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VisionZero’: Is it achievable for rugby-related catastrophic injuries in South Africa?
  1. James Brown1,2,
  2. Wayne Viljoen1,3,
  3. Clint Readhead1,3,
  4. Gail Baerecke4,
  5. Mike Lambert1,2,
  6. Caroline F Finch5
  1. 1 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  2. 2 Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  3. 3 South African Rugby Union, Cape Town, South Africa
  4. 4 Chris Burger Petro Jackson Players’ Fund, Sports Science Institute of South Africa, Cape Town, South Africa
  5. 5 Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
  1. Correspondence to Dr James Brown, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; jamesbrown06{at}

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South Africa is home to an estimated 53 million people, 400 000 of whom play rugby union (‘rugby’) ( Although rare, rugby can be associated with permanently disabling injuries, which are tragic for the player and their family and also negative for the sport’s image.1 To reduce these injuries, a nationwide injury prevention programme, called ‘BokSmart’ (, was launched in South Africa in 2009.

Due to its vast socioeconomic disparities, South Africa is a difficult context for the implementation of any health intervention, let alone injury prevention programmes. South Africa ranks as the most inequitable country in the world ( Moreover, this inequity extends to healthcare: a recent report indicated that the poorest quintile of South Africans receive <10% of the country’s health benefits despite requiring close to 40% of these services, according to their self-reported health (figure 1).2 This disparity is partly due to infrastructure deficiencies in under-resourced communities. For example, rugby coaches in low socioeconomic areas mentioned infrastructure-related barriers to implementing BokSmart that were not mentioned by coaches from high socioeconomic areas.3 The fact that the same programme/strategy is implemented into different contexts …

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  • Contributors JB and CFF conceptualised the idea. JB drafted the first version and CFF edited this. WV, CR, GB and ML then edited the manuscript prior to submission.

  • Funding CFF is funded by a National Health and Medical Research Council Principal Research Fellowship (ID1058737).

  • Competing interests JB’s postdoctoral fellowship is paid for by the BokSmart programme.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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