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Monday’s ABC Four Corners episode looked at the life and death of Nick Lowden, who at 23 was the youngest footballer to be diagnosed with chronic traumatic encephalopathy (CTE). CTE affects participants in collision and combat sports – having been first identified in boxers nearly a century ago – as well as soldiers and domestic violence victims. “Why am I like this?” Lowden asked his mother. “What’s wrong with me? What’s wrong with my brain?”

The worst of these stories end up in the flat, neutral tone of coroner’s reports. In 408 subheadings, John Cain’s inquest into the death of Shane Tuck documented what CTE does to the brain, the lives of athletes and their loved ones. The Tuck and Lowden families spoke of young men who didn’t understand what was happening to them, who drew on their athlete’s instinct to fight, and who eventually retreated. Nothing I have read about a footballer has been so crushing as Cain’s detached description of the final 24 hours of Tuck’s life.

These stories are almost always about professional or semi-professional players. What’s harder to gauge, and harder to mitigate, is the impact at the grassroots level. Lowden was no park footballer. It was in the best junior feeder competition in Australia, the under-18 TAC Cup, that he first suffered a serious concussion. He won a premiership in the strong SANFL competition, but there are dozens of tiers below that. As the standard drops, so too does the quality of grounds and umpiring, and the ability to access medical help. Many country clubs are operating on an increasingly thin line. Ask anyone running a club in the suburbs or the bush and they’ll tell you there’s a growing disconnect with the AFL.

It’s something Peter Hanlon covered in a feature series for the Age on the 40th anniversary of a notorious country grand final between Colac-Coragulac and South Warrnambool. Hanlon described the game as “outrageously violent” and interviewed men who’ve battled a raft of mental health challenges in the ensuing decades, as well as their increasingly concerned families. “For every Danny Frawley and Polly Farmer,” he writes, “there are thousands who endured multiple concussions in the suburbs and the bush who are pondering a frightening thought – what if that’s me?”

The questions posed by Four Corners are the same questions that grieving parents, coroners, litigants and broken men in their 40s and 50s are asking: what is the governing body’s level of responsibility and culpability? Is the AFL responsible for the entire junior, suburban and country footballing ecosystem? Is it responsible for incidents from 40 years ago? Is it responsible for educating every parent about head trauma?

What’s beyond dispute is that the AFL has been too slow to act on the dangers of CTE. For nearly a decade, their concussion guidelines were shaped by Dr Paul McCrory, who in 2016 dismissed “the carry on and hoo-ha” around CTE. Before being exposed as a plagiarist, he led a multimillion-dollar AFL study into concussion that was criticised for “a lack of governance, stewardship and coordination”. On Four Corners, the AFL’s general manager of health and football operations, Laura Kane, said the league still didn’t have a CTE policy, but claimed it was committed to research in the area. Many of Cain’s coronial recommendations were “on track”, she said, adding that “repeated head trauma is extremely undesirable”.

They were the well-thumbed words of a league all too aware that lawyers are circling, and words that should have been spoken by CEO Andrew Dillon. The words were inadequate not only on a human level, but in addressing the wider existential threat the sport must confront. While concussions can have serious and ongoing consequences, it’s the accumulation of microscopic damage to the brain from bumps and tackles that leads to CTE. Lowden, who started playing at six years old, could have had CTE even if he had never experienced a concussion.

The neuropathologist Michael Buckland calls CTE a “disease of exposure”. The way we’re going to prevent it, he told Four Corners, “is by reducing exposure, just like skin cancer and the summer sun”. That means significantly reducing contact training hours. It means increasing the age at which young players are allowed to tackle, which is sure to meet considerable resistance. Boston University’s Ann McKee, a world-leading expert in CTE, wants to ban tackling until adulthood. A lot of neurologists disagree on this. But most concur that the key is to start contact sport at a later age, and that having fewer and shorter matches at the senior level is essential. The latter two in particular are at odds with the AFL’s commercial imperatives.

So much of the AFL’s focus has been on head injuries at the elite level of the game. But nearly three-quarters of a million people play some sort of version of Australian rules football – from Auskick to the thousands of junior and senior clubs across the country. Kane said: “Our job is not to communicate every single aspect of risk that exists in our game.” And she’s right. But a 23-year-old with CTE violently shifts the parameters and the risk profile. We’re no longer talking about 60-year-old former champions at risk of developing dementia. We’re no longer talking about tinkering with the rules at the professional level. We’re talking about whether this sport is inherently unsafe for all who play it. It’s a question a lot of parents are asking right now. It’s a question many former players are asking. It’s a question the AFL failed to answer properly on Four Corners. And it’s a question they soon may have to answer in a courtroom.