NFL Pledges to Stop Anti-Black Practices In Deciding Brain Injury Claims

In early June, the National Football League (NFL) pledged to repeal its practice of "race-norming." Going forward, brain injury claims from Black players will be reviewed using the same standards as those from white players.

The pledge comes after two retired Black NFL football players filed a civil rights lawsuit in August 2020 after being denied monetary compensation for brain injuries.

The NFL has been compensating players for brain injuries related to the game since a landmark 2013 case, after officially acknowledging the link between professional football and brain health.

What Is Race-Norming?

Race-norming began more than 40 years ago as a way to account for systemic inequities linked to race. However, the lawsuit argued that the NFL has used race-norming to make it harder for Black players to qualify for monetary compensation.

The plaintiffs say that the NFL falsely assumes that Black players have "lower cognitive function," and therefore do not have to compensate them for brain injury claims as they would white players.

"It was a relief to learn that the NFL has pledged to take action on changing these unjust practices in their evaluations," Elena Tsoy, PhD, a postdoctoral fellow in neuropsychology at the University of California, San Francisco, tells Verywell. "I hope that they will involve experts in cognitive and behavioral sciences to develop a more patient-centered approach to clinical evaluations, and follow through with their stated goals of eliminating bias in the administration of the settlement funds."

How Race-Norming Is Used

According to an op-ed in The Guardian by Kenan Malik (a writer trained in neurobiology), race-norming "is bigotry that began with good intentions." Although it was first implemented in the U.S. as an anti-racist measure, Malik argues that the practice has not lived up to its intentions in the football arena in the 40 years since.

Malik writes that the idea was to adjust scores when results showed a racial divide. For example, on tests where white students did significantly better, Black students' scores would be weighed in proportion.

The practice was thought to account for systemic inequities and legacies of slavery and racism that cause Black people to be poorer, less educated, and exposed to more violence than white people.

Race-Norming In Medicine

Tsoy says that race-norming is also practiced in medicine when medical test scores are adjusted based on a patient’s race.

There are several known links between ethnicity, race, and a person's risk for specific health conditions. For example, Tay-Sachs disease is more common in people of Ashkenazi Jewish or French Canadian ancestry, and sickle cell anemia is more common in people of African heritage.

The risks are the product of genetic predispositions that developed in certain geographic areas, which can be passed down for generations. When screening and treating patients for these conditions, doctors consider race and ethnicity.

Neuropsychology and Race-Norming

In neuropsychology, race-norming developed to prevent over-diagnosis of cognitive impairment in non-white older adults. Tsoy says that "Race was used as a proxy of social factors that were not historically captured in research, such as poverty and discrimination."

Instead of immediately attributing symptoms to brain disease, neuropsychologists considered systemic inequities by recognizing that poverty and discrimination have health consequences.

Tsoy says that the NFL included race-norming as a part of their original evaluation protocol. To begin with, Black players were assumed to have lower cognitive ability than white players, which meant that Black players needed to score significantly lower on cognitive tests than white people to meet the criteria for cognitive impairment.

It was those scores, in turn, that would qualify them for monetary compensation.

"The NFL case illustrates the harms that result from using these corrections as part of a formulaic diagnosis with individual patients," says Tsoy. "Furthermore, the continued use of race norms for cognitive testing reinforces the false idea that there are genetic differences in cognition by race."

What Happens Now?

Since its creation in 1920, the NFL has denied the impact of football on brain health. It wasn't until 2009 that the league officially acknowledged the link.

In 2013, the league was pushed further. In addition to having to verbally acknowledge the risks to the brain that the sport poses, the NFL also had to start taking responsibility monetarily by paying retired players who had sustained brain injuries.

Moving forward, the NFL will face even more scrutiny in how it evaluates brain injury claims. In addition to the two plaintiffs who filed the lawsuit—Kevin Henry and Najeh Davenport—medical experts have brought attention to the case by publicly expressing concerns about the NFL's race-norming practices.

Tsoy was one of them. "This change will mean that both Black and White players will have the same standard for award eligibility," says Tsoy, "And likely more Black players will qualify for an award under the Settlement Agreement."