Chahal, CAA

Khanji, MY

Patel, RS

Ricci, F

Vyas, V

English

UCL Discovery

Page 1 of 7  Title:  Sports associations: harnessing their influence for health promotion   Vishal Vyasa,b, Fabrizio Riccic,d,e, C Anwar A Chahala,f,g, Riyaz S Patela,h, Mohammed Y Khanjia,b,i  a Barts Heart Centre, Barts Health NHS Trust, London, UK b William Harvey Research Institute, Queen Mary University of London, London, UK c Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, “G.d’Annunzio” University, 66100 Chieti, Italy d Department of Clinical Sciences, Lund University, Jan Waldenströms gata 3e - 205 02, Malmö, Sweden e Casa di Cura Villa Serena, Città Sant’Angelo, Pescara, Italy f Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA g Center for Inherited Cardiovascular Diseases, WellSpan Health, PA, USA h Institute of Cardiovascular Sciences, University College London, London, UK i Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, UK   Address for Correspondence  Dr Mohammed Y Khanji  Department of Cardiology Newham University Hospital Barts Health NHS Trust Glen Road London E13 8SL United Kingdom  Email: m.khanji@qmul.ac.uk  Phone: +44(0)20 7363 8079  Word count:   924 words 1130 words with references        Page 2 of 7  Widely regarded as one of the best footballers in the world, a model athlete and a celebrity with over half a billion social media followers, Cristiano Ronaldo created an outpouring of media reaction following his now widely-cited, yet simple health promotion gesture at a Euro 2020 championships press conference. His action of moving two Coca-Cola bottles, positioned deliberately in front of him and instead holding up a bottle of water has wide-ranging implications for what the role professional sports people, and their governing institutions, have in promoting healthy lifestyles, while balancing the need to work with major corporate sponsors.   Ultimately, a core motivation for professional sports associations is sporting performance, athlete development and fostering the appropriate behaviours and attitudes required to cultivate this aim, i.e., healthy living amongst athletes to support elite performance. Should they likewise play an active role in promoting these values, attitudes, and behaviours amongst the millions of individual fans, associated parties and society at large which follow and support their progress? Thus, aligning themselves with one of the World Health Organization’s key global health strategies of advancing ‘health and wellbeing’.1   With the Euro 2020 championships being played against the backdrop of the coronavirus disease-2019 (COVID-19) pandemic, this would seem an ideal opportunity for a major sports tournament to help kick start health promotion and encourage healthy habits, such as undertaking regular exercise, reducing intake of sugary drinks and smoking cessation. Given COVID-19 is associated with worse outcomes in those with unhealthy lifestyle characteristics and pre-existing chronic diseases2-3, this would once again be particularly relevant. In this regard, elite sports people and by proxy their governing bodies wield tremendous influence over the general population. The social media following of Ronaldo and other elite athletes Page 3 of 7  might be one measure of their influence, and the international media reaction to the Coca-Cola incident highlights the impact even apparently small gestures can make.   Early examples of sporting associations acknowledging their role in wider health promotion came from Australia in the 1990s, when tobacco sponsorship and advertising were replaced with healthy choices.4 More recently an alcohol-use prevention programme was implemented to reduce harmful levels of alcohol in sports, labelled ‘Good Sports’.5 In the Netherlands, tennis clubs have pioneered healthy eating alongside social health and safety6 and this could be promoted more formally by tennis associations such as the Association of Tennis Professionals (ATP) and associations representing other sports. Finally, the Union of European Football Associations (UEFA) have partnered with the European Healthy Stadia Network to promote healthy food and drink options for fans to choose from,7 further highlighting the incongruence in choice of drinks displayed at the Euro 2020 press conferences. With another major international sporting event held this summer – the Tokyo 2020 Olympic Games, a recent study highlighted that aside from the Beijing 2008 and Nagano 1998 Summer and Winter Olympic Games respectively,8 population data suggests that there was no sustained increased in prevalence of physical activity or sports participation post-Olympics. Given pre-Olympics bid documentation typically cite the health benefit to the population and grassroot sporting participation as a legacy of the Olympics, 8 this appears to be a missed opportunity.    Sporting events could form an ideal platform for health promotion, from encouraging consumption of healthier food and beverages at sporting venues to, utilising a traffic light system to label food and drink sold and ‘pop-up’ health check stalls where attendees could have a health assessment, including simple blood pressure and possibly finger-prick lipid Page 4 of 7  checks, which could facilitate a more personalized, computed cardiovascular risk score alongside health education/counselling or referral. personalised cardiovascular risk score to be calculate along with brief advice. With men constituting a sizeable proportion of fans at sporting events yet being typically reticent to attend preventative medical encounters, this would be prime opportunity for health promotion. Taken together, sporting events could act as a regular reminder and opportunity to encourage good health and wellbeing.  In general, advertising and sponsorship have come under increasing regulation over recent years, following numerous consultations and evidence indicating their impact on adverse health behaviours. A recent systematic review identified that exposure to television food advertising was predictive of children’s dietary intake, while even short-term exposure to unhealthy food advertising increased calorie consumption in children.9 Of course, corporate sponsorship of such major sporting tournaments helps fund these events and the development of the sport itself, and it would be naïve to assume that such events could occur without support from major sponsors. There are also contractual obligations that would need to be met. Yet it is reasonable to ask if there is room to balance what would appear to be competing interests? Sadly, it is unlikely that we will ever find out if an alternative sponsorship agreement could have been made for Euro 2020 or whether health promotion was a key factor discussed in any contract negotiations with sponsors. However, we must also consider that major companies themselves have a corporate social responsibility programme with environmental, social and governance (ESG) concerns taking a greater focus since the start of the COVID-19 pandemic. The Business Roundtable’s new Statement on the Purpose of a Corporation,10 signed by 181 chief executive officers (including Coca-Cola’s James Quincey) highlights the shift in the corporate focus from solely serving shareholders to considering all stakeholders – including society as a whole, as factors in fostering success. Indeed, the Page 5 of 7  importance of ESG factors in driving business value is reflected in ESG stocks outperforming those with weaker ESG ratings in 2020!11 Thus, corporations too are recognising their wider role in society and that financial success is intimately linked to societal improvement.   Sports clubs and associations play an instrumental role in driving increased participation in sport and can simultaneously align this core function with a societal responsibility and opportunities to promote other healthy behaviours. Harnessing their influence for public health promotion will sow the seeds for a healthier future for the communities that sport serves to enrich.    Conflicts of interest None declared  Authors’ contributions MYK conceptualised the idea. MYK, VV, and FR planned the draft outline. VV wrote the original draft. MYK, CAAC, FR, and RP provided critical review for important intellectual content. All authors approved the final version.  Page 6 of 7  References 1. https://www.who.int/activities/promoting-health-and-well-being [Accessed 28 June 2021]. 2. Nieman DC. Coronavirus disease-2019: a tocsin to our aging, unfit, corpulent, and immunodeficient society. J Sport Health Sci 2020;9:293–301. 3. Lavie CJ, Sanchis-Gomar F, Henry BM, Lippi G. COVID-19 and obesity: links and risks. Expert Rev Endocrinol Metab 2020;15:215–6 4. Holman CDJ, Donovan RJ, Corti B, Jalleh G, Frizzell SK, Carroll AM. Banning Tobacco Sponsorship: Replacing Tobacco with Health Messages and Creating Health-Promoting Environments. Tobacco Control. 1997;6:115-121.  5. Rowland B, Allen F, Toumbourou JW. Impact of alcohol harm reduction strategies in community sports clubs: Pilot evaluation of the Good Sports program. Health Psychology, 2012;31:323–333. 6. Pluim BM, Earland J, Pluim NE. The development of healthy tennis clubs in the Netherlands. British Journal of Sports Medicine. 2014;48:898-904.  7. https://healthystadia.eu/uefa-euro-2020/ [Accessed 29 June 2021]. 8. Bauman AE, Kamada M, Reis RS, Troiano RP, Ding D, Milton K, Murphy N, Hallal PC. An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity. Lancet. 2021; 398:456-464. 9. Russell SJ, Croker H, Viner RM. The effect of screen advertising on children's dietary intake: A systematic review and meta-analysis. Obes Rev. 2019 Apr;20(4):554-568.  10. https://www.businessroundtable.org/business-roundtable-redefines-the-purpose-of-a-corporation-to-promote-an-economy-that-serves-all-americans [Accessed 28 June 2021] Page 7 of 7  11. https://www.ftadviser.com/investments/2020/11/10/how-esg-linked-stocks-outperformed-in-2020/ [Accessed 28 June 2021]  

Sports associations: harnessing their influence for health promotion

https://discovery.ucl.ac.uk/10137739/1/Patel_Revised%20v2%20Health%20Promoting%20Behaviours%20Article%20EJPC_FINAL.pdf

Sports associations: harnessing their influence for health promotion

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