HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Monday, June 23, 2014

Guest Blogger Associate Dean and Professor Alicia Ouellette with Coauthor Meredith Dedopoulos, 3L at Albany Law School- The World Cup and Health: If You Can’t Stand the Heat, Don’t Play in Manaus


More than a week into the 2014 World Cup, a Brazilian judge has issued an order requiring FIFA[1] to give players water breaks to protect their health.  Yet the judge’s ruling is unlikely to alleviate any of the health risks of playing in the scorching conditions of Brazil because in order for water breaks to be mandatory, the temperature must meet FIFA’s benchmark of 90 degrees Fahrenheit.  Since most of the games have been played in conditions just below this threshold, the players remain unprotected from heat-related conditions that threaten their health and their participation in the rest of the tournament.   

The heat and humidity in the Amazon city of Manaus, which will host four group stage games, have been particularly brutal.  Italian midfielder Claudio Marchisio described what it was like during the match between England and Italy: “At times it felt like having hallucinations due to the heat.”  The conditions were not unexpected.  Located in the Amazon jungle and accessible only by boat or plane, Manaus averages temperatures between 75 and 87 degrees Fahrenheit, with a similar percent humidity.  From the time it was announced as the host city for this match in December 2013, press coverage, especially in England, focused on the oppressive tropical climate and concerns about how the players would adapt. 

The tropical conditions of Manaus pose serious health risks, not just for players but for spectators as well.  Heat and humidity—and their effect on perspiration—can cause dehydration, decreased muscle and nerve functioning, and increased fatigue.  In extreme cases, heat exhaustion can lead to heat stroke, which can result in death.  Former Brazilian player Mirandha warned England’s players that it would be “difficult to breathe” there.  To prepare for these conditions, in the weeks leading up to kick-off, the England team trained in the warm climates of Portugal and Miami, wearing extra layers during practice to simulate what it would feel like in Manaus.  Both the England and the Italian teams exercised in heat-acclimatization chambers.  All of these efforts were designed to ready the players and their bodies for the climate that awaited in Manaus, which England coach Roy Hodgson admitted every team had wanted to avoid before the draw.

FIFA, the organization with the power to minimize the likelihood of heat-related health risks, exacerbated the problem by moving the England-Italy kick-off time to earlier in the day.  Originally, the match was scheduled for 9PM local time, which translated to 2AM in England and 3AM in Italy.  The day after the schedule was released, FIFA moved the time of the game up by three hours,[2] in response to lobbying by British and Italian television companies, who were worried about decreased viewership if the games were played in the early morning hours in those time zones.  Neither of the teams had a say in the decision, and England managing director Adrian Bevington acknowledged that playing at the later time would have been better because it would be cooler at night: “We can’t deny that it’s better to play in Manaus later in the day.”  In short, appeasing the concerns of the television broadcasters was more important than protecting the players from health problems. 

In the weeks leading up to the tournament, Brazil’s players’ union filed suit to force FIFA to be more responsive to these health concerns.  The union asked FIFA to change the starting times of 24 group stage matches that were scheduled to begin at 1PM local time, asserting that “players would be at risk because of intense heat and humidity in some venues.”  In addition, or in the alternative, the union pushed FIFA to institute mandatory two-minute water breaks during each half of the game.  In response, FIFA refused to comply with either of those requests, pointing out that it had already considered venue climates in making the tournament schedule[3] and insisting that water breaks would only be allowed on a game-by-game basis, depending on the temperature and humidity conditions before each match.  

Yesterday’s court order requires FIFA to comply with its announced protocol of allowing water breaks when temperatures reach a certain level, or else face a fine of $90,000 for non-compliance.  The order lacks any real force, however, because it leaves in place FIFA’s own standards for when water breaks are required.  The benchmark for mandatory cooling breaks is extremely high: the Wet Bulb Globe Temperature, which represents the effects of temperature, humidity, wind speed, and sunlight, must be above 90 degrees Fahrenheit.  FIFPro, the international players union, criticized that benchmark as too high: “There’s enough medical evidence to support it should be closer to 28 degrees (82 degrees F[ahrenheit]). . . .  FIFA’s heat policy simply does not pay enough attention to detail and it falls well short based on available medical data.”  Nevertheless, the Brazilian judge rejected the request to lower the benchmark temperature.  Accordingly, the court order is limited in that it merely provides a mechanism of enforcement if FIFA fails to comply with its own rule. 

The tensions between players’ representatives and the sport’s organizers over athletes’ health are similar to those playing out in the controversy over the NFL and concussion injuries.  Unlike American football, which can be regulated by state and federal action, there is no similar authority to enact health-related regulations for an international soccer tournament like the World Cup.  All of the power is concentrated in FIFA, an international non-profit, as the recently issued court order demonstrates.  FIFA’s record of using laws or regulations to improve health does not inspire much confidence.  For example, in the build-up to this summer’s World Cup, FIFA pressured Brazil to relax its ban on alcoholic beverages in stadiums so that one of the tournament’s sponsors, Budweiser, could have its product (beer) sold at the games.  FIFA pushed for this change despite knowing that the alcohol ban had been enacted to reduce violence at matches.  Again, fiscal concerns seemed to trump concerns about public health and safety. 

FIFA’s “cooling break” option, which was designed to appease concerns about the effect Brazil’s climate would have on player health, has turned out to be meaningless because no games have reached the threshold temperature of 90 degrees Fahrenheit.  Prior to the start of the England-Italy game, commentator Ian Darke noted that the temperature was 88 degrees Fahrenheit, with almost 70% humidity; at half-time, the temperature had dropped slightly to 81 degrees, but the humidity had risen to 74%.[4]  Yet these conditions did not rise to the level that would allow water breaks, so the players could only hydrate during stoppages in play for injuries and substitutions, in addition to half-time. 

While FIFA’s regulations did not deem the weather conditions hot enough to mandate cooling breaks, several players have suffered from cramping due to the heat, especially towards the end of the ninety-minute game.  Italy coach Cesare Prandelli lambasted the decision not to have cooling breaks: “It was ridiculous not to have timeouts.  We had to slow down our pace to regain our breaths. . . .  Thankfully the referee had the sensibility to interrupt the match every now and then.  But it’s just absurd.”  

As group stage play continues, the heat continues to affect player health.  Nine players—including three from the U.S. team—have already been sidelined with heat-related hamstring injuries.  As teams attempt to cope with a reduction in available players due to injuries in their squads—some of them tournament-ending—coaches will be even more apprehensive about the consequences of heat fatigue on niggling injuries and recovery time before the next game. This issue will be of particular importance for the U.S. team, which plays its next game in Manaus and could clinch a place in the knock-out round with a win against Portugal. 

How the teams cope with playing games in the stifling Brazilian heat could be considered a test run for the tournament in 2022, which is supposed to take place in Qatar, a country that makes Manaus feel like Alaska.  On the first day of the 2014 World Cup, it was 117 degrees Fahrenheit in Qatar, and the average temperature in the summer is 105 degrees.  Qatar’s climate was well-known when the country was chosen by FIFA as the host site in December 2010—in fact, FIFA’s own technical reports noted the “potential health risk” the climate posed for both players and spectators.  Nevertheless, Qatar was selected, a choice that FIFA President Sepp Blatter recently admitted was a “mistake.”  

Whether the tournament will actually take place in Qatar is still up in the air.  After concluding that a summer tournament would not be sustainable in the scorching temperatures of the Middle Eastern country, FIFA representatives began advancing the idea that a winter tournament was the only option.  This change would wreak havoc with the domestic club teams’ seasons, which take place from August until May, and it could also interfere with the Winter Olympics, which are scheduled to take place in early 2022.  After an overwhelmingly negative response to the suggestion that the tournament be moved to the winter, FIFA backtracked and announced that no decision will be made until 2015. 

The dangers posed to players and fans by scorching conditions make the decision to stage the tournament in Qatar something of a mystery, and give rise to suspicions that bribery played a part in the decision, an allegation that has often dogged FIFA.[5]    Recently, new allegations of bribery in the tournament bidding process have come to light, leading to calls for the 2022 World Cup host site to be changed.   If, as suspected, financial motives played an improper role in the decision to award the 2022 World Cup to Qatar, this would be another in a long line of troubling examples of how members of the governing body of the world’s most popular sport give more weight to finances than to the health and welfare of the game’s players and fans.  

The complaint that individuals in positions of power are not looking out for the well-being of their constituents has become the centralizing theme of the ongoing protests in Brazil.  Beginning last summer during the Confederations Cup,[6] Brazilians took to the streets to protest what they saw as an imbalance in public spending.  In other words, the government was spending too much on preparations for the World Cup—more than $11 billion— and not enough on improving the quality of life of Brazilians.  The demonstrations initially began as a protest over an increase in bus fare, yet quickly morphed into a broader demand for investment in public services such as education, transportation, and health care, with more than one million people taking to the streets to voice their dissatisfaction.  The Brazilian government reduced the bus fare to its original price, but the desire for societal improvement did not abate.  On the eve of the World Cup this summer, the protests from the previous summer resumed, but in much smaller numbers, and they have continued to take place each day of the tournament. 

Perhaps the lesson in all of this is that power concentrated in the hands of the few is often detrimental to the many.  Those who make decisions that affect the health and well-being of broader society—of the every-man—are too often motivated by greed and power.  In this way, the concerns about the climate and conditions in Manaus are representative of a greater struggle in the soccer world—and in society in general—between those who play the sport and those who control its administration. 

Or maybe it’s all just a game. 


-Associate Dean and Professor Alicia Ouellette with Coauthor Meredith Dedopoulos, 3L at Albany Law School

[1] The Fédération Internationale de Football Association, commonly known as FIFA, is the international governing body of soccer.

[2] FIFA also adjusted the times of six other games.

[3] In support of this claim, FIFA pointed out that the host cities with the three hottest climates—Manaus, Cuiabá, and Fortaleza—did not have any games scheduled for 1PM local time during the group stage.

[4] 2014 FIFA World Cup Brazil: England vs. Italy (ESPN television broadcast June 14, 2014).

[5] As comedian John Oliver put it, “I hope [the allegations of bribery are] true, because otherwise, it makes literally no sense.”

[6] The Confederations Cup is an eight-team tournament held in the host country of the World Cup during the summer of the year preceding the actual World Cup.  It is considered a kind of “dry run” for the World Cup the following year.  In June 2013, the Confederations Cup was held in Brazil.

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