On the front foot: improving wellbeing through the beautiful game



Doctors are harnessing the powerful bond between sports clubs and their supporters to reach people who often have little contact with the NHS. Tim Tonkin reports

Football stadiums resemble fortresses of unimaginable wealth, with their great, gleaming corporate backs turned against the terraced streets below.

The contrast between them and the working-class communities where they were planted a century ago, and often remain, can be stark.

Thanks to the efforts of doctors – and some imaginative outreach work – the clubs are providing more than just a weekly diet of triumph or woe to their fans.

GP Chris Pritchard works one day a week with Everton in the Community, which aims to focus on three areas affecting the local community: health and wellbeing, disability and employment.

He says the deep and powerful connection between fans and their team means football clubs have an almost unique ability to help the NHS engage with potentially hard-to-reach sections of the patient population.

‘A lot of what Everton in the Community does is try to engage those people who don’t necessarily seek normal healthcare routes,’ he says.

‘Where I am based is known as the L4 area of Liverpool – one of the most socially deprived areas of the city and probably the country. Some of the greatest health inequalities in Liverpool are found here, issues relating to public health and long-term health conditions which aren’t being met properly.’

 

Badge of honour

The club recently provided pre-match HbA1c screening tests by NHS nurses to supporters, to coincide with Diabetes Awareness Month.

Dr Pritchard says the club’s community outreach work involves a range of projects, such as ‘tackling the blues’, which engages with pupils at 150 local schools on physical activity and wellbeing, and ‘active blues’, which is aimed at men aged 35 to 50 struggling with mental health problems.

‘We go into schools and we use the Everton badge,’ he says.

‘People recognise that, and they feel more comfortable speaking to someone who is wearing an Everton shirt than they would someone in a shirt and tie.

‘I think if every Premier League football club, every cricket and rugby club was to engage with its community, healthcare professionals could tap into hundreds of thousands of potentially new patients who wouldn’t otherwise see healthcare services.

‘Hopefully in the next 10 years every club will aim to have this sort of thing on board.’

 

Check-up service

Brighton emergency medicine consultant Chetan Trivedy (pictured below), meanwhile, sees cricket as a way of reaching patients from ethnic minorities who may be reluctant to present to health services.

Dr Trivedy founded Boundaries for Life, which offers a number of free health check-ups to spectators and staff at cricket grounds in England and Wales. The consortium, which includes healthcare providers and the voluntary sector, helps assess blood pressure, cholesterol levels and alcohol consumption, as well as checking for oral cancers and early indicators of diabetes.
20190746 thedoctor January issue 17 
He says: ‘Cricket is the only sport that’s followed by a significant number of those from ethnic minorities: Indian, Pakistani, Bangladeshi, Sri Lankan, and those from the West Indies and South Africa.

‘We ask a lot of the people that come to us whether they’ve been [to get their health checked] before, and they haven’t; they only go to the doctor when they are ill as opposed to for prevention.’

 

Untapped idea

In its nine years, the organisation has helped deliver more than 5,000 free health checks but Dr Trivedy says the potential for sports organisations to improve the health of the wider public is still largely untapped.

‘The Oval [cricket ground in south London] has a capacity of about 20,000 to 25,000. If you’ve got people who are a captive audience, there’s an opportunity to reach out to communities who may not see their GP.

‘On a good day we can see 40 to 50 people, we have people queuing up because the checks are free and the results are instant.’

The initiatives come as local authorities, traditionally the main source of funding for leisure activities, are under a tremendous squeeze.

 

Spending cuts

Liverpool University senior lecturer in sport business Dan Parnell (pictured below) was part of a team which found a significant reduction in participation rates in sport among women, people aged between 14 and 29 and those from black and minority ethnic backgrounds, between the years 2008 and 2013. Overlapping with this period, the Institute for Fiscal Studies found a cut of more than 40 per cent in spending by English local authorities on leisure services between 2009-10 and 2017-18, and separate figures show the number of council-owned football pitches fell by 710 in the same period.

Dr Parnell says there should be much greater investment.

‘We know physical activity works, we know that football works we know it’s value for money.

‘Let’s stop messing around and put some large community-based interventions in place so that we can evaluate and start to deliver [on improving health].’

 

Invest in sport

The BMA, in a briefing published last October, raised concerns about the effect of funding cuts on local authorities, which have in many cases forced the sale of leisure facilities.

BMA public health medicine committee chair Peter English (pictured below) says: ‘While encouraging people to take part in more sport and exercise is an increasingly important component in social prescribing, our analysis shows that the importance of this is not being prioritised in current policy decisions.

Peter English, Chair of Public health medicine committee 2018

‘If the Government is to make any progress in improving the health of the nation and reducing inequalities, much greater investment into sporting and recreation facilities is one of the most central changes that must occur over the years ahead.’

The latest Health Survey for England gives an insight into the challenge. It found that 67 per cent of men and 60 per cent of women were classed as either overweight or obese in 2018, with 28 per cent of children aged two to 15 also falling into these categories.

 

Hamstring pie

The survey also found that rates of obesity were linked to socio-economic factors, with 20 per cent of adults living in the least-deprived areas classed as obese compared with 36 per cent of adults living in the most deprived regions.

Watching football on the TV – and without wishing to sound judgemental – the crowd and players may be wearing the same shirts but there is an almighty contrast in the bodies underneath them.

This might sound obvious but a century ago, it would have actually been hard to tell the difference between 11 randomly selected, almost universally lean football fans, and the players who were stocky but rarely athletic, and would have thought a hamstring a kind of novelty pie.

The gap between the waistlines of those who play sports at the highest level and those who cheer them on has become not quite as great as the gap in their respective salaries but is still a matter for concern and alarm.

The most ardent fans say they would do anything for their teams. Let’s see if this includes exercise.



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