The steep economic cost of contact sports injuries

There is increasing evidence that contact in sports has negative long-term health consequences. The constant hitting — the jarring of the brain at each hit — can have negative effects even if there is no apparent injury. But when an obvious injury does occur, there are also short-term costs from the injury itself — such as medical costs, time lost from various activities, and costs associated with the pain and suffering. These economic costs are often overlooked in the broader debate about the safety of football and other sports.

In a recent study, Christopher Champa and I estimated the economic cost of contact in college and high school sports. For college, the estimated cost per year ranges from $446 million to $1.5 billion; for high school, the range is $5.4 billion to $19.2 billion. And these are only the short-term costs; the long-term costs may be much higher. Any cost-benefit analysis of the issue is incomplete if it doesn’t include a close look at the billions in annual damages caused by contact sports-related injuries.

To estimate the costs we compared injury rates in contact sports to those in non-contact sports. For college we counted non-contact sports as tennis, baseball, indoor track, cross country, and outdoor track. The contact sports in the study were football, wrestling, ice hockey, soccer, basketball, and lacrosse. For high school, we looked at one non-contact sport, baseball, and four contact sports: football, wrestling, soccer, and basketball. We counted injury rates per 1,000 exposures; each “exposure” is one athlete’s participation in a practice or competition.

(The study used data from the 2009–2010 to 2013–2014 academic years, compiled by the NCAA Injury Surveillance Program the High School Reporting Information Online project. The data are from a sample of reporting colleges and high schools and expanded to national totals.)

The study examined the average injury rates over these five years for all injuries and then for concussions only. For college football there are 7.79 injuries per 1,000 exposures, which compares to 2.62 for the non-contact sports. For high school football the rate is 3.73 versus 0.90 for the non-contact sport (baseball).

For concussions, there are 0.92 concussions per 1,000 exposures in college football compared to 0.06 for the non-contact sports, about 15 times higher. The high school football concussion rate is similar, at 0.90, which compares to 0.10 for the non-contact sport, 10 times higher.

Overall, it is clear from the data that contact leads to more injuries — and higher economic costs. In our study we asked the question how many injuries would be saved if the contact sports were changed in to have injury rates similar to those in the non-contact sports. To have this come about, rules would have to be changed.

For ice hockey, soccer, and lacrosse, the rules would have to be changed to allow no contact and the refereeing would have to be tighter. In addition, headers would have to be banned in soccer. For football the game would have to be changed to be non-contact football. An example of non-contact football is flag football, although other non-contact options are possible.

Basketball is odd in that it is not supposed to be a contact sport, but its injury rates are in the contact sports range. There is, of course, contact in basketball and players frequently fall. Possible rule changes would be banning dunk shots (so that less of the game is in effect played above the rim) and tighter refereeing. Some experimentation would undoubtedly be needed to change the rules for each sport to achieve injury rates similar to those in non-contact sports.

If contact were eliminated, our research shows that the savings would be large. College sports would have an estimated 49,600 fewer injuries per year, including 6,900 fewer concussions. Football accounts for over half of these at 26,000 fewer injuries, including 4,400 fewer concussions.

The numbers are much larger for high school because there are many more high schools than colleges. Under rule changes that eliminated contact, high school sports would see an estimated 601,900 fewer injuries, including 161,400 fewer concussions. Football accounts for about 70 percent of these at 426,700 fewer injuries, including 120,800 fewer concussions. The dollar estimates from these savings have been mentioned above.

Of course, many people enjoy the contact part of contact sports, and implementing these rule changes would not be popular with everyone. For example, changing football to be, say, flag football would be a major change in the sports culture in the United States. But the estimated annual savings would be large — up to $1.5 billion for college and $19.2 billion for high school, not counting possibly much larger long-run savings. Note also that eliminating contact in a sport does not mean eliminating the sport. If, for example, football were made a non-contact sport, there would still be a Harvard/Yale football game, including tailgating!

Given the large costs of contact, if parents and students are going to make informed choices as to what sports to participate in, they should know the injury rates. Unfortunately, high schools and colleges appear to be reluctant to collect and report sports injury information. It’s my personal view that Yale, where I teach, and other colleges and universities, should collect sports injury data and issue yearly reports, as Yale does for sexual harassment claims. Many food items are required to have labels listing what’s in the food; surely Yale should let parents and students know what the injury risks are in each sport.

I hope our study will stimulate more data collection and more reports. And perhaps if our results hold up, more thought will be given to taking the contact out of contact sports.