Should we privilege sport for health? The comparative effectiveness of UK government investment in sport as a public health intervention

INTRODUCTION: Claimed links between sport and health are pervasive. This paper interrogates evidence for the UK government’s theory of change that sport can be used as a public health intervention to increase physical activity among the less and least active to deliver improvements in the physical health of the population. Regardless of efficacy evidence linking sport participation to improvements in physical health, effectiveness evidence to support the processes by which it is assumed that sport participation can be increased among the less and least active is unclear. METHOD: Two time-series analyses of current and historical national survey data explore evidence for the effectiveness of sport as a public health intervention for physical health. RESULTS & DISCUSSION: There is no top tier evidence from controlled designs to support, and some second tier evidence from time-series analyses to undermine, the effectiveness of sport as a public health intervention to increase physical activity among the less and least active. Despite sustained UK government investment, sport participation has stagnated or fallen from 1990, whilst since 1997 an additional 10% of the population have become physically active in ways that do not include sport. CONCLUSION: There is no evidence that sport is effective as a public health intervention to improve physical health. In comparison to the opportunity cost of not implementing potentially effective alternatives that promote wider physical activity choices that do not privilege sport, investment in sport as a public health intervention may cause net harm to the physical health of the UK population