Sport, neurodegenerative illness and the social determinants of health

This article proposes a Social Determinants of Health framework as a counter to the prominence of bio-determinist tropes in understandings of the relationship between concussion and later life neurodegenerative conditions in athletic populations. It is argued that debates about concussion (or repetitive head impacts) causing CTE have been particularly influenced by broader social trends towards neuro-essentialism. This paradigm reduces complex social behaviour to brain matter and continues to dominate the field despite the recent diversification of evidence from autopsy-based studies of neuropathology to epidemiological studies comparing recorded causes of death among former elite athletes. In contrast, this article explores the 'causes of causes' of neurodegenerative conditions. It outlines the ways in which the distinct dynamics of: a) employment, b) education, income and wealth, c) health systems and services, and d) social environment and public safety relate to the specific occupational conditions of elite sport and likely negatively shape health outcomes of athletic populations. The article concludes by arguing that to more effectively address these particular health harms we must move beyond narrow, mono-causal models and evoke a cultural change that extends beyond making rule changes and adjusting psychological attitudes and behavioural norms, to redress the social structural parameters of elite sports participation. The continuation of narrower, neuro-centric and reductionist paradigms obscures the causes of the causes of neurodegenerative decline and limits the scope for change.