Lifespan Perspective of Professional Footballers’ Health

Dear editor,

From the last decade of the twentieth century, professional football has become a transnational global business in which financial profits are as important as sports successes (1). Being a full occupational category, professional football relies on a diversity of stakeholders including among others players, clubs, (inter)national governing bodies, sponsors and sport ministries (1). Despite the fact that professional footballers are workers i.e. employees in the eyes of the law, the World Footballers’ Union (FIFPro) representing more than 65,000 professional footballers worldwide emphasizes that professional footballers should have the same (labor) rights as any employees in any occupational category and the same rights from one employer to another, especially when it comes to their health (2). Nevertheless, the most important stakeholders in professional football other than players’ unions, namely clubs i.e. employers and official football authorities, have been refraing from looking at the health of footballers in a lifespan perspective, neglecting relevant occupational and health statements as well as players’ needs.

Lifespan Perspective of Footballers’ Health

In 2009, the World Health Organization (WHO) and International Labour Organizations (ILO) have stated that “the protection, promotion, surveillance and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations long after they enter their retirement years is not only a labour right but a fundamental human right that should be facilitated by social partners and stakeholders (3). Being applicable to any workers and thus to professional footballers, such a statement puts the physical, mental and social well-being of any player in a lifespan perspective. However, stakeholders in professional football other than players’ unions have been avoiding putting players’ health in such a lifespan perspective, especially clubs i.e. employers and (inter)national governing bodies. For instance, Fuller et al. (2012) have recently described through the presentation of research studies conducted by the F-MARC (FIFA’s Medical Assessment and Research Centre), FIFA’s approach for protecting the health of football players, including professional footballers (4). Among studies related to gender, age or environmental conditions, most of the researches that have been done so far were directed towards the epidemiology of musculoskeletal injuries, which is definitely a relevant topic in professional football in any continent (5). However, it seems peculiar that studies about mental health problems that might occur during but also after a football career, or about the long-term consequences of injuries (e.g. osteoarthritis), are scarce or lacking, and that setting footballers’ health in a lifespan perspective seems to be neglected (6-8). This is even more peculiar because it does not concur with the view and needs towards improvement in medical care and support previously expressed by the most important stakeholders in this occupational category, namely the professional footballers.

Footballers’ View and Needs Towards Sustainable Health

At the start of the twenty-first century, Drawer and Fuller (2002) conducted a survey among retired professional footballers in order to explore their views on the adequacy of the medical and socioeconomic services they received during and at the end of their careers (9). While satisfaction with medical support was reported by more than half of the former players, only one out of five former footballers (19%) were satisfied with the educational support they received during their career (9). From the respondents who were forced to retire as a consequence of an injury, 40% to 85% were dissatisfied about the medical and educational support they received during their career, stating that their injury would limit their future career/earning opportunities and lead to long-term health problems (9). One decade later, a similar study (by means of interviews) was conducted among both current and former professional footballers as well as their club physicians in order to explore potential needs in medical care and support during and after a career in professional football (10). All three groups of participants acknowledged that the medical care and support during a football career was exclusively directed towards physical health (mostly injuries), while adequate support related to mental and social well-being was lacking (10). After a career in professional football, neither medical support nor any information related to potential physical, mental and social health problems that might occur on the long-term was reported to be unavailable (10).

Both aforementioned studies show that professional footballers are negligibly or insufficiently informed and supported about health risks other than musculoskeletal injuries arising from their careers in the short- and long-term. These scientific findings, in addition to the anecdotic information available, emphasize the failure of the different stakeholders in professional football to put the physical, mental and social health of players in a lifespan perspective, which does not concur with the WHO and ILO statement related to human and labour rights of any workers in any occupation.

Challenges Towards Lifespan Perspective of Footballers’ Health

With regard to the aforementioned, all stakeholders in professional football should realize that the current health support in professional football does not concur with the WHO and ILO statement related to human and labour rights of any worker in any occupation. Consequently, the upcoming challenge especially for players, clubs, and (inter)national governing bodies is to put the physical, mental and social health of professional footballers in a lifespan perspective. The unconditional condition is of course to put the safety and health of players during any training or competition at the number one priority (“players' health is non-negotiable”). In addition, several tools, being relevant either in the early or later stage of a football career, might be taken into consideration, namely:

• -Mandatory attention to career planning in the youth academy of all professional clubs in order to prepare the post-football life and avoid any potential mental and psychosocial problems, career planning being based on relevant tools such as secondary and higher education programs, goal setting, mental and life skills training, longitudinal monitoring of psychosocial traits, and empowerment of the level of readiness (cognitive, affective, motivational, behavioral) for career transition (11);

• -Development and implementation of self-awareness programs for professional footballers with regard to relevant health conditions that might occur during but also after a football career (among which osteoarthritis, depression, adverse health behaviours, addiction, gambling);

• -Development and implementation of self-management programs (including e-Health) related to health conditions that might occur on the long-term across football clubs (that can be used by players regardless of their labour contract with a given football club);

• -Mandatory minimum medical standard in all professional football clubs, involving among others players’ right to have a medical second opinion, basic education of coaches about health, and availability of a psychologist/psychosocial consultant;

• -Strengthening of the independent and leading position of sport/club physician(s) within all professional football clubs when it comes to decisions related to the health and safety of professional footballers;

• -Development and implementation of an exit-career examination for recently retired professional footballers, playing a key role in the self-awareness program acknowledged previously;

• -Development and implementation of interventions/programs aiming to counsel recently retired professional footballers about the application of relevant measures and skills in order to promote healthy lifestyle and empower their sustainable health and functioning (especially in group sessions in order to prevent the lower social support often reported at the end of a career).

With regard to the tendency of professional football clubs to care exclusively about the short-term aspects of their players i.e. employees, the logical expectation is that the aforementioned tools should be considered through a joint effort from other stakeholders in professional football, especially (inter)national players’ unions and (inter)national governing bodies.