Five Lessons from the Super Bowl for Improving Population Health

By Judith Monroe
March 11, 2014 | Discussion Paper


In a presentation to the Institute of Medicine Roundtable on Population Health Improvement, Nancy O. Andrews, President and CEO of the Low Income Investment Fund (LIIF), talked about the concept of quarterbacks for healthy communities, which was introduced in LIIF’s and the Federal Reserve Bank of San Francisco’s Investing in What Works for America’s Communities (Andrews and Erickson, 2012).

While listening to Nancy discuss quarterbacks, I couldn’t help but flash back to the Super Bowl and the emotion I felt during the game. I am a fan of football, but I am a huge fan of Peyton Manning, having lived in Indiana during his many seasons with the Colts. In fact, Peyton is the reason I even started watching football. Of course, I was disappointed when the Denver Broncos lost this year’s Super Bowl, but, as Peyton said, the game will serve as motivation to “to fuel us this off-season into the next.” As much as I admire Peyton’s amazing mental and physical skills as quarterback on the field, I am an even greater fan of how he translates his role as quarterback to his work off the field.

Peyton and his wife Ashley established the PeyBack Foundation in 1999 to promote the future success of disadvantaged youth, and the Peyton Manning Children’s Hospital at St. Vincent opened its doors in Indianapolis in 2003. Six years later, Project 18 (Peyton’s jersey number is 18) was created to tackle childhood obesity, and Peyton was there front-and-center as an exemplar role model for children and their parents (Peyback Foundation, 2014). I was privileged to be on Peyton’s team and support Project 18 in my role as the state health commissioner.

I am excited by the concept of having a “quarterback” in every community to improve population health. Community quarterbacks do not need to have the stature or resources of a Peyton Manning, but I believe that this idea is a great analogy for how we can mobilize improvement of population health. Quarterbacks for healthy communities and their team members would be well-served to take away the following five lessons from the Super Bowl.


1. Fundamentals

In football, to achieve the collective goal of making it to the end zone to score the most points, mastering the fundamentals is the key to success. Speed, tackling, blocking, passing, and receiving all help pave the way to the ultimate football achievement: The Super Bowl. The National Football League (NFL) selects 26 players each year to be on the USA Football AllFundamentals Team, and five 5 of those players selected this year played in the  Super Bowl, including Peyton Manning (Frolo, 2014). The quarterback coordinates the multiple plays of his team to have a successful game. These players are honored for exhibiting the offensive and defensive techniques that promote the standards of USA Football, a sponsor of the Centers for Disease Control and Prevention’s Heads Up Football Program, which aims to make the sport better and safer.

As every player on a football team must master the fundamentals to be successful, everyone on the community team must learn and understand the fundamentals for population health, also known as the determinants of health: medical care, public health, genetics, behaviors, social factors, and environmental factors. The social factors, or social determinants of health, have garnered critical attention in recent decades, such as early childhood development programs, education, literacy, housing, adequate income, and safe neighborhoods. For example, public health attention on housing can be traced back to 1890s-era slums, notorious for overcrowding and unsanitary conditions, but ultimately cleared through public health initiatives. Currently, there is renewed attention to connecting community development efforts to public health metrics to address contemporary threats to health.


2. Team Effort

As great as Peyton is, getting to the Super Bowl is undoubtedly a team effort. The Seattle Seahawks—this year’s winner—played great defense and offense, and they played effectively as a team. In American football, there are 11 players on the field and each has a specific position, or role. The quarterback’s role is to direct the team toward the end zone and help them score as many points as possible. The quarterback touches the ball on every offensive play and is under great pressure to put points on the scoreboard. The quarterback calls the plays that the coach plans but also needs to be quick-thinking and innovative, changing the play if needed. The quarterback is the most visible and well-known player on the team—the leader.

Similarly, it takes a team to realize the potential of a healthy population. All sectors have responsibilities and a role to play, and the quarterback is the key to driving comprehensive, multi-sectoral, and outcome-based community development initiatives. The quarterback will be under pressure to produce positive outcomes and, therefore, will need the skills to keep the team moving the ball in the right direction. In Investing in What Works for America’s Communities, the authors highlight many successful strategies for revitalizing communities. They describe the role of a community quarterback and the quarterback’s needs, including actionable data that link across multiple community silos—e.g., data that connect healthcare providers, public health agencies, housing, transportation, and community organizations, and can be converted into usable information, such as a community’s housing stock, public transit, or schools that need attention.


3. Paying for the Quarterback

As a star quarterback, Peyton Manning was one of the highest-paid players in the NFL this year. Where do NFL teams get their money? They do not rely on a single source of funding; rather, they make money through the sale of merchandise, advertising dollars, cable fees, stadium proceeds, and from the fans, who buy the tickets and root for their teams every week. A star quarterback in the NFL helps attract funds and guide the successful implementation/fruition of those funds on the field, but he does not have responsibility for the various funding streams.

In the population health realm, the authors of Investing in What Works for America’s Communities discuss ways to pay for the community quarterback in the chapter “Routinizing the Extraordinary,” and like the NFL, they recommend several funding sources. They suggest that the community-development finance system could be the foundation in some cases, but that a larger, more complex web of other funding sources and income streams would make the community-wide improvement activities possible. The book’s authors argue that a central challenge for the community quarterback is to weave the different funding streams together for maximum impact. The quarterback will need to be entrepreneurial and innovative. The quarterback will need to look for those investments by one part of government or other community entities that benefit another and realize savings, thereby offering reinvestment opportunities. An example of this would be an investment in improved housing that results in decreased asthma attacks and decreased emergency department visits with savings for healthcare payers. Socially motivated investors, social impact bonds, community benefit dollars, and accountable care organizations offer new ways to move the ”resource” ball down the field toward healthier communities (IOM, 2012, 2013).


4. 12th Man

In football, “12th Man” is a term used to describe the football fans and how they are the 12th player on the team—a term started and trademarked by Texas A&M University and later licensed to the Seattle Seahawks. The Super Bowl-winning Seahawks have passionate fans who honored their victorious team in a parade in downtown Seattle. The event drew more than 700,000 fans, and the effect of the 12th Man’s support on the Seahawks’ victory has been widely acknowledged.

When the Colts won Super Bowl XLI in 2006, I remember being amazed at how it brought everyone in Indiana together with a sense of shared pride. So how might a community quarterback rally the 12th Man? The quarterback needs to have contagious tenacity that spreads to the team and a clear vision for how to achieve a healthier population—higher quality of life, safer neighborhoods, more economic prosperity. This strategy wins games, which in turn draws the power of the community. Like Seattle, when the team wins, the community should celebrate it publicly, allowing its 12th Man to share in the success. The community quarterback and the multisector team should keep score and when they achieve measurable success, public officials could claim a day of celebration, engaging partners and the media.


5. Visibility and Value

Football is the most popular sport in America, and Super Bowl XLVIII was the most-watched television event in history, with 111.5 million viewers. Why is the NFL so successful? Marketing and branding, yes. But what about drama? Football fans love the drama and the thrill of victory; we tune in to see what happens to our favorite players and teams, even in the off-season. We root for our heroes to win and to be the best, and we hope our opposition fumbles the ball. Some of us even bet on who will win.

The community quarterback needs a team that is skilled in marketing and branding—partners who can help bring what is hidden into the light, and teammates and supporters who can tell a good story. In population health, the opposition is chronic disease, mental illness, addiction, and injury, all of which affect the lives of citizens and rob the community of its resources, stability, and sustainability. A community quarterback needs to have a vision for how to weaken and destroy the opposition, and then inspire their team to help them execute the right strategies to win the game. Winning the game depends on the priorities set by the community. For one community, winning might mean the population has less chronic disease—such as heart disease, diabetes, or cancer; for another community, it may mean less binge drinking and alcohol-related accidents. Another community may measure success in improved early childhood development and housing for the elderly.

There are many similarities between the great game of football and what we do in public health. It takes a team to play the game, rallied on by supporting fans, yet every community needs a quarterback to lead that team to a win. Victory can be attained when we work toward common goals, master the fundamentals for reaching those goals, know the strengths of each player, gain an understanding of what the opposition is, get the job done collectively for maximum impact, and celebrate the wins when we make them happen. Using this strategy is the only safe bet.



  1. Andrews, N. O., and D. J. Erickson (Eds.). 2012. Investing in what works for America’s communities. Federal Reserve Bank of San Francisco and Low Income Investment Fund.
  2. Bostic, R. W. 2014. Community development and population health: An overview. Presentation to the IOM Roundtable on Population Health Improvement. (accessed February 20, 2014).
  3. CBS News. 2014. Super Bowl 2014 ratings set new record. ratings-set-new-record (accessed February 8, 2014).
  4. Frolo, J. 2014. USA Football announces fifth annual All-Fundamentals Team. (accessed February 8, 2014).
  5. IOM (Institute of Medicine). 2012. For the public’s health: Investing in a healthier future. Washington, DC: The National Academies Press.
  6. IOM. 2013. Population health implications of the Affordable Care Act: Workshop summary. Washington, DC: The National Academies Press.
  7. PeyBack Foundation. 2014. Project 18. (accessed February 20, 2014).



Suggested Citation

Monroe, J. 2014. Five Lessons from the Super Bowl for Improving Population Health. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201403c


The views expressed in this discussion paper are those of the author and not necessarily of the author’s organization or of the Institute of Medicine. The paper is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of the Institute of Medicine and is not a report of the Institute of Medicine or of the National Research Council.

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