If you were than one in every four adolescence gets enough exercise in this country. We have an epidemic across the nation. It cost about 90 million a year direct cost projected to be 190 billion by 2030. We know that physical activity levels have dropped 32 of less than two generations and that between the ages of nine and 15, our physical activity level has dropped 75 . A lot of kids fallout of sports during the middle school years. And we know that there are Many Health Benefits from playing sports, stronger bones, better heart health, lower levels of depression and we know that one study in 2004 out of Penn State University said that adolescents who played sports are eight times more likely to be active in sports at age 24 as adolescents who do not play sports. So in a nation we have a real interesting getting and keeping as many kids active in sports in their teenage years as possible. At the same time, we have another set of statistics we have to contend with particularly as it relates to the sport of football. You know i worked for espn and we recently conducted a survey of parents and 58 of those with suns younger than age 15 say they were cole very concerned about youth with all injuries. Nearly one in five discouraged their sons from playing the game. Foot wall has the highest concussion rate in sports along with hockey, and you have a lot of parents, a lot of people are wondering chico is this a game that is safe for my kid . Should i introduce them to at . What are the shortterm consequences . What are the longterm Health Consequences . So the central question we are going to be looking at today is how can football, the institution of football best serve the interests of children and communities and Public Health . How can football serve children, communities and Public Health . Everybody at the table here has their own narrow interest. We work for this organization or that organization and we are trying to grow our membership or whatever else it may be but this is a collective conversation about what are some great ideas that people have developed out there and could be scaled up, and is there a Common Ground that people can find to move this conversation forward and address the needs of the nation and the concerns of parents. People are worried. Should we hold off on football until high school somewhat arguing not play at all . Or can it be made safer through reforms at the lower levels . And what is the role of the nfl, the Players Association and profootball and the industry in general and creating an environment that is productive . Aspen begin to address these questions at the aspen ideas festival in june where we convened a panel called head games, can foot all save itself from itself and jim brown, the nfl legendary, the legendary nfl running back was on the panel and dan garza, professor at stanford who has worked on mouthguard technology that can measure the force of impacts on the head and kevin turner who was the subject of documentary which you will see a clip of it called american man produced by a colleague of mine who works at hbo. So, this panel will be featured in a show on the world channel on november 20 at 8 00 p. M. And on line as well. Pbs is working with, Public Television is working with the Aspen Institute to turn this into a onehour session. There will be a whole onehour session which will include conversations about football safety but we are going to play about a tenminute clip of that. [no audio] [inaudible conversations] lets come back to it. Sorry about that. So what i would like to do now is start off this conversation about the under 14 question, the prehigh school equation and i would like to do that with our special guest, dr. Robert cantu who many of you will of course are familiar with. He is the chief of neurosurgery and chairman of the department of surgery and drifter of services of Sports Medicine in concord massachusetts as well as the clinical professor of neurosurgery and the codirector of Boston University center for the study of traumatic and and encephalopathy. Is the he is a Senior Adviser to the nfl head neck and Spine Committee and is cofounder of the sports legacy institute, an organization dedicated to addressing the concussion crisis through research, treatment, education and prevention and he is the author of the new book, called concussions and their kids, americas leading expert on how to protect Young Athletes and keep sports safe, written with marc hyman who is with us here today as well. So dr. Cantu, what is the central thesis of your book here . First of all time i would like to thank you in the Aspen Institute for convening this Conference Today and for inviting me to participate in it. I think before i answer your question, i would like to start i just simply saying i am prosports. I want every sport to be continued and i wanted to be played in greater numbers, and i believe all of the opinions that i hold are trying to have that happen although right now maybe not everybody fully believes it. Footballs value is the exceptional exercise obtained in playing it. The last time i checked, it was the minutes if not hours of physical activity playing the sport that counts, not the milliseconds of bashing heads. As for the medical director of the National Center for catastrophic sports injury research, we track catastrophic sports injuries in this country. 97 of which comes from the sport of foot wall or 96. 9 to be precise. And that is even before you start to get into the concussion issue. Please believe that all sports that are currently being played should continue to be played that they should be made safer with regard to the head issue and in the sports of football especially involving our very young youth, we believe the tackle football should not be played, rather flag foot should be substituted and in the substitution of flag football its perfectly okay if pats are worn and if even helmets are worn. But the act of tackling, which is the activity were almost all of the serious injuries happen and the majority of the concussions as well is eliminated and instead flags are pulled. I personally view this as a tremendous opportunity for usa football because, if they were to offer flag football is an option and promote it, all they wrote the benefits that are needed would be there. The head injury risk and other injuries would the largely decreased and i think football would be gaining individuals coming from other sports at highrisk of head injury, especially like soccer. Soccer has been a drain on football for two decades and i think he would go the other way of foot ill were to offer the flag is an option to tackle. Youngsters are not miniature adults. Brain injuries and youngsters are a bigger problem than they are and adults. Youngsters brains are not fully my eliminated. That is the coding of the telephone wires as an analogy. It helps in and transitioned to get or structure and support to the brain fibers connecting nerve cells. Youngsters brains are more susceptible to the excited toxic shock of concussions and. Youngsters have big heads on weakness like the bobble head although head daul effect that puts them at greater risk than and it. I commend the nfl did try to alleviate this problem but tend to have the oldest equipment, the least experienced coaches, almost never have medical personnel on the sideline. Youngsters do not have informed consent i would offer. Rarely do they really understand the risk, especially at the youth level. So for these reasons as well as others which im happy to get into, i think that we should seriously approach football from a different standpoint for our youngest individuals and take tackle out of the football football at the youth level. And all of them came from one individual who was conflicting the trauma on others. There is not so good signs to tell you exactly what the scope of this problem is because statistics are just not been accumulated. What we do know from a wide variety of sources is that the brain of our youth are more susceptible to injury and the impact that the springs are being asked to absorb some times reached the same level commit bdg or higher that we see and adults and there is a lot of emerging evidence both on structural dti, on metabolic studies, functional mri as well as neuropsychological testing suggests that she dont even have to have concussions recognize for your brain structure and or function to deteriorate over a season of hope. Preseason testing versus postseasons declines under all three of those disciplines. So theres plenty of of evidence i believe we need to look at this differently. I was thinking of someone who was telling me hes a freshman in high school and its his first year playing and there were an awful lot of injuries this year, possibly because these kids havent played football before and theyre been introduced to tackle for the. Youve heard the thought. Kevin draskovic said North Carolina believes you need to teach kids how to tackle earlier to protect themselves at 14, 15 of 16. I mightve heard that once or twice. Kevin as Department Chair where we are adjunct professors, so ive heard that hes a respected colleague inquiry firm. I think in this one area we seriously disagree. Maybe theres one or two others, but i cite the following. If you look at some of the great individuals played in the National Football league, tom vries not a bad example. The guy that ran for 251 yards last week against oakland and other didnt play it down until they got to high school. Lets forget about them. Lets look at Tony Gonzalez, the alltime leading type and still adding to his numbers he played basketball at my alma mater end up in new england are right guard for years with Stephen Mayle who didnt play for in high school and college, came out of college with an outstanding of the wrestling career. Not much future in olympic style wrestling. Theres another activity that doesnt cope with the same name, but this guy to have that could fill you in where you can make a buck. So she went to football and theres many tracks as it did play football in college like some not to go into the nfl and call each. If you got the elite genes in the work got sick, you can make it in whatever sport you dont have to pick it up at a very early age. Youre going to be better at age five or 10 or 12 if you do. When your age 20 and will be what god gave you and which are willing to do for yourself that determines where you will find out. I dont play for second inning to teach the skill set at an early age to necessarily perform at a high level in your 20s for the reduce or even in high school. I dont think you necessarily need to stop them from learning skills if you go to flag football because flight football you will pull a flag to bring them down in tackling, but you can still teach all these skills. You can still teach tackling skills without having tackle be a part of the play. Instead of bashing heads you are hitting dummies, tackling dummies. The winningest football coach in this country, Tom Gagliardi known as 80s doesnt doesnt have any tackling once the season starts in his teams have won and his teams have embraced it. The only tackling that goes on as an gameplay. But they practice all week long. They just dont bring them to the ground. We talked about the importance of getting kids active. As a football one the sport but is actually accessible to kids over beasts are overweight . Theres no room on the soccer team or in any of these speeds, but in foot tall as a place. You eliminate the opportunity to give those kids physically to be opportunities. Lactam is checked, and site did have tackles and guards in different positions and i dont see flag eliminating those individuals from playing. Yes, they dont have as much as an advantage, but i think they can play flag football and get the aerobic benefits plan as a youngster i really did feel theres a lot of aerobic stuff that goes on. I dont want to see less of it. One governing body that is new to misdirection is is hockey. They have been body checking. Theyve also gotten rid of championships. There was a lot of angst when they were having this discussion about whether to push body checking off. What do you think of their reforms, how they work out. What if we learned . Two years ago when we started writing, it was 11 years of age full body checking started as you just indicated and over the course of the last two years, theyve upped it to 13. So the 13, 14yearolds are the minimum age that they start with full body checking. I came out and was facilitated by several reports out of canada that showed the incidence of concussion was dramatically higher when there is full body checking. So it was really good stuff that made it easier and i commend him greatly. I am not hung up whether its 14 or 15. Waitress relatively immature, move it up to 15 before you Start Coalition activities if you want. The reason that arbitrarily pick 14 is simply you want to learn at some point all of the skills and play sports similar as played in college. We will have that debate later and i look forward to it. How do you feel about some of the reforms that other organizations have adopted such as limits on practice time during the course of the week. Getting rid of certain bull in the ring type of drills . Well, i certainly commend all of those reforms. Acting role in the ring is insane at any age and doesnt help you play the sport any better. But lets think about it a little bit. Reducing the hitting by one third, and i support that. But that is up to 40 minutes a day, theoretically every day they practice, the ivy league a couple years ago went to hit two days a week in the National Football league and the Players Association now dont even have once a week. 14 times in 18 weeks. So these kids who have no medical personnel on the sideline, players sport than the late 1900 was designed for adults that came out of college and almost died in college if it werent for teddy roosevelt. The sport of his made for adults is being played at the youth level without medical personnel in attendance and are practicing every arguably 500 greater than the nfl uses. Affixed to open up the conversation a little bit. If you want to make a comment, ask a question. Go ahead and push your name tag up. The executive director of the u. S. A. Folk all. Talk to us a little bit about what you say football is doing in this area. Before that come address the general question. Is football serving the best interests of children in communities and how can it be improved . It is certainly striving for parents and kids. We all recognize this challenge is. We are at a point where we are learning. First i should think dr. Cantu for raising this important issues. I believe we are all in this together. Were all looking ways to create a better for players. I hope we are and that is to provide accurate and whenever possible evidencebased data for appearance. We have to be careful certainly not to scare parents. My interaction with parents across the country as they are looking for frankly someone to say we care about your kids. We were taking action. We recognize challenges and were doing something about it. So virtually theres two sides as best as i can tell. Theres a sports site in the football side and of course the science side. I will let the medical experts talk about the science side. Certainly zurich and others have been working closely for some time. U. S. A. Football have 3 million kids to play tackle football. Roughly twopoint play flag. It is a great outfit, a great option. In fact we suggest the experience should be flag no matter what age. In addition, we work with pop warner to make them better and safer. If that includes things that really nationally accredited program, using practice plans. Most coaches doug is practice plans come as you make sure you have an organized structure prior to his to make sure we have volunteers to come the commissioners, coaches out there putting their time. We need to educate them. Certainly every medical expert, every expert on this issue comes back to education being the most critical. U. S. A. Footballs focus is largely about education. We provide the best resources we can to make sure those folks are prepared. Literally down to drills that have 3d animations. You can literally be in the palm of your best techniques, nutrition information. Things like this are resources that ultimately folks to ultimately deliver a safer experience. With that said, we fully agree we need to how practices. Its actually started up a conversation a couple years ago akin to our our office and talk about the concept. It came up with something called levels of contact. The basic premise is there is a progression in track this. Start with error. The new transition 75 speed and may be the last 20 minutes your blood contact. So its things like that that is an agebased teaching concept. We set it about this cognitively, emotionally, physically. But in an eight under, 12 and under, how do we develop these folks . Parents of a 17yearold daughter and 16yearold son is football. To see development of an 8yearold or a 10yearold is dramatic. Emotionally, physically, cognitively, all of these things weigh in on how we ultimately produce resources that make the game safer. So those kinds of things seemed to me a logical step, maybe an interim step, a logical step in lieu of evidencebased right now that suggest we should effectively had 3 million kids stop playing football. Why not just adopt dr. Cantu suggestion of flag only before 14 . What is the argument about that . We support flag. If im not mistaken the arthur organizations work as well. The flag only is what you suggest . Yeah, from our standpoint, interacting with tears, talking to coaches are folks that love this game. Just help us understand how to play it more safely. So i guess in shortages to see that leap just yet, but that needs to be we need to take such a dramatic leap. Again, there is room to Work Together with the science experts and medical experts to create programs and resources and probably stronger standards that ultimately it didnt make this a better safer again. Dr. Cantu. Yeah, i would like to thank scott very much, too. It mostl