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Sport as a setting for action
The settings approach to health promotion has received increasing support as socio-ecological perspectives on the complexity of systems and the societies in which people make health choices have become recognised as key influences of their health-related behaviours.1,–,3 Sport has been suggested as one such setting for promoting social good, particularly health,4 5 and for delivering health promotion messages.6 7 Like other social institutions, sports clubs are mediating institutions providing an interface between private and public life.8 Although the primary role of sports clubs is to organise and provide opportunities for competition and participation in sport, community sports clubs are also considered by those actively involved in them, to be social organisations for promoting social good, particularly health.5 9,–,11
Health promoting sports clubs
Internationally, the concept of health promoting sports clubs has been interpreted broadly to include constructs such as ‘coaches/instructors interaction skills’; ‘collaboration with other clubs and/or health professionals on health issues’ and ‘social development and the healthy outcomes of sport’.4 5 Given the importance of sport settings, it is rather surprising that there has been little published on how health promotion through sport has been achieved. Most work has come from the Scandinavian countries4 5 10 11 or from Australia.12,–,18 For example, early Australian efforts to promote health through sport focused on delivering health promotion messages at sponsored sporting events and tying sponsorship to the implementation of policies that created healthy sporting environments.12 The topics of healthy eating, sun protection, smoke-free environments, responsible service of alcohol and injury prevention have remained the focus of health promotion efforts in community sports clubs in some parts of Australia.13,–,20 More recently, the focus has broadened to encompass the concept of a welcoming and inclusive environment with an interest in using the health promotion policies and practices as a mechanism for leveraging participation in sport.15
Action through peak sports bodies
Most of the studies referenced above were conducted by the health promotion researchers wanting to work in the sports setting. This issue takes a more global look at health promotion through sport and describes several initiatives driven by an international peak sports body. Two papers from the Fédération Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC) describe how this peak sports body has started to use its role as a leader to promote health education in regions most needing it. The first paper by Dvorak et al21 describes how FIFA has planned and implemented its ‘11 for Health’ health education programme in Mauritius. As for any effective wide-scale health promotion programme, the planning phase is long and complex.2 Without stakeholder buy-in, it will have little chance of success and this paper outlines how FIFA has achieved this. The FIFA F-MARC team has had an even longer history of applying a risk management approach to reduce the risks of injury and ill-health in their sport, and the paper by Fuller et al22 summarises their achievements over 1994–2011.
Sustainable promotion of physical activity through sport
For population health gains, all programmes for promoting health through sport will need to be sustained over a long period. The study by Trinh et al23 shows how physicians can work with community stakeholders to significantly increase physical activity levels in previously inactive patients over a 6-week period. Although being a short-term trial, the study identified some ongoing challenges for longer-term implementation such as the need for resources and ongoing communication between all groups. As an example of a long-term programme, the December 2011 issue of BJSM published a paper that described Allez Hop, which was implemented as a nationwide programme in Switzerland to promote physical activity through sport, with a strong partnership from the health promotion and federal sports agencies.24 After 10 years, the main user group was middle-aged women, and there was some suggestions of changed physical activity behaviours in this group. However, the programme had a low overall population-level response rate, and the measures of behaviour change were taken over a short-term follow-up.
The challenges going forward
Ongoing efforts to use sport as a setting for sustainable health promotion will require continued investment, resources, enthusiasm on the part of the programme developers and an increasing workforce to deliver such programmes. Health and sports promotion experts alike will need to develop new approaches to help sports bodies, their clubs and other stakeholder groups build capacity to disseminate their messages better. There is also a need for improved theoretical underpinnings of all programme development and new methods for evaluating the outcomes of such programmes in the implementation setting of real-world sports delivery.
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Footnotes
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Competing interests None.
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Provenance and peer review Not commissioned; internally peer reviewed.