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The health and social benefits of the Olympic Games to the general population are doubtful
Five cities were in pursuit of the 2012 Olympics. At the heart of each application was the bid document, which has crucial chapters on health and the Game’s legacy. The Evaluation Committee of the International Olympic Committee (IOC) visited each city and interrogated their medical advisors, one of the current authors included, on every detail of the proposed health provisions.
With regard to the legacy, it is clear that the IOC’s increasing concern is to develop the benefits left by the staging of this elite, mass spectator, sporting event. A legacy of health gain is at the centre of many of the bids, although to generate one is not as straight forward as it might at first appear. The health equation of an Olympic games is by no means simple. Profound effects are felt by the communities in which mass events are staged, as well as by the populations viewing them, and these may not all be beneficial.
The benefits for non-participants may derive in two ways.
Populations viewing an event may be inspired to exercise. In a poll of nearly 900 adults, 26% stated that they had been inspired by British medal winning performances at the Olympic Games in Athens to play more sport, or to become more actively involved in sport in the future.1 However, good data on how often these intentions result in lasting action remain wanting.
The link to a specific sport may be direct. After the British Olympic success in curling, the sales of related equipment escalated substantially. The consequent exercise will have brought measurable health gain to Scotland, a black spot for deaths from stroke and heart attack. If only its population exercised, cases could fall by over a third—no drugs, angioplasty, or bypass can offer this scale of gain.
Sporting injury may in part negate the beneficial effect, as perhaps could be said of the upsurge in boxing following Amir Khan’s Athens success. In general, it might be suggested that exercise improves health whereas sport may pose a risk to it, although at least here the health equation is simple. Overall gain equals the benefits of exercise minus the injuries from the sport participated in.
Clearly, mitigation of the negative impact of sports injury may derive from improving the availability of sports medicine services. For some nations there is certainly considerable scope. Whilst it has been estimated that 10% of all injuries treated at hospitals derive from sports, the British National Health Service currently has no sports medicine provision. The speciality was only recognised to coincide with the IOC Evaluation Committee’s inspection in February 2005 and the first trainee is yet to be appointed. If there is to be a net gain to national health the speciality must have trained and appointed adequate numbers ahead of the surge in demand 2012 will bring. This stands whether or not the Games’ organisers strive to amplify the natural surge by positive measures to promote wider sports participation as a means of delivering the promised legacy. If the NHS sports medicine provision comes after the event a legacy of disability from poorly managed sporting injuries will loom.
It is likely that a four year training programme will be agreed with the first recruitment in 2006. If just two hundred sports doctors were viewed as sufficient to meet the national demand by 2012, the deaneries will need to be given the funds for around one hundred posts until then, though numbers could be substantially reduced thereafter. These numbers, or anything like them, will require the incorporation of the private sector in training rations as well as the funding of posts overseas. The 2012 London Olympics will be staged all over the country and will stimulate sporting participation more than any other event in Britain’s history. To host the Games without a nationwide sport and exercise medicine service already established would be as to use an activated virus as a vaccine.
To maximise health gain, an event should be portrayed in a way that stimulates therapeutic exercise more than potentially injurious sport. For some nations there is certainly considerable scope. Only 32% of adults in England take 30 minutes of moderate exercise five times a week, a recommended minimum, compared with 57% of Australians and an exceptional 70% of Finns.2 The health benefits for the British population from an increased level of exercise3 would far outstrip anything that could be achieved for them by other means, including reducing obesity, cutting smoking, better cancer and blood pressure screening, healthcare planning, or health service resourcing.
Depending on the event and its viewing figures, there is a potential to encourage exercise on a global scale. For the health of advanced nations, it would be the equivalent of supplying safe drinking water to the struggling world. The target audience of such a scheme, the classical TV gazing couch potato, is reliably available as the viewer. Our current failure to link the viewing of mass spectator sport to a widespread uptake of regular exercise is possibly the most costly failure in our strategy to reduce disease in the developed world.
In the context of spectacular events such as World Cup Football, Commonwealth and Olympic Games, benefits may also accrue from inward investment in the communities staging the event. This lay behind Rio’s attempt and was at the heart of London’s, with the aim of changing a large tract of poor East London. New transport systems, sporting venues, hotels, living accommodation, hospitals, employment, and business opportunities will all result. Each is directly associated with improved community health—unemployed people in poor housing die young.
However, for advanced nations, there is no clear evidence of this association being reversed by placing the same communities in work and better housing. There is a danger too of gentrification, simply displacing local poor communities. Long term local financial liabilities also need to be factored in. Montreal’s population is thought to have suffered financially for well over two decades after their 1976 games.
Sponsorship of sport by companies selling unhealthy products substantially increases their consumption—why else would aggressive and successful companies spend millions doing it? People are killed by this, and tobacco companies have therefore been excluded from many areas of sport. Questions have been raised about fast food and soft drink manufacturers. The “Coca-Cola Olympic City” is the abiding memory for many of the 1996 Olympic Games in Atlanta. Thought as a result to have been the only Games ever to have been run at a profit, it was sponsored by, and heavily promoted, Coca-Cola consumption. If healthy sponsors could be found, there is the potential to change not only patterns of exercise but diet too. This combination is the key to Western health.
Similarly there is the potential to influence social behaviour for good or ill. Team spirit and the sporting ethic lie at the heart of most performances. In contrast, the malignant behaviour of a minority of competitors who use performance enhancing drugs, and the behaviour of competitors on and off the pitch in some sports are bad examples.
There are other social, community, and environmental factors that more clearly act as hazards. Voiced as a concern in Athens, major events provide an opportunity for organised crime. Furthermore, the consequences to health of the associated drugs and prostitution are worrying. Terrorism too seeks mass media and spectacle. The incidents that unfolded on 5 September 1972 at the Munich Olympics testify to this. The current events in Iraq will place London at risk if the situation has not changed by 2012. Major accidents such as occurred at Hillsborough and Heysel are rare, but immensely costly in terms of human tragedy. The mass travel of spectators hazards injury and the environment. To factor these issues into an equation on health gain is clearly relevant, although complex. They must also be balanced against the gains to world peace, bonding, and unity—the commonality that a Games brings.
Of course, simply to watch a sporting event brings no health gain at all. Indeed, an elegant English study of World Cup Football showed an increase in the number of hospital admissions and fatalities from myocardial infarction associated with key matches.4 The increase could not be accounted for by victims simply having an inevitable attack brought forward, as rates did not subsequently fall. Quite simply, watching national football kills measurable numbers of citizens. England lost the football, but no one has studied 1966 or the last Rugby World Cup to determine if winning is safer—certainly the current authors nearly died several times during the latter!
Thus, on the positive side of the health equation are to be found: a definite potential to increase levels of exercise and improve diet. On the negative side the list is longer: the potential for getting the dietary message wrong, injuries from increased sport, health risk of spectatorship at the venue and at home, risks of mass travel, and enhanced exposure to crime, disaster, and terrorism. Elements that might lie on either side of the equation are: the beneficial and malign influences on society of inappropriate role modelling, the prevailing politics, and the slings and arrows of inward investment. In summary, if gain is to be had from mass sporting events, it will be by focusing on the key issues of increasing the levels of spectator exercise, not sport, and by successfully encouraging healthy eating.
Elite sporting events associated with mass viewing need to be planned and executed so as to deliver on their potential for health gain and not leave a legacy of lost lives and blighted communities. If done well, the gains could be massive, but perhaps no more than the losses if executed poorly.
Although the benefits of exercise are irrefutable, the research published on the health legacy of major sporting events is scant. Referencing tends to be circular, and the markers of improved health are almost invariably indirect. It has been acknowledged that, although hard data to support the economic benefits and urban renewal are quite commonly generated, research into the health related impact is lacking.5 Very few hard data have been derived to support the widely professed assumptions that the effects of any given indicator are indeed beneficial to health. The fact that the Finns exercise so much more than the rest of us and yet have witnessed the same Olympics suggests that other influences on healthy living have been more at play, although this in itself does not mean that major sporting events cannot be used effectively.
It is to be hoped that the Olympic Games of 2012 will provide us with the opportunity to change an enthusiasm for these mass events built on beliefs and assumptions to one fashioned from hard fact. This would indeed be a legacy worthy of an Olympics.
The health and social benefits of the Olympic Games to the general population are doubtful
Competing interests: none declared