK – and rugby’s governing bodies in this country are highly resistant to the introduction of comprehensive monitoring.
The four rugby unions of England, Scotland, Wales and Ireland have rushed out many initiatives, including concussion management protocols, but none have been evaluated. Most of the serious injuries in rugby are avoidable and preventable. But prevention requires radical changes to the laws of the game. It means removing the collision element, namely the tackle. Martin Raftery, the medical director of World Rugby has now stated that the laws of rugby may have to change to reduce concussion risk, but World Rugby is dragging its feet in tackling the dangerous tackle.
World Rugby determines the laws of the game, but its interests are in the professional game and business. This year’s Rugby World Cup is expected to bring nearly £1 billion to the UK economy. The problem for children is that World Rugby and the rugby unions also determine the rules of rugby in schools. The link between the professional game and the children’s game should be severed – governance of the children’s game should not be determined by World Rugby and the Rugby Unions.
Writing in the British Medical Journal in January 2015, the editor-in-chief, Fiona Godlee, wrote: “Let’s call the current state of monitoring and prevention of rugby injury in schools what it is: a scandal. It needs urgent remedy before more children and their families suffer the consequences of collective neglect.” The BMJ poll of doctors later confirmed that 72% felt the game should be made safer.
Parents expect the state to look after their children when they are at school. By allowing the sport’s own governing bodies to decide what, if any, information to collect and to determine the laws of the game for children, the UK government has abdicated its responsibilities to children under the UN Convention on the Rights of the Child – leaving them exposed to catastrophic risk.