The issue of the long-term effect of concussion on professional sportsmen has become a major topic of discussion in the last 12 months. In March, it was revealed that a former National Rugby Union player along with six other former sportsmen would be donating their brains to Australia's first Sport Brain Bank. This is to enable researchers to study the relationship between sport-related concussion, head injury and Chronic Traumatic Encephalopathy (CTE).
Each year, Swiss Re use in-house crowd-sourced discussions to develop a list of emerging risks and trend spotlights for sharing with the industry via our SONAR Report. As the 2018 SONAR report has just been released, it was an opportunity to look back at one of the key topics from a previous SONAR, Concussion in Sport. This was raised in 2014 as an issue likely to impact the insurance industry.
The topic of concussion – or mild Traumatic Brain Injury (mTBI) – generated a lot of interest in 2014. A year later the subject came full-steam into the public consciousness following the movie Concussion, which followed the discovery of the degenerative brain disease, CTE in NFL players. The movie brought a spotlight to the devastating effects of CTE and subsequent player lawsuits in the US. It created a wave of discussion and debate on how we can prevent and manage concussions in sport.
Impacts of mTBI and community approach
As anyone who has suffered a concussion knows, it can lead to memory loss, confusion, impaired judgement, emotional control issues and can also cause post-concussion syndrome. Repeated concussions have been linked to CTE, which can develop into dementia, Alzheimer’s and Parkinson’s disease, and ultimately death. Currently CTE can only be diagnosed post-mortem by studying the brain of the deceased – one such study of the brains of American professional footballers showed that 110 out of 111 NFL players had some form of CTE at their time of death.
In a worrying trend, concussions are seemingly on the rise. While some of this increase can be attributed to improved reporting practice and better protocols around concussion management, the numbers are significant. In the past decade, concussions have increased by 200% among teenagers aged between 14 and 19 and the number of reported sports-related concussions doubled between 2002 and 2012. And as players get stronger, knocks get harder.
Furthermore, many concussions occur during training, not just on game day. In fact, one-third of concussions happen at training and there is now the identification of a new risk from sub-concussive impacts. It's arguable that these concussions are more likely to be brushed off during training and not adequately assessed and managed.
Not all brains react in the same way and contrary to popular belief, you don’t have to be knocked out to suffer a concussion. Research has shown up to 90% of concussions do not involve a loss of consciousness and a secondary concussion can be much more hazardous to a player’s immediate and long-term health. In the last few years we have seen a fantastic and positive surge of women in contact sport. On the other hand as women become more involved in such sports at community and elite levels, their physiology and aspects of their play mean they are more exposed than men to concussions. Yet research on sportswomen and their brains is woefully lacking.
Financial impacts and litigation on the rise
The annual cost of concussions to the Australian community is estimated at around $40 million and likely to significantly rise with increased scrutiny around mTBIs.
As a comparison, in the US where class actions, lawsuits and player research is better established, the annual cost of head knocks in sport is closer to $60 billion, with the NFL class action alone resulting in a $1 billion fund established for ongoing medical care of players. There are a number of class actions currently underway in the US including a very recent suit involving young female soccer players. Closer to home, there is also litigation in progress with several former NRL and AFL players involved in individual claims and potentially class actions against the Leagues to seek compensation for the effects of concussion on their long-term health. The common thread in litigation is prior knowledge of chronic injury potential of head trauma through sport.
What does this mean for Insurers?
There is wide perception that the issue of concussion centres on professional sport and therefore only the small amount of insurers that underwrite that segment need to be concerned. However, the bigger issue is at the grass roots level of sport, especially involving children.
In Australia, a sporting nation, we encourage our children to take up sports from a young age. Research is ongoing regarding a causal link between sport-related concussion and long-term brain injury. Should a scientific pre-mortem method be established, it will likely have wide-reaching impact across many different insurance segments. This awareness has led sporting clubs, schools, governments, associations and companies investigating ways of mitigating the risks. These bodies are assessing what more can be done to protect participants, both in early identification of concussion and also treatment post-concussion.
As insurers, risk is our business. With transformations in the social framework, changes to the legal environment as well as industrial and technological advancements, insurers have been managing changes to the risk landscape since the industry was established. Therefore, when it comes to concussion – and indeed other emerging risks – there is a great opportunity to exchange knowledge and provide up to date information on the potential impacts and liability exposure. Following that, offering guidance on best practice protocols to help manage specific risks and minimise exposure is also something the industry has historically done well.
This year's SONAR Report identifies a new set of emerging risks, which are developing and evolving, but difficult to quantify and sometimes not understood. Among this year's lists is:
Towering Infernos – Combustible Cladding
Funny Money – do we need to worry about cryptocurrencies
Eyes Wide Shut – The world is sleeping less
A Brave new world – Emerging Geopolitical risk
Like Concussion in Sport, it will be interesting to see how this year's SONAR risks develop in a few years' time.
Location: Sydney NSW, Australia