The Silent Epidemic: Assessing Policy Equilibrium and Punctuation on the Issue of Sport- Related Concussions
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The Silent Epidemic: Assessing Policy Equilibrium and Punctuation on the issue of Sport- Related Concussions Major Research Paper Alex Quirion Supervisor Catherine Liston-Heyes November 2016 Abstract Sport-Related Concussions (SRC) represent an important public health issue. An estimated 1.8 to 3.5 million SRC occur each year in the United-States. As our understanding of the brain evolves and evidence becomes available, policymakers are increasingly interested in addressing the issue of SRC. Analysed through the theoretical lens of Frank Baumgartner and Bryan Jones’ Punctuated Equilibrium Theory (PET), this Major Research Paper investigates the forces that contributed to policy stability, and those that contributed to policy change on the issue of SRC. As a policy process theory, the PET documents how policymaking is characterized by long periods of stability and incremental change, only to be punctuated through radical shifts. While most policy process models are interested in understanding either policy stability or change, the PET encompasses both. Our research delineates the contextual conditions and narratives of four SRC incidences, two of which involve athletes at the amateur level (Zachery Lystedt and Rowan Stringer), and two involving professional athletes (Mike Webster and Sidney Crosby). The qualitative data retrieved from our cases is compared with the theoretical components of the PET. Our findings suggest that although SRC have plagued the sport landscape for years, only recently have they risen to the agenda of policymakers and been subject to state intervention in the United-States and Canada. In the 1990s, policy stability on the issue of SRC was the result of a negative feedback process dominated by monopolistic subsystems that dampened change through a supportive policy image. On the contrary, policy change in the last ten years can be attributed to a positive feedback process characterized by policy entrepreneurs who were successful in redefining the issue by using appropriate institutional venues. This Major Research Paper concludes with recommendations for policy entrepreneurs. In particular, our research suggests that policy change goes beyond simple partisan and electoral explanations. Agents of change seeking to alter the mindset of apathetic policymakers should strategically align their lobbying efforts, discourse, and overall actions to create a self-reinforcing process that accentuates change. 1 |Q u i r i o n Key Words Sport-related concussions, punctuated equilibrium theory, policy process, agenda setting, issue definition, policy monopolies, policy images, policy entrepreneurs, policy venues Acronyms CDC Centers for Disease Control and Prevention CIHI Canadian Institute for Health Information CTE Chronic Traumatic Encephalopathy FIFA Federation Internationale de Football Association HDIC Hockey Day in Canada IIHF International Ice Hockey Federation IOC International Olympic Committee LOC Loss of Consciousness MTBI Mild Traumatic Brain Injury Committee NFL National Football League NHL National Hockey League PET Punctuated Equilibrium Theory SAC Standardized Assessment of Concussions SIS Second Impact Syndrome SRC Sport-Related Concussions TBI Traumatic Brain Injury 2 |Q u i r i o n Table of Contents Chapter 1: Introduction ...................................................................................................................... 4 Research Questions .......................................................................................................................... 5 Scope of Thesis and Importance of Research ............................................................................... 5 Sport-Related Concussion Policies in Canada and the United States ...................................... 7 Research Methodology .................................................................................................................... 9 Chapter 2: Theoretical Framework: Punctuated Equilibrium Theory ................................... 12 Chapter 3: Literature Review: Filling an Empirical Gap ........................................................... 17 Chapter 4: Analysis and Discussions ............................................................................................ 28 Negative Feedback Process (Policy Stability) ............................................................................ 31 Positive Feedback Process (Policy Change) ............................................................................... 39 Chapter 5: Conclusion ...................................................................................................................... 45 Policy Implications ........................................................................................................................ 47 Looking forward ............................................................................................................................ 47 References ........................................................................................................................................... 52 3 |Q u i r i o n Chapter 1: Introduction Traumatic Brain Injury (TBI) has been famously coined the “silent epidemic”, in large part because incidences are significantly underreported, and ultimately remain untreated (Kelly et al, 1991; Kiraly, 2007; Buck, 2011; Caroll & Rosner, 2012). As our understanding of the brain evolves and evidence becomes more available, there is a growing awareness of the long-term cognitive effects associated with TBI, which includes physical symptoms (headaches, nausea, fatigue, dizziness), cognitive symptoms (memory, attention and executive function impairments), as well as mental health concerns (depression, anxiety and post-traumatic stress disorder) (Weng, 2015). In recent years, increased awareness of TBI has been driven by the topic of Sport-Related Concussions (SRC), a subset of TBI. This Major Research Paper is interested in the policy process1 of SRC in the United States and Canada. In both countries, the issue of SRC has recently shifted from the systemic (unofficial) public agenda to the institutional (official) agenda. The former refers to all the issues and topics that are perceived as deserving public attention, while the latter consists of those issues that actually receive attention from policy elites. Agenda setting is grounded in the notion that no political system has the institutional capacity to address every problem. In any given social setting, ideas and issues compete against each other to gain political attention, and only a small number of issues from the systemic agenda make their way to the institutional agenda (Cobb & Elder, 1983). Our research is therefore guided by a simple observation: SRC policies2 have 1 The policy process is defined as the study of the interactions over time between public policy and its surrounding actors, events, and contexts. (Sabatier & Weible, 2014). The policy cycle involves a multi-cycle approach which usually includes Policy Identification, Agenda- Setting, Implementation, and Evaluation. 2 For the purpose of this research, the term “policy” is used broadly, and does not refer to a specific course of action. As pointed out by Birkland (2014), the study of policy should not be limited to written Laws or Regulations. A policy can be defined as a Statement made by Governments to 4 |Q u i r i o n been characterized by extended periods of stability and incremental change at the macro-level, but have recently risen to the agenda of policymakers. The focus is on which factors contributed to policy stability, and which ones contributed to change on the issue of SRC. Research Questions The research utilizes a qualitative, multiple-case research design (see research methodology section). Four distinctive cases will be analysed, two of which involve athletes at the amateur level (Zachery Lystetd and Rowan Stringer), and two involving professional athletes (Mike Webster and Sidney Crosby). The contextual conditions surrounding these cases, as well as the experience of the actors involved will be analysed through the theoretical lens of the Punctuated Equilibrium Theory. Ultimately, the study seeks to answer the following research question: What factors contributed to policy stability, and which ones contributed to policy change on the issue of SRC? The following sub-questions guide the research process: Who were the prominent members of the monopolistic subsystem that ensured equilibrium and incremental change? What supportive policy image was put in place by monopolistic subsystems? Which policy entrepreneurs were successful in creating policy punctuation? How did a change in the policy image impact SRC policies? Which institutional venues were exploited by policy entrepreneurs to push for policy change? Scope of Thesis and Importance of Research Initial studies concluded that 300,000 SRC occurred annually in a country like the United States, but that incidence rate appears to be conservative as it only accounts for athletes who address a public issue. These statements can be found in “Constitutions, statutes, regulation, agency or leadership decisions, or in changes in the behavior of government officials at all levels.” 5 |Q u i r i o n suffered loss of consciousness (LOC) (CDC, 1997). Considering that the vast majority (90%) of SRC don’t involve LOC, and that cognitive brain injuries are often underreported due to the absence of widespread surveillance mechanisms, the Centers for Disease Control