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Republished editorial: London's Olympic public health legacy: Will it turn to dust?
  1. Denis Campbell
  1. health correspondent, Guardian, London, UK denis.campbell{at}

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London won the Olympic bid on the back of a promise to increase young people's participation in sport.

Denis Campbell assesses the likelihood of success

For years cities and countries vying to host mega sports events like the World Cup and Olympic Games competed on the basis of who had the best venues, most robust security systems, most imaginative legacy plans, and other similarly technical aspects. But in 2005, London rewrote the rulebook in its quest to win what some call sport's greatest prize—the right to stage the summer Olympics. If London got the Games, it would use them to inspire young people to play sport.

In early July that year bid teams from the five cities vying to host the event in 2012—London, Paris, Madrid, Moscow, and New York—gathered in Singapore to make a final presentation to the International Olympic Committee (IOC). Not even the key figures in London's team, headed by Sebastian Coe, a double Olympic gold medal winner turned politician, expected to be first across the line.

Where the other four pitches embodied perspiration, London's went for inspiration. Its 100 strong team inside the Raffles City Convention Centre's ballroom gave a clue to its intentions. Among its contingent were 30 pupils from Langdon secondary school in Newham, east London, near where the Games would be held if London won.

In an evocative address, Coe tapped into a fear inside the IOC and the wider global concern about many children's increasingly sedentary lifestyles: “We can no longer take it for granted that young people will choose sport. Some may lack the facilities, or the coaches and role models to teach them. Others, in an age of 24 hour entertainment and instant fame, may simply lack the desire.” But Coe added, “We are determined that a London Games will address that challenge. So London's vision is to reach young people all around the world. To connect them with the inspirational power of the Games. So they are inspired to choose sport.”

London's winning pitch—led by Seb Coe (r)—promised to inspire children to “choose sport.” This figure is only reproduced in colour in the online version.

London's pitch was unprecedented. While previous host cities had made umpteen promises about their impact and their legacy, none had included anticipated gain in sports participation or physical activity. “We had to dare to be different,” one senior member of London's team explained.

However, while Coe's speech was long on ambition, it was short on detail as to how the challenge of motivating young people to play sport would actually be met. As Mike Weed, professor of sport in society at Canterbury Christ Church University in Kent, recalls: “The key for London in Singapore was the pledge to inspire a new generation to choose sport. It was a very bold and ambitious pitch. But it was a fairly vague idea . . . At that stage there was no meat on the bones, no specific detail of how that pledge would be realised . . . The pitch was made with no real clear idea about whether it could be done or how it could be done, if at all.”

Back in London, it fell to ministers to put flesh on the bones of Coe's pledge. The targets they set and policies they embarked upon to achieve them are crucial to the question of whether it will now be honoured. As Tessa Jowell, the Olympics minister in the 2005 Labour government, recalls: “We were determined to be the first Olympic bid to set challenging but achievable targets as a measure of our ambition—that by 2012 two million more people would be physically active, a million more would be playing sport regularly, and 60% of young people would be doing at least five hours of sport per week.”

A 2012 legacy policy document produced in 2008 by the Department of Culture, Media, and Sport said that: “We hope to see people becoming increasingly active, with a goal of seeing two million people more active by 2012 through focused investment in our sporting infrastructure and better support and information for people wanting to be active. The new focus on sporting excellence in England will reinvigorate clubs and coaching, which will attract and bring on young sporting talent.”1

Aspirational target

So the ensuing political expression of Coe's Singapore sales pitch was broader than it had been, involving targets for increased physical activity, not just greater participation in sport. That was pragmatic. Sport is popular, but armchair fans vastly outnumber actual participants. Research shows that the idea of playing it actually turns quite a few people off, but also that many Britons would like to somehow be more physically active. Labour used a range of measures to meet its goals. The aim of getting two million people more active by 2012 became a responsibility shared by the Department of Culture, Media, and Sport and the Department of Health, each of which was meant to inspire one million people. Jowell, though, describes that two million figure as “an aspirational target,” albeit one “which had a clear framework of programmes to help the government departments to meet it. The target was not just about increasing participation in sport for the sake of it. It was also to tackle one of the most serious health epidemics facing the UK, that of obesity.”

ANDREW MILLIGAN/PA. This figure is only reproduced in colour in the online version.

At the core of the government's strategy to tackle the increasingly couch potato lifestyles of young people was an investment of £162m (€199m; $250m) a year in a network of School Sports Partnerships across England. Through these partnerships groups of schools could access for free sports coaches, who tutored pupils in a wide range of sports and other physical activities, such as yoga, dance, and circus skills. In 2008 Labour declared its intention to give schoolchildren aged between 5 and 16 the chance to do five hours a week of sport by 2012, a big increase on the two hours schools were supposed to provide at that time. Ministers had, Jowell says, a “driving ambition to be the first Olympic Games which could point to a public health legacy.” This effort seemed to be paying off. Between 2002 and 2007–08 the proportion of young people doing at least two hours of sport or physical exercise a week in or after school rose from 25% to 90%. By the time Labour left office in 2010 some 55% were doing at least three hours a week.2

Rash promise?

But how wise was Coe to make such a pledge? The experience of other big sporting events, both in the UK and abroad, suggests that this laudable aspiration may have been based more on emotion than evidence. In 2002 Manchester hosted the Commonwealth Games, a much smaller competition than the Olympics. Fred Coalter, a professor of sports policy at Stirling University, has concluded that it did not lead to an immediate post-event boost in participation. Writing in 2004, a full year before Singapore, he also cited research showing that hosting such major sporting events produces nothing more than a limited “trickle-down effect” on the membership of sports clubs.3 Rather, he cautioned, “If large-scale changes in sports participation are to occur, this will be the result of complex (and not well understood) interactions between such factors as changing public attitudes and values, changing distributions of work time, sustained government investment in schools and improved infrastructure of local, quality facilities.”

The House of Commons culture, media, and sport select committee offered an arguably more relevant view in 2007. The committee's conclusion was plain: “No host country has yet been able to demonstrate a direct benefit from the Olympic Games in the form of a lasting increase in participation.”4

Months later the London Assembly published research it had commissioned from the London East Research Institute at the University of East London which found a mixed picture of the overall effect that hosting the summer Olympics had had on the last four cities to do so—Barcelona (1992), Atlanta (1996), Sydney (2000), and Athens (2004).5

In Barcelona, a study in 1995 found that new sports centres created after the 1992 Games had had 46 000 new users; the percentage of people in the city doing some sort of physical or sporting activity at least once a week had risen from 47% in 1989 to 51% by 1995; and the proportion of women taking part in sport had grown from 35% to 45% over the same period. For Atlanta, the only available indicator of sporting activity was United States-wide sales figures for sports goods—very unscientific evidence. Sales of athletic equipment rose in the years after the Atlanta Games, as did those of athletic and sports clothing and bicycles, albeit slightly, while those of jogging and running shoes and cross-trainers barely moved. At best there had been “a slight increase in [the] US propensity to sports participation.”

Other research published last year casts even more doubt on the premise that an Olympics motivates young people to play sport. Sakis Pappous, of the Centre for Sports Studies at the University of Kent, analysed the effect of the Games in Athens.6 Although in the year before the event in 2004 some 6% more people in Greece took part in sport, the rise proved short lived. By 2009, the number of people exercising regularly had fallen by 13% and had even slipped well below the level seen before 2004. “What is evident from the statistics is that the Games in Greece had at best only a temporary impact on participation in sport and physical activity,” said Pappous. “The data for the Greek population suggests that, if a broader strategy towards an active lifestyle is not implemented, then sporting excitement on its own will not sustain participation,” he added.

Pappous's findings are a direct challenge to Coe's Singapore certainty. When a Department for Culture, Media, and Sport spokesman responded to them, he insisted that ministers and London 2012 organisers remained “completely committed to delivering a lasting sporting legacy from the 2012 Games.” But, he added with notable realism: “Increasing participation as a result of hosting the Games is not an easy task and past host cities have not managed to achieve that, but we are not shirking from our ambition.”

“The pitch was made with no real clear idea about whether it could be done, or how it could be done”

Mike Weed, professor of sport in society. This figure is only reproduced in colour in the online version.

None of this pessimism about Coe's pledge being fulfilled should surprise ministers. In 2009 the Department of Health received the results of research it had commissioned to help it get more people more active more often. Weed and six colleagues from the Centre for Sport, Physical Education and Activity Research (SPEAR) at Canterbury Christ Church University produced the 69 page systematic review.7

In their view, “The 2012 Games (or any other major sports event or sport franchise) is not a magic bullet to raise participation in physical activity and sport, or to encourage positive health behaviours.”

Elite inspiration?

They also noted “the potential of elite sportspeople to deter participation because of the perceived competence gap”—that is, many people are put off doing sport because they cannot imagine being anywhere near as good at sports as everyday sporting heroes.

Weed is sceptical that 2012 will produce many equivalents of the young Coe in 1968. “I've heard Seb Coe say over and over again about how he watched the Olympics in Mexico when he was a young boy at school and this is what inspired him. The problem with that, to be blunt, is that he's not normal, and nor is Kelly Holmes [who won gold at both 5000 m and 10 000 m for Great Britain in Athens in 2004] or the people who go out and win Olympic medals. What inspires people like that isn't the same as what inspires or motivates ordinary members of the public,” Weed cautions. “They are almost the worst people to advise government on policies to get people involved in sport because while they have a lifelong interest in and commitment to sport and are used to training twice a day—that's not a mindset that inspires or is relevant to most people.”

“What inspires people like [Seb Coe] isn't the same as what inspires ordinary members of the public.” This figure is only reproduced in colour in the online version.

Inactive Britain

The available evidence about existing levels of sports participation underlines how tough a task it is to increase them. Since 2006 the best available measure has been the regular Active People surveys conducted by Sport England, the agency which seeks to boost involvement in grassroots sport. When the first study came out, detailing activity patterns in 2005–06, it found that 6.295 million adults (aged 16 and over) in England did at least 30 minutes of sport at moderate intensity at least three times a week. That figure rose in the three subsequent surveys to 6.815 million (2007–08), 6.930 million (2008–09), and then 6.938 million (2009–10) before falling off to 6.927 million in 2010-11. Put another way, the proportion of all those aged 16 and over doing three sessions of sport a week has only risen from 15.5% to 16.3% since 2005–06. According to the most recent survey just 26.1% of those aged 16 to 34 do three sessions a week, as do only 16.2% of 35 to 54 year olds and a paltry 7.7% of those aged 55 and over.

Participation in sport among all those aged at least 16 even dropped between 2009–10 and 2010–11 in Hackney, Greenwich, Newham, Tower Hamlets, and Waltham Forest, the council areas nearest the Olympic Park in Stratford, east London. If the pending arrival of the world's biggest sports event on their doorstep is not inspiring them to do more, it may not do so elsewhere either. Even when the much less onerous criterion of how many people did sport for at least half an hour just once a week was applied—the measure Sport England plans to use as its key yardstick in future surveys, despite concerns that it is too undemanding—the total, some 14.691 million, was still barely a third (34.6%) of those aged 16 and over. That represents just a 0.4% increase between 2005–06 and 2010–11.

“By 2012 two million more people will be physically active”

Tessa Jowell, Olympics minister 2005. This figure is only reproduced in colour in the online version.

The data for 16 to 25 year olds, the age group that might be seen as most likely to be inspired by the feats of sportspeople largely their own age, are just as dismal. Since 2005–06 the proportion of them doing three sessions a week has risen from 29.3% to just 30.1%, while those doing half an hour once a week actually fell, from 55.7% to 54%.

These statistics paint a depressing picture of just how heavily uninvolved in sport people in England are. But Gavin Sandercock, director of the MSc course in cardiac rehabilitation at Essex University and one of Britain's leading experts on young people and physical activity, says the methodology of the Active People surveys—unverified self reporting—means the true picture is probably even worse. A British Heart Foundation study using readings from accelerometers worn by children and young people showed that only 11% of them do enough exercise, whereas surveys based on how much exercise they said they got concluded that 40% of boys and 30% of girls said they did, he said.

Getting young people hooked on sport or other exercise is inherently very difficult, he said. Two recent reports have helped explain why. Many girls are being put off physical activity for life because of bad experiences of school physical education and sport lessons, according to research among 1500 schoolboys and girls by the Women's Sport and Fitness Foundation published in May.8 Just over half (51%) of the girls they talked to said they had been deterred from involvement for that reason. Some 45% believe that “sport is too competitive” and did not like being “forced” to play games such as hockey and netball; many wanted to try non-traditional activities such as dance but their school did not provide them. A third believed lessons were aimed at the sportiest pupils, while 48% said they did not like getting sweaty because that would ruin their hair and was “not feminine.”

Government action

The rise in the number of people doing at least three sessions of sport a week, as measured by the Active People surveys, began under Labour but has begun to decline under the Conservative Liberal Democrat coalition that took power in May 2010. The coalition's determination to reduce Britain's deficit has seen them cut Sport England's budget by 28%, despite its key role in turning Coe's words into action. It has also scrapped both the target to get one million more people physically active by 2012 and the one aimed at getting one million others playing sport by this year.

Hugh Robertson, the sports minister, said that the failure to get more people playing sport was disappointing but that “a million sounds like a target that was plucked off the wall and it was.” He also called the agency's way of measuring participation “utterly duff.” Coe has also criticised Sport England for having “singularly failed in the past” to motivate and facilitate greater involvement in sport.

Sport England defended Active People as “a robust survey,” the findings of which are also used by the Department of Health, Department for Transport, and local councils. Its most recent survey found that while participation in four sports had grown since the previous survey, involvement in 19 had fallen. For example, the number of people playing tennis at least once a week fell from 487 500 in 2007–08 to 375 800 in 2010–11, a period in which Britain's Andy Murray has consistently been one of the world's top ranked players.

The coalition policy that has generated the greatest concern about the chances of increasing sports participation was education secretary Michael Gove's decision in late 2010 to withdraw the £162m a year funding for the School Sports Partnerships. According to the Guardian, Gove's decision is meaning that “School sport is suffering. Competitions are being cancelled. After-school clubs are being scrapped. PE teachers are receiving less training.”9 Chris Dunne, headteacher of Langdon Park secondary school in London's East End, around a mile from the Olympic Park, speaks for many in education when he calls the policy the single most unhelpful thing the coalition could have done in trying to exploit 2012's potential.

The coalition stresses that it is just as committed as Labour to ensuring the Olympics inspires young people into sport. But few teachers see ministers' alternative to the partnerships, a new annual School Games, as an adequate replacement for the regular sessions of coaching and playing that the sports partnerships provided. Its budget is £20m over two years—a fraction of what Labour thought youthful sports participation merited. In 2010 the coalition also launched a “mass participation legacy plan” drawn up by Sport England, called Places People Play. The agency said that the £135m National Lottery funded initiative “will bring the sporting legacy to life in communities across the country, answering London 2012's Singapore promise to inspire a new generation to play sport.”

Time will tell if the strategy proves effective. But Weed was unimpressed with its emphasis on providing sports facilities; £90m of the £135m was designated for that. “Even the sum of £32m to be invested in Sportivate, a programme of opportunities for 14 to 25 year olds, is for the supply of opportunities. As such, the government's mass participation legacy plans contain no strategies to harness the London 2012 Olympic and Paralympic Games to stimulate demand.” The likelihood, Weed added, was that the resulting new facilities would be well used, but by existing sports participants rather than those currently not participating.

I asked the London Organising Committee of the Olympic Games, which Coe heads, if he still expects his 2005 pledge to be fulfilled. The spokeswoman who replied was circumspect. “Our aim has always been to use the power of the Games to inspire young people around the world to choose sport. We have a unique opportunity to increase participation, at community and grassroots levels as well as the elite level, and more people playing sport will have a positive impact on the health of the nation,” she said. Certainly a wide range of organisations and individuals are doing their bit to ensure greater participation does result, including NHS London, the strategic health authority for the capital, London mayor Boris Johnson, several government departments, and Sport England. But will it all be enough?

BMJ.COM BLOGS Domhnall MacAuley

Research of doubtful relevance

What happened? Remember your first days at medical school—wide eyed optimism and how you were going to change the world, save lives, cure disease, help the sick, make a difference to people's lives. Looking at a lifetime dedicated to medical research—how much have you achieved when measured against the ambitions of youth. As I troop around conferences, read abstracts, attend presentations, and appraise research papers I cannot help wondering if we have lost our way. Most of what is on view and, dare I say, published in medical journals is of tangential relevance to patient's health.

It is our fault really. We have created a system where the volume of publication seems more important than the quality, where authors focus on chopping the data into multiple publications rather than a single meaningful paper, and where outputs are stretched across multiple journals reflecting different perspectives. If asked to pick just one research paper that represents your best work, your contribution to medical research, would you be happy with it?

Journals are not blameless. A correspondent wrote recently pointing out that we published a meta-analysis of eight papers and this was the eighth meta-analysis of more or less the same basic original papers. He was right. Medical journals also play this circular game.

Maybe it's the metrics. Achievement is measured on research output rather than research outcomes. Research excellence is based on points won on an arbitrary scale. Research income is a key metric with success measured on how much money you accumulate in research grants. Playing medical monopoly. And, yes, I do appreciate that research must be built on an overall understanding of the background to a topic, often piecemeal and based on exploratory and observational work, and that research costs money. But, the balance seems skewed. Academic recruitment stresses research output and grant income rather than health gain. One may argue that these are proxy measures of quality. But, the process itself has become the outcome.

So, let's take a long hard look at ourselves. As a successful researcher with long list of publications—what do they mean? Looking honestly on your research career, how much of what you published really matters? How much really makes a difference? How does your research measure up against your own early aspirations.

Domhnall MacAuley is primary care editor, BMJ

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  • ▸ This article is an abridged version of a paper that was published on Cite this article as: BMJ 2012;344:e4207

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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