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Sport, physical activity and recreation are important for everyone, but perhaps more so for the approximately 15% of the world’s population that experiences disability.1 The United Nations’ Convention on the Rights of Persons with Disabilities clearly states that the benefits of sport are relevant at every level of participation.2 This includes experiences from grassroots community-led clubs to school-based adaptive or inclusive sports opportunities, to high performance events including the Deaflympics, Special Olympics and Paralympic Games.
The proportion of individuals experiencing disabilities who can and have benefitted from sport and recreation opportunities, however, continues to lag in comparison to the general population. Several barriers preclude equitable participation. As one example, while there are 206 IOC members there are only 184 National Paralympic Committee members. How can we elevate the profile of para sports locally if equity does not exist on the world stage?
Recent global trends suggest, however, that change is coming and that we are on the cusp of significant innovation that will enable more inclusive and equitable opportunities for sport participation for all. This editorial highlights these movements and provides several ways the sport and exercise medicine (SEM) community can engage to advance inclusion and accessibility.
Global efforts to address equity, diversity, inclusion and accessibility
We are amid a global movement to rectify and address issues related to equity, diversity, inclusion and accessibility. As a result, disability sport may benefit from the same advances occurring in women’s sport—in particular, an increased profile and more parity in financial rewards, which though still not equitable, are improving. One example of this is the 2022 Commonwealth Games in Birmingham, UK. These were the first major international multisport games to have equitable competitive opportunities for both women and men, as well as five events for Para sport that were full medal status. Other alterations in sport such as the addition of ‘Paralympic’ to the official name of the ‘United States Olympic and Paralympic Committee’, the increased prevalence of Special Olympic Unified Sports opportunities across communities, and an increasingly closer working relationship between the IOC and International Paralympic Committee are perhaps signs of greater inclusion to come.
Marketing efforts targeting the disability community
A second trend is the increased recognition of the economic relevance of persons with disability. Former US Senator Ted Kennedy, a disability rights advocate noted that ‘persons with disabilities present business and industry with unique opportunities in labour-force diversity and corporate culture, and they are a large consumer market eager to know which businesses authentically support their goals and dreams’.3 This understanding has grown in recent years with global corporations such as Toyota, Proctor & Gamble and IKEA explicitly marketing to consumers with disabilities, which also increases their marketing appeal more broadly. This change is also noted in the recognition of people with disabilities as desirable employees. The COVID-19 pandemic led to an increased acceptability of working from home, which has greatly facilitated the inclusion of people with disabilities into the workforce.
Media portrayals of athletes with disabilities
Images and stories presented in the media often influence public perceptions. Historically, athletes with disabilities are under-represented in the media, and when they are portrayed, they are often represented as ‘objects of pity, charity or medical treatment that have to overcome a tragic and disabling condition or conversely, presented as superheroes who have accomplished great feats, so as to inspire the non-disabled’.4 Several recent initiatives have advanced the authentic and inclusive representation of people with disabilities in the public media. One example is Channel 4 in the UK which for the 2022 Paralympic Games was the first to have an entire presenting team composed of people with disabilities. After broadcasting the 2012 Paralympic Games in London, Channel 4 also developed a Disability Code of Portrayal that provides guidelines on disability representation across all their platforms.5 6
Recognising unintended consequences
It is important to recognise that these promising global trends could also result in pitfalls and unintended negative consequences. Despite the increased focus on equity, diversity, inclusion and accessibility across sectors, disability is often left behind. For example, Principle 6 of the Olympic Charter notes that ‘sport does not discriminate on grounds of race, religion, politics, gender or otherwise’. Disability would fall under the final category, but by not being named explicitly, does it risk being overlooked or undervalued in comparison? Another unintended consequence of enhanced disability inclusion in sport is that only those with disabilities that are closest to the able-bodied perception of ‘normal’ might benefit. For example, athletes with technologically impressive prosthetics or high-end sport wheelchairs are often showcased at the expense of athletes with more significant disabilities whose bodies may be seen as less ‘acceptable’. Finally, while technology can enable sport inclusion, if the broader market does not recognise its value and companies do not find efficiencies for its production, then the costs will remain prohibitively high and only the wealthy will benefit, creating further disparities to sport participation for persons with disabilities from low-income backgrounds.
A call to action
The SEM community has an important role to play in ensuring that people with disabilities have opportunities to engage in physical activity and sport for health. Box 1 presents ways in which all SEM professionals can contribute to this global movement, and we encourage everyone to get involved! Through strong leadership, collaboration and advocacy, we are confident that the SEM community can catalyse important opportunities for positive change.
A call to action: how sport and exercise medicine professionals can contribute to disability inclusion in physical activity and sport
Include people with disabilities in your research or clinical team to ensure that the disability lived experience is recognised in all aspects of your work.
If you are a researcher, ensure that your study design is inclusive of people with disabilities—this should include considerations for participant recruitment, outcome measure selection, data analysis and dissemination.
If you are a clinician, learn about the unique medical conditions commonly impacting athletes with disabilities and how these may intersect with common sports-related injury and illness.
Consider disability accessibility in your workplace through the lens of universal design—this should include both structural considerations (eg, ramps, elevators) and also digital accessibility.
If you see injustice or inequitable treatment of people with disabilities—be an ally and speak up!
Patient consent for publication
This article is part of a series commissioned by the BJSM for the World Innovation Summit for Health (WISH) 2022. The BJSM peer reviewed, edited and made the decision to publish. The series, including open access fees, is funded by WISH, which is an initiative of the Qatar Foundation.
Twitter @davidfhlegg, @MaryDubonMD, @SportswiseUK, @CheriBlauwetMD
Correction notice This article has been corrected since it published online first. The acknowledgement statement has been added.
Contributors All authors contributed to the editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.