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Preventing sports injuries at the national level: time for other nations to follow New Zealand’s remarkable success
  1. John W Orchard
  1. Dr J W Orchard, Sports Clinic, Cnr Western Ave and Physics Road, University of Sydney, Sydney 2006, Australia; johnorchard{at}msn.com.au

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Imagine yourself reading an editorial in Traffic Injury Prevention about the best system for preventing and managing traffic accidents. The editorial suggests that it is wrong for national governments to take an interest in preventing and managing road trauma. It argues that competition among car manufacturers, local governments and trauma hospitals can be relied upon to ensure road safety. It asserts that driving a motor vehicle is an inherently risky activity and that motor vehicle users should not expect non-driving taxpayers to help fund national government involvement.

As you read that editorial you disagree vehemently, perhaps even feeling outrage. You are aware that the countries in which national government bodies are dedicated to preventing and managing traffic accidents have excellent records at lowering mortality and have lower rates of injury than those countries without organised systems.1 You appreciate that the editorial mounts an argument that may sound good in theory, but in the real world it has been proven wrong. The laissez-faire (“do nothing”) approach to traffic injuries costs countries like India (which lack necessary government infrastructure) thousands of deaths per year compared with countries that have nationwide systems dedicated to lowering traffic injuries.2

Now imagine a similar editorial about sports injuries in the British Journal of Sports Medicine. Very few countries have a national government body taking responsibility for sports injuries. Generally, countries rely on the general health system, sports organising bodies and individuals themselves to manage and prevent sports injuries (the laissez-faire government approach). Some countries (particularly in Western Europe) have elements of a nationwide approach to managing and preventing sports injuries.310 However, only one country—New Zealand—has a completely socialised and universal approach to managing and preventing sports injuries; it uses the same template that is used for traffic injuries.11 Have we reached a point where we can assess the relative value of the widespread government laissez-faire approach versus a socialised approach to managing and preventing sports injuries?

In 2002 Finch and Orchard argued that New Zealand’s socialised approach to preventing sports injuries should, in theory, be superior to the approach of countries like Australia which has a laissez-faire national government approach.12 This argument was largely based on the fact that such an approach had proved superior for traffic injuries.12 In 2008 there is evidence to say “case proven”—what works for traffic injuries does work for sports injuries.11 Researchers working with the New Zealand Accident Compensation Corporation have reported that:

  • With the benefit of a nationwide prevention programme,13 New Zealand has lowered the incidence rates of catastrophic spinal injuries in rugby union by over 50% for the entire country.14 The incidence rates in New Zealand are now far lower than the latest reported rates for rugby union in countries such as Australia, South Africa and England.11 14 15

  • With the benefits of nationwide prevention programmes, the rates of mouthguard usage in contact sports have substantially increased and the rates of dental injuries have substantially decreased.16

  • The costs of administering and implementing major nationwide sports injury prevention programmes have been shown in most cases to be far cheaper than the direct and indirect medical costs for the sports injuries prevented.17

Can we compare the scoreboard in New Zealand with other countries? For the most part we can’t, because countries with a government laissez-faire approach to sports injuries generally don’t keep any records (let alone comprehensive ones) of national sports injury rates.12 However, to use this lack of comparative data as an excuse for inaction would be a “head in the sand” approach.12 There are examples in other countries where good national injury databases are kept and some preventive measures instituted.35 9 18 19 Unfortunately, there is still a feeling that in most situations in other countries we are losing the battle against sports injuries. Why is this still the case?

It is now over 15 years since van Mechelen outlined the sequence of steps towards sports injury prevention in Sports Medicine.20 What seemed like an easy blueprint has not, however, led to widespread success in sports injury prevention. One barrier to progress has been the lack of conformity in injury definitions among authors, and this has led to the publication of consensus statements.2123 Finch has also recommended that additional stages should be added to the van Mechelen paradigm.24 In this TRIPP (Translating Research into Injury Prevention Practice) paradigm, steps are added to ensure both that experimental research is applicable in the real world and also that proven preventive measures are actually applied by sports and individuals.24 This final additional step may involve lobbying for rule changes and using the media to encourage uptake of preventive measures.

Perhaps, for most countries, the lobbying needs to come at the start rather than the finish. New Zealand (and perhaps a few Western European countries) can currently apply the van Mechelen and TRIPP paradigms to sports injuries nationwide as they have national injury surveillance systems in place. Most other countries of the world cannot. If it is recognised that the New Zealand approach is superior—which it now should be13 17—other countries need to lobby to have their national governments form sports injury surveillance and prevention bodies.11 It is difficult to convince governments to spend money on new ventures, but perhaps the twin approach of presenting the successes of New Zealand and promoting safe sport as a key government obligation in the prevention of obesity will have an impact.11 We can also learn from the fight against cigarette smoking that there can be a delay of decades between the identification of the correct action to take and the successful lobbying of governments to implement the required action.25

This month Norway hosts the 2nd World Congress on Sports Injury Prevention and we are reminded that this sparsely populated country arguably leads all nations in the science of preventing sports injuries.2631 It is a remarkable coincidence that a similar size country, on the opposite side of the world but also replete with fjords and glaciers, is emerging as the leading challenger to the world title in this most important competition! New Zealand’s system for preventing sports injuries is not perfect8 but, in 2008, it is the home of the world’s best nationwide system for preventing sports injuries and this deserves recognition.

There is global agreement that universal national efforts prevent traffic injuries. In the future, it is logical that this approach will be seen to be just as essential for sports injuries in enlightened countries. The majority of us, living in countries with systems inferior to the New Zealand approach, have a hard task over the next few years to lobby in favour of nationwide systems. We cannot all have fjords and glaciers, but we can try to emulate world’s best practice at preventing sports injuries.

REFERENCES

Footnotes

  • Competing interests: None.

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