Leaving a legacy
Article Outline
A recent systematic review, published in the British Medical Journal, reached a potentially unpopular conclusion. Having reviewed the evidence from major, multi-sporting events from 1978 to 2008, the authors considered that for both health and socio-economic benefits:
“There is a lack of evidence on the impacts of major multi-sport events on the host population, and until decision makers include robust, long term evaluations as part of their design and implementation of events, it is unclear how the costs can be justified in terms of host population benefits.”1
In a supporting editorial, Mike Weed, a leading academic in the field of sport and society, was more cautious. Yet he too concluded that in evaluating the wider benefits that are likely to accrue from the London 2012 Olympics and Paralympics:
“…the risk for the UK population is not that we will not get the benefits we want for our £150 a head investment in London 2012, but that there will be no robust evidence of what we have paid for.”2
Given that delivering a legacy is a key theme for the London 2012 Olympics and Paralympics,3 an inability to provide robust evidence of health, social and economic benefits is a major issue that must be addressed.
Yet just how can you evaluate a legacy? One immediate problem is that of determining what is the legacy of interest for an evaluation? Take as an example the Games of the XI Olympiad, held in 1936 in Berlin. The ruling Nazi Party sought to create a legacy of national unity and to provide an international showcase for its ideological stance on racial supremacy; as we know, neither happened. We know that an African-American called Jesse Owens showed himself to be a remarkable Olympian by winning four gold medals in field and track events and created a very different legacy. Though even then, one may question the nature of the Owens' legacy. The US Olympic team only participated after there had been a significant debate on whether the US Olympic Committee should boycott the Berlin Olympics on grounds of the frank, anti-Semitic stance of the Nazi regime. A significant voice in that debate had been that of African Americans who argued that sporting triumph by African-American athletes would undermine Aryanism and promote African-American interests within the United States.4 That the former of these “legacies” was immediately apparent, the latter legacy took at least another 30 years to be manifest and, arguably, only then in a somewhat peripheral way.
In this edition of Public Health, several of the authors of the systematic review published in the British Medical Journal offer one possible solution to the problem: use health impact assessment. In the paper, they present the approach to, and findings from, the health impact assessment commissioned in support of the Glasgow 2014 Commonwealth Games.5 The paper – perhaps unsurprisingly – concludes that what evidence does exist would suggest that health impact would be mediated through factors such as the economic consequences, self-esteem and civic pride, participation in wider, cultural events and the development of new infrastructure. Though not suggesting that the health impact assessment provided a blueprint for evaluating the legacy, it did consider that it was:
“…the start of a process to predict the impact of hosting the Games on health and the determinants of health; to influence the planning of the Games and the associated legacy programmes; and to evaluate the actual impact of the event (thereby facilitating a comparison between predicted and actual outcomes.”5
The authors highlight that their proposed approach is not without its own problems, not least of which is the lack of evidence from which to predict impact. Take as another example the legacy of the 16th Asian Games taking place later this year in Guangzhou. It will be the first Asian Games to go tobacco free, bringing it in line with International Olympic Committee policy. Against such a background, one could legitimately ask what would be the impact of the Games on smoking behaviour in Guangzhou. Another paper in this issue of Public Health demonstrates that the measure used to elicit evidence about smoking behaviour in China can bring about a significant under-estimate of smoking prevalence.6 Thus the degree to which a localised ban associated with a major multi-sport event might influence behaviour in comparison with a universal ban on smoking in public places is difficult to anticipate.
If specific, measurable change in risky health behaviour is hard to predict, what chance to predict the wider health legacies, often mediated by social, environmental or economic impacts? This is no idle speculation. Against the current, global economic background, national and international agencies are looking not just to specific benefits, but to the wider “value added” benefits of such events. That such wider effects do exist and can be predicted is evidenced in a third paper in this issue of Public Health. In this study, authors from Taiwan have shown that the 2009 change in tobacco taxation may be predicted to have a direct, significant impact in reducing cigarette consumption. They also predict it will have an effect on reducing alcohol consumption.7 Ultimately, this is the type of clear robust research that will at last begin to identify the type and size of expected impacts.
Whilst an approach based on health impact assessment will, as the authors conclude, provide a helpful way of shaping the dialogue about evaluation, it is arguable that it will be a matter of judgement to establish which of the many possible “legacies” are to be delivered. There is a tradition shared by many world religions to abstain from certain foods at certain times of the year. For the many orthodox Christian churches, the period of Lent, leading up to the great religious festival of Easter, is one such period of abstinence (from meat) and fasting. As a practice, it is considered to be a personal discipline that helps the individual to focus on what is important for their life and well-being; leaving a legacy of deeper personal and spiritual awareness. In the 16th century (CE), Roman Catholic missionaries to central and south America recognised the importance of such fasting and abstinence, yet sought to have the Capybara, a large semi-aquatic rodent and a staple part of the diet for some communities, classified as a fish. This meant it could be eaten during Lent with a clear conscience and what we would now call food security maintained. But how is such a legacy seen today? As part of a human response to real circumstances or evidence of institutional convenience?
Whilst economic developments in both London and Guangzhou are clearly important legacies that may have an impact on health in the long-term, the short-term delivery of an affordable Games will see the provision and marketing of vast amounts of fast-food, over-salted or sugared popcorn and carbonated drinks, sold by the Games’ official sponsors at participating Olympic venues and across the Globe.
How, one wonders, will that legacy be measured in years to come?
In this August issue of Public Health we are happy to bring you our usual, varied set of papers covering the full range of public health practice. Whilst there have been significant efforts globally to reduce tobacco smoking, there is still much to do to remove the threats posed by smoking to public health. So we are pleased to present two papers, one from China and one from Taiwan, that explore measurement consistency in self-reported smoking behaviour and the impact of cigarette taxation on lifestyle behaviours. We are also publishing a letter which poses an intriguing question about the appropriateness of using a cancer diagnosis as a prompt for opportunistic interventions for smoking behaviour. If your 2009 CE was dominated by influenza, you will be interested in the two papers on student responses to pandemic H1N1 and a new set of estimates for human H5N1 from Egypt. In the run up to both the 2012 Olympics and the 2014 Commonwealth Games, we are pleased to offer a consideration on how to assess the health impact of such large scale sporting events. To round things off, we have papers on food safety in Benin City and on training needs for health professionals in identifying cases of domestic abuse. Whilst this may not be your usual holiday reading, we are sure there will be something here to catch your attention.
References
- The health and socioeconomic impacts of major multi-sport events: systematic review (1978–2008). BMJ. 2010;340:c2369
- . How will we know if the London 2012 Olympics and Paralympics benefit health?. BMJ. 2010;340:c2202
- See: http://www.legacycompany.co.uk/ [last accessed 15.06.10].
- . The Nazi Olympics: Berlin 1936. Washington, DC: United States Holocaust Memorial Museum; 2000;
- . A health impact assessment of the 2014 Commonwealth Games in Glasgow. Public Health. 2010;124(8):444–451
- . Agreement among multiple measures of self-reported smoking status in Chinese urban residents. Public Health. 2010;124(8):437–443
- . Effect of cigarette taxes on the consumption of cigarettes, alcohol, tea and coffee in Taiwan. Public Health. 2010;124(8):429–436
PII: S0033-3506(10)00215-5
doi:10.1016/j.puhe.2010.06.005
© 2010 The Royal Society for Public Health. Published by Elsevier Inc. All rights reserved.
