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Emergency Medicine News:
doi: 10.1097/01.EEM.0000419258.88947.51
Screened & Examined

Screened & Examined: Rugby Nation

Ballard, Dustin MD

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Author Information

Dr. Ballard is an associate emergency physician at Kaiser-Permanente in San Rafael, CA, and the chair of the CREST ED Research Network. His writing credits include co-authorship with Angela Ballard of the award-winning travel narrative A Blistered Kind of Love: One Couple's Trial by Trail (Mountaineers Books, 2003) and authorship of The Bullet's Yaw (IUniverse, 2007). Dr. Ballard writes a biweekly-medical column for the Marin Independent Journal, which he posts on his blog: http://incisionanddrainage.blogspot.com. He is currently working at Starship Children's Hospital in Auckland, New Zealand.

Here in New Zealand, I often reflect on October 2010. Those from Northern California will surely recall that month. The fall colors were black and orange, and the season was flush with fearful beards and late-inning “torture.” The cauldron of Giants baseball fever hovered between bubble and froth during those pennant-winning weeks, and our community had cohesion of purpose I hadn't seen before.

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So why is it that half a world away (where virtually no one knows the difference between a slider and a curveball) I'm consistently reminded of the 2010 World Champs? Well, it's because the fervor of fall '10 is replicated daily in New Zealand but for a much different sport: rugby.

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New Zealand has been a rugby nation since shortly after its incorporation into the British Empire in the early 19th century. The British, you see, were intent on avoiding the opulent mentality that plagued prior empires, and so chose a formidable and stoic sport to promote throughout their colonies. I don't know how successful this tactic was elsewhere, but in New Zealand the game — and its paradigm — took root.

Rugby “shapes New Zealand social history and everyday life,” according to Dr. Robin McConnell in his profile Inside the All Blacks. Case in point: It's been seven months since the New Zealand national team won the Rugby World Cup on home turf, yet the All Blacks remain ubiquitous. Flags, some homemade, ripple from car antennas and balconies, babies don All Black onesies, and bottles of the nation's top selling beer (Steinlager) declare, “All Blacks…25 Years of Unconditional Support.”

Weekend afternoons bring rugby pitches covered with brightly uniformed youngsters, some of them so small that the size of the ball dwarfs their head. Locals are already fretting about the next round of international play, a series of test matches against Ireland. If you are looking for front-page news, any snippet about a present or former All Blacks player will do. Did you know that the legendary Michael Jones is helping to bring a Carl's Jr. franchise to New Zealand?

The All Blacks are a national team and rugby a national sport in New Zealand; we really have nothing comparable in the United States, especially in terms of unity and loyalty. Given size and diversity differences between the two countries, this may not seem a fair comparison, but it nonetheless raises the question of whether this shared passion for and culture of rugby pervades Kiwi life beyond the pitch? And in particular, does it help make Kiwis happier and healthier?

Ask my wife: rugby is a sport played by short men wearing too-short shorts around gigantic thighs. Others define it by discipline, masculinity, and stoicism. It is the type of sport in which a player (true story) might insist on playing most of a match with one testicle hanging torn from his scrotum. Stories like this are common, and lead one to believe that the stoicism of Kiwis is unparalleled, an observation that finds some support in studies on pain tolerance. (J Occup Rehabil 2011;21[3]:395.)

It could be that rugby plays a role in the Kiwi approach to death and dying, one that, anecdotally at least, is more cognizant of the “good death” and more accepting of futility than that of many other countries. And the national morale is clearly boosted by a shared enthusiasm over rugby. This fits under the umbrella of social identity theory, which posits numerous cognitive and physiologic effects of “in-group” behavior.

Indeed, ask psychologist Jonathan Haidt, the author of The Righteous Mind, and he will tell you Kiwi rugby culture represents a classic case of the power of shared identity. “People who worship the same idol,” Mr. Haidt wrote in a March 17, 2012, New York Times editorial “can trust one another, work as a team, and prevail over less cohesive groups.” (http://nyti.ms/MnV98m.) The sport has served as a vehicle for cohesion-driven success in many, many circumstances across the globe. If in doubt, check out The 16th Man, a documentary about the 1995 Rugby World Cup in South Africa.

The All Blacks are intimidating when take the field. Fifteen men, dressed in the black that they have worn for more than a century, representing New Zealand's South Pacific roots — Pakeha (European New Zealanders) standing alongside native Maori and Pacific men who have immigrated here in large numbers over the years. Most are 6 feet tall or more, some are 250 pounds, but they are not quite the short men my wife has in mind, though they definitely have the gigantic thighs. And then the real intimidation begins.

As the game is about to start, the team in black stares down their opposition. Their leader starts to chant. This isn't the national anthem; that has been and gone. This is the Haka, a traditional Maori war dance. The challenge is set, and as Richie McCaw, the current All Black captain, simply states, the Haka is “integral to New Zealand culture.”

Some argue that such collective benefits of the sport of rugby are greatly overwhelmed by its other culture of rowdiness, drunkenness, and intolerance. Some Kiwis live for rugby, but others detest it. One blogger, in a piece entitled “NZ Rugby Morally Bereft,” writes that rugby “promotes [machismo], alcoholism, violence, sexism, and colonialism. Rugby has also created a crippling crisis in our health sector.” Certainly the first statement has some truth to it; the only rugby match I attended hosted a highly intoxicated crowd, and I won't even attempt to describe the experience of visiting a stadium urinal. Rugby injuries are common, but I can't believe they are a crippling crisis. Rugby may have a higher injury rate than many other sports, and concussions (especially under-reported concussions) are of particular concern, but the rates of devastating injuries such as spinal cord injury are actually not that high. A review of nationwide injury claims related to rugby from 1999 to 2007 found an average of 743 a year, most of them limb and soft-tissue injuries, with a rather modest (given the nature of health expenses) yearly cost of $5.3 million.

One of the few academics who has closely studied and written about the cultural and societal effects of Kiwi rugby is Brendan Hokowhitu, PhD, an associate professor of Maori, Pacific, and Indigenous Studies at the University of Otago. He shares a rather bleak assessment of the health effects of the sport. “I wouldn't say there is anything historically at least positive about New Zealand rugby culture and health,” he wrote. “Rugby was very much part of the establishment, and was as such quite oppressive of women and alterity [cultural freedom] in general.”

So the All Blacks culture does have a dark side, but the cohesiveness of the culture certainly has positive effects on national identity and group mentality. New Zealanders consistently score highly in international surveys of happiness. A nationwide survey of 8,000 Kiwis found very high levels of people feeling like they “belong to New Zealand.” Another survey of about 6,000 people conducted by psychologist Marc Wilson of Victoria University in Wellington found that Kiwi respondents with stronger identification to rugby reported being happier, more optimistic, and having higher self-esteem.

The beneficial effects of happiness on health are obvious and well documented, and should not be underestimated. I wonder if the rugby in rugby culture could be replaced with a group activity with fewer downsides? Could a less dangerous and less rambunctious diversion replace it? Golf is popular here so perhaps the All Greens might substitute. When it comes to group identity, however, such a change is much easier to talk about than to make. It's a bit like asking a Giants fan to root for the Dodgers.

© 2012 Lippincott Williams & Wilkins, Inc.

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