Better football, better health?

The 2026 FIFA World Cup is just over a month away!  The Fédération Internationale de Football Association (FIFA) holds the World Cup, a tournament between men's national football (soccer) teams, every four years.  The reigning champions are Argentina, who won their third title at the 2022 World Cup by defeating France.  This year's tournament will take place from June 11 to July 19, 2026, and it will be jointly hosted by the United States, Mexico, and Canada (the first time that the World Cup has been hosted by three countries).  Forty-eight countries will be playing in the tournament this year, which is also the first time that this many teams have played in the tournament.

Bill Shankley, a former World Cup player for Scotland and manager of the Liverpool Football Club (a team that currently plays in the English Premier League) from 1959-1974 reportedly once said, "Some people think football is a matter of life and death...I can assure them it is much more serious than that."  He may have had more of a point than he originally thought or intended.  Researchers John Appley and Andrew Street published a study in the Journal of Health Services Research & Policy in 2001 which compared the rankings for the international teams of 176 countries against the rankings for the same countries on the World Health Organization health performance index.  According to their data, if a national team does well, the country is also likely to have a good health system.

Importantly, the paper started out as a joke.  Andrew Street told Roger Dobson, writing for the British Medical Journal, "The intention was to sow doubt about supposedly sophisticated attempts by the World Health Organization to measure health system performance.  But there are some serious messages.  The most notable is that data can be misused to prove almost anything you like - such as that countries with better football teams will have better health systems.  Just because the WHO analysis looks sophisticated, it does not mean it is right."

I am reminded of the famous association between a country's per capita chocolate consumption and the number of Nobel Prizes received by its citizens, published a few years ago in the New England Journal of Medicine (see "Chocolate Consumption, Cognitive Function, and Nobel Laureates"), which I mentioned in a previous blog post (see "Michael Jordan, Chocolate, Coffee, and the Nobel Prize"):

There are a couple of important take-home points to emphasize here.  First, data can be massaged to show just about anything, so be careful about making any definitive statements or conclusions from any "big data" analysis.  Second, correlation does not prove causation.  The way to improve a country's overall health is not to strengthen the country's national football team.  

Third and perhaps most important, evaluating a country's overall healthcare system is a lot more nuanced than most people think.  As I have stated a number of times in previous posts (see, in particular, "Measure What Matters"), most commonly cited metrics of a country's healthcare performance have more to do with measuring the overall health of the country's population than with the quality of their healthcare delivery system.