On soccer, the World Cup, and the water we swim in

A Goldfish extra, reflecting on the role of opportunity in soccer and health

This piece was co-authored by Mohammed Abba-Aji, and also appears here, on his new Substack.

I have quite been enjoying watching the men’s soccer world cup the past few weeks. The FIFA World Cup, perhaps the most prominent worldwide sporting event has not disappointed—it has had great games, some sublime individual performances, and more impressively excellent teams. One of the central stories of this World Cup has been, of course, the USMNT crashing out to Belgium in a performance as uninspired as the start to their campaign was inspired. This has occasioned substantial reflection, with blame apportioned—depending in my estimation on the apportioner’s biases—on the coach, the federation, the players, the referee. Just about anyone but the structural forces that really bring about such outcomes.

I have previously written on the history of the game and the way small perturbations shape complex systems. I return to it now because it has been hard to avoid as one has watched and reflected on this year’s World Cup. In the US context, how could a country as large, wealthy, and athletically engaged underperform as it does in soccer? American athletes lead the world in basketball, in track and field, in swimming, in gymnastics. But not in soccer, the most widely played game on earth. In this sport, the US remains an also-ran, as we were painfully reminded during this World Cup.

The explanation that usually follows is that soccer arrived late here and that the game needs another generation or two to bear fruit. While this explanation is comforting and assuring, it is only partly true. Consider for example, Japan, a country that did not professionalize its domestic league until 1993. Japan now qualifies for every World Cup and regularly advances. Or Croatia, a nation of under four million people, which reached a final and a semifinal in successive tournaments. Or Morocco with a fraction of America’s resources, which reached the quarter finals of the World Cup and the semifinal in 2022 (and played impressively at this World Cup). Clearly a country’s wealth, its footballing heritage, and its population size matter. But neither are enough to explain its success or failure in soccer. So, what, then, is at work in ours?

The fundamental explanation that I have found most compelling is this. The US, while a large country, is drawing on soccer talent in its formative youth leagues, in what is often referred to as a pay-to-play model. These youth leagues are accessible and affordable to only a small proportion of the US population. Youth, particularly from lower income households find it difficult to engage in the sport at a meaningful level at a young age. Parent surveys show that families earning under $50,000 spend about $890 a year on a child’s primary sport. Families earning over $150,000 spend more than twice that amount—$2,361. Similarly, the elite youth soccer pathways, the leagues from which national team players are drawn, cost far more. This could run anywhere between $8,000 to $15,000 per child per year once travel, coaching, and club fees are counted. Further compounding this gap is the accessibility to such resources. ZIP codes that host America’s elite development clubs have median household incomes more than $30,000 above the national median.

There is no reason to believe that rare ability (or, if we prefer, “talent”) is not distributed across a population. And through a system that restricts who may participate, the US is losing a substantial proportion of its population where talent be found. The sports America dominates recruit through public schools, which cost families little and therefore sample the entire population. A gifted athlete in any county in the US will, sooner or later, run in front of a coach. This was how one of the most accomplished Olympians of this generation, Simone Biles, was discovered during a local daycare field trip to a gymnasium. Soccer, recruiting through private clubs, prices out most of the population before any coach has a chance to look. A country selecting its players from the top income quintile will lose to countries selecting from everyone, however large or rich it may be. The results of the past week are what sampling bias looks like on a scoreboard.

A counterexample for this can be found in how France has instituted systems that facilitate access to infrastructure and participation regardless of a child’s household income. The resulting abundance of soccer talent in France is such that 99 players in this World Cup were born and trained in France. Of these, 23 play for the French team; the remaining 76 play for other countries.

What relevance then if any does this bear to health? The mechanisms on display in the soccer pipeline, opportunity tied to the ability to pay, bear a striking resemblance to the mechanisms that produces health differences across the population. A young soccer player who, because of the resources available to them will have the opportunity to be seen by a top scout who is seeking talent across the country can get to tryouts and eventually play with a professional team, maybe even make it to the World Cup. Similarly, is the resources that shape the world around us—stable housing, sustainable income, safe neighborhoods, supportive social networks—create the opportunities for us to be healthy, or not. A child whose asthma or failing eyesight is caught early because a school nurse of a well-resourced clinic was there to catch it stands a chance to grow up healthy and live to meet their potential. Potential—be it in soccer ability, or in health that precedes everything else—is developed only where opportunity reaches.

In health as in soccer, opportunity is closely tied to resources. The inputs that generate health along the life course, nutritious food, safe neighborhoods, stable housing, good schools, timely medical care, are allocated in this country substantially by ability to pay. There is therefore no mystery as to why health tracks income and wealth with such remarkable fidelity. We price the conditions of flourishing, and the outcomes follow the prices.

And it is then not surprising that as resource inequality in the US has climbed over the past four decades, the participation gap in youth sports has widened, as has the gap in health indicators between haves and have nots. Since, 2012 the participation gap between children from the poorest and wealthiest households has widened from 13.6 to 20.2 percentage points. Similarly, the richest 1 percent of Americans now live 10 to 15 years longer than the poorest 1 percent. These both reflect the same phenomenon, an uncomfortable reminder that a child priced out of play at eight is measurably more likely to be priced out of health at fifty.

In my 2021 Goldfish post on soccer I talked about another theme that influences both soccer and health that stands true to this day. Complex systems amplify small structural choices into large divergent outcomes. American youth soccer was organized, decades ago, around a private club as opposed to the public school system. This design choice has compounded through every generation of children since. This shapes who plays, who is seen, who develops, and who stands on the field in a World Cup. Similar design choices are embedded in our health systems, in how we finance care, zone neighborhoods, fund schools, and price food—the fundamental work of public health. The impact of these design choices compounds the same way, through generations. Only in this case, quietly, until they surface as a life expectancy gap.

Health has no quadrennial global reckoning. Its results accumulate slowly and privately, in clinics, streets, homes, and schools making them easy to attribute to chance or choice. And so, the conditions producing health continue to go unremarked for generations. Perhaps, while the sporting version of the lesson is fresh in our minds, the question the opportunity gap poses, “who never gets the chance to thrive and flourish?” is worth re-asking and resurfacing. This is the same question our health data have been asking for decades. Who never got the opportunity to engage the conditions that produce long, healthy lives? A country this wealthy can choose systems that engage everyone, in play and in health alike. The return on that choice would appear where it matters more, in years of healthy life, distributed as talent always was, everywhere.