The health and welfare of retired athletes is a complex and often overlooked issue. While the focus is often on the immediate physical and mental challenges of retirement, the long-term health impacts of a professional sporting career are a growing concern. The case of Sonny Bill Williams, a retired All Black and professional boxer, highlights the issue of who bears the cost of these health consequences. In this article, I will explore the broader implications of this question and offer my own perspective on the matter.
The Health Cost of Playing Rugby
The discussion around the long-term welfare of athletes often centers on concussion, and rightly so. However, the impact of repeated head impacts is just one part of a larger picture. Retired athletes can suffer from a range of health issues, including osteoarthritis, chronic pain, reduced mobility, hip replacements, back pain, mental health challenges, and the loss of identity that can follow a career in elite sport. Research suggests that these problems are not isolated, with former rugby players reporting more serious injuries, higher rates of osteoarthritis, and higher levels of hazardous alcohol use than former non-contact sport players.
International research supports this finding. A scoping review found that retired male elite rugby players had a higher prevalence of osteoarthritis, mild cognitive disorders, depression, and hazardous alcohol use than control groups. A 2025 study also found that each previous shoulder or knee surgery was associated with roughly double the odds of osteoarthritis in that joint later in life. These findings raise important questions about the long-term health impacts of professional sport and the responsibilities of sports organizations and governing bodies.
Mental Adjustments to Sports Retirement
The psychological side of retirement is another critical aspect of this issue. Professional athletes can lose structure, status, income, and a sense of belonging and identity after retirement. A recent study of retired elite rugby players found that athletic identity and psychological flexibility were linked to wellbeing after retirement. This highlights the need for comprehensive support systems to help athletes navigate the transition to retirement and manage the mental health challenges that can arise.
New Zealand is making progress in this area, with professional players becoming life members of the Rugby Players Association and accessing support during their careers and in long-term retirement. Services include mental wellbeing, career advice, financial education, retirement services, and professional networks. However, gaps remain in the current system to help players living with osteoarthritis, chronic pain, repeated surgeries, and mental health challenges that may appear years after a contract ends.
Getting Cover for Gradual Conditions
The Accident Compensation Corporation (ACC) plays a major role in New Zealand's sport injury system, covering accident-related injuries and providing treatment, rehabilitation, and financial support. However, ACC does not cover everything, and gradual conditions can be more difficult to get cover if they are treated as age-related, degenerative, pre-existing, or not clearly linked to a covered injury. Private health insurance is not always a fallback, with pre-existing conditions commonly excluded unless cover is specifically agreed. Some policies never cover pre-existing hip, knee, or back issues, nor reconstructive or reparative surgery.
This creates a grey zone, where retired players may have pain and need surgery or joint replacements connected to years of professional sport, but these may not fit ACC requirements, private insurance, or player-welfare systems. A recent article develops an ethical framework for asking when, if ever, society is justified in tolerating foreseeable sport-related harm because sport is considered to be in the 'public interest'. This does not mean athletes should simply put up with the harm, but rather it asks what responsibilities sport has if it relies on public-interest arguments to accept risks that would be unacceptable in other settings, especially when those risks are known and can affect players long after retirement.
The Question of Long-Term Player Welfare
The question is not simply whether rugby can ever be safe; collision sports will always involve risk. A better question asks what long-term player welfare should look like when some risks are foreseeable, repeated, and increasingly well-documented. This might mean stronger transition planning, long-term health monitoring, clearer medical support, or case management to help retired players navigate ACC, insurance, and public health systems. Rugby does not need to be risk-free to be ethical, but if the game continues to provide entertainment that generates revenue and national pride, it is reasonable to ask what responsibilities remain when the playing days are over.
For some athletes, the bill arrives long after retirement. The ongoing costs of professional sport should be shared, and the question of who bears the cost of these health consequences is a complex and important one. As the sport continues to evolve and adapt, it is crucial to consider the long-term welfare of athletes and ensure that they receive the support and care they need.
