Exploring the increasing interdependence of community sport and health policy in England

ABSTRACT

Governments in many countries are increasingly interested in using community sport as a vehicle for improving public health through physical activity (PA) promotion. This has been associated with an increasing interdependence between the community sport and health policy sectors. However, there are no empirically grounded studies which have examined this directly and systematically in England. By examining Sport England’s Get Healthy, Get Active (GHGA) initiative, this paper presents novel evidence derived from interviews held with strategic policy-makers from Sport England and a professional football charity (Everton in the Community), and 67 men who engaged in one of the GHGA funded programmes, Active Blues. The findings reveal how the increasing interdependence between community sport and health policy has been characterised by tightly contested and congested relations of power at local and national levels. Although Sport England was the lead organisation which coordinated and was accountable for community sport, it was nevertheless highly dependent on organisations outside of the sector, including health organisations, to deliver their community sport goals. This was indicative of the relatively vulnerable and marginal position which Sport England, and sport policy, occupied in the policy landscape and the associated generalisation of interests from sport to public health. The policy spillover from more powerful policy sectors such as health, to comparatively less powerful ones like community sport, raises questions about the degree to which government can realistically expect to achieve their formal community sport and health policy goals.

KEYWORDS:

• community sport
• figurational sociology
• partnerships
• physical activity
• policy spillover
• public health

Introduction

Governments in many countries are increasingly interested in the use of community sport as a vehicle for improving public health through physical activity (PA) promotion. This has been associated with an increasing interdependence between the community sport and health policy sectors (Bloyce and Smith 2010, Misener and Misener 2016, Weed 2016, Milton et al. 2019, Smith et al. 2022). In England, government concern with using sport to improve health, including through increasing individual- and population-level PA, can be traced back to the early 1930s but especially to developments in government policy following the publication of the first White Paper on sport in 1975 and the second – Sport: Raising the Game – in the mid-1990s (see Ireland 2001, Houlihan and White 2002, Bloyce and Smith 2010). In the light of growing concerns about the increasing prevalence of non-communicable diseases (NCDs) such as obesity, the benefits of PA have also been frequently extolled as part of successive health policies published since the early 1990s (Ireland 2001, Bloyce and Smith 2010). These health policies were not – and still are not – narrowly confined to National Health Service (NHS) medical health care priorities, particularly those related to spending on hospitals, reducing waiting list times, and provision of medical care (Baggott 2015, Hunter 2016, Calnan 2020). They also included a particular focus on public health policy, which is concerned more with population-level health promotion and prevention (Baggott 2015, Hunter 2016, Calnan 2020), including through PA, and more recently, sport. Thus, any attempts to explore the increasing interdependence between the community sport and health sectors requires an analysis which ‘extends beyond health services policy and organisation’ (Baggott 2015, p. 1) and considers ‘the political processes that underlie the emergence of health issues, the formulation of policies and their implementation’ (Baggott 2015, p. 2).

We shall focus here on policy formulation since, to the best of our knowledge, there are no empirically grounded published studies which have directly and systematically examined how the increasing interdependence between the community sport and health policy sectors has shaped the formulation of community sport-for-health programmes in England. Specifically, we examine the networks of interdependencies, or relations, which characterised Sport England’s Get Healthy, Get Active (GHGA) initiative, launched in 2013, to explore how GHGA was developed as part of the increasing alignment between sport and health policy sectors, especially following the London 2012 Olympic and Paralympic Games (Milton et al. 2019). How the development of GHGA shaped the approach taken by the Sport England funded organisations involved in the initiative is then explored via a case study of the Active Blues programme. Active Blues was intended to promote PA and health among men living in North Liverpool, and which was delivered by Everton in the Community (EitC, the official charity of Everton Football Club) and evaluated by researchers at Edge Hill University.

Theoretically, based on the work of Norbert Elias (Elias and Dunning 2008, Elias 2012a, 2012b, Dunning and Hughes 2013), we draw upon and extend existing figurational sociological explanations of community sport and health policy processes (e.g. Bloyce et al. 2008, Bloyce and Smith 2010, Malcolm 2017, Smith et al. 2019, Gibson and Malcolm 2020, Thompson et al. 2021) by analysing the experiences of different groups who constitute policy figurations (i.e. policymakers and funders, senior programme delivery managers, and programme participants). We explore the interdependency networks, or dynamic power relations, which constitute policy processes, and which have accompanied changing policy, policy and funding priorities (Bloyce et al. 2008, Bloyce and Smith 2010, Smith et al. 2019). Specifically, we examine the interdependence between government, Sport England, health bodies, and local community sport and health organisations, and how the differential power relations between these generate intended and, to a large extent, unintended outcomes (Elias 2012a, 2012b, Dunning and Hughes 2013) in the pursuit of government’s community sport and health policy goals (Bloyce et al. 2008, Bloyce and Smith 2010, Malcolm and Gibson 2019, Smith et al. 2019).

Community sport and health policy and programming

As explored elsewhere (e.g. Houlihan and White 2002, Bloyce and Smith 2010, Collins 2010, Smith et al. 2022), historically government interest in community sport (and mass participation especially) in England has been variable, and it has often had to compete with elite sport for political, policy and funding attention. Since the mid-1970s and particularly the early 1990s, however, community sport has gradually become an increasingly politically important policy and funding priority. This was a process which coincided with the continued strengthening and development of health policies in which the benefits of PA were endorsed. For example, while criticised for failing to recognise the significance of health inequalities and their causes, The Health of the Nation (Department of Health 1992), published in 1992 emphasised the health benefits of leading an active lifestyle. It also prompted many community sport organisations to use health and PA promotion as politically important bargaining tools to further strengthen their perceived contribution to public health problems (Ireland 2001, Bloyce and Smith 2010).

In 1994, the increasing political and policy salience of community sport was supported by, inter alia, the introduction of a new National Lottery, followed three years later by a renewed (albeit vague) emphasis on mass sport participation in the policy priorities of the newly elected Labour government (Bloyce and Smith 2010, Smith et al. 2022). Sport England also deliberately began to adopt a broader definition of sport to include all forms of PA in 1999 so that its contribution to public health promotion would be better recognised, and so that it could begin to access government funds for this (Bloyce and Smith 2010). In Saving Lives: Our Healthier Nation (Department of Health 1999), though, the Labour government’s renewed health policy focus on health inequalities was not accompanied by a parallel emphasis on the role sport was perceived to play in addressing those inequalities. The benefits of a physically active lifestyle, by contrast, did underpin the emerging health care services policy agenda, including the National Service Framework for Coronary Heart Disease (Department of Health 2000), which required all NHS bodies to agree to a policy commitment of increasing PA (Bloyce and Smith 2010).

The publication of Labour’s first sport policy, A Sporting Future for All (Department for Culture, Media and Sport 2000), made little mention of the contribution sport might make to health (Bloyce and Smith 2010). It did, however, make clear that Sport England and national governing bodies (NGBs) of sport were to be modernised. Cooperating NGBs would be given enhanced responsibilities, but those who failed to perform against newly introduced Key Performance Indictors (KPIs) and other performance targets (e.g. Public Service Agreements) would have their funding reviewed (Department for Culture, Media and Sport 2000). Sport England were also expected by the government (via DCMS) to adopt an increasingly strategic, rather than delivery-led, approach to its community sport work (Houlihan and Green 2009, Bloyce and Smith 2010, Smith et al. 2022). This was accompanied by an expectation that Sport England would ‘establish meaningful, outcome driven targets against which performance can be measured [and] develop agreed and robust reporting procedures that will enable DCMS to measure Sport England’s performance against objectives’ (Department for Culture, Media and Sport 2001, p. 44), including public health. The increasing political, policy and funding priorities of PA promotion were reinforced in Game Plan in 2002 which began to address sport and PA collectively by encouraging mass participation and the intended health benefits and cost savings of doing so (DCMS/Strategy Unit, 2022). The health paper, Choosing Health (Department of Health 2004b), the Chief Medical Officer’s Report At Least Five a Week (Department of Health 2004a), and Choosing Activity (Department of Health 2005), similarly emphasised the important role sport (broadly defined) and especially PA were believed to play in public health prevention work, and the role the National Health Service (NHS) was expected to play in PA promotion. However, they also signalled the beginning of a gradual de-commitment to tackling health and other social inequalities in favour of promoting competition, choice and individual responsibility to promote public health through local policy and action (Calnan 2020).

This policy trajectory where public health and health care services policy began ‘encroaching into sport, and sport policy encroaching into physical activity’ (Bloyce and Smith 2010, p. 117) gathered further momentum following the publication of the public health focused 2007 Foresight Report (Foresight 2007), and 2008 cross-government strategy, Healthy Weight, Healthy Lives (Department of Health/Department of Children, Schools and Families 2008). The DCMS strategy, Playing to Win (Department for Culture, Media and Sport 2008b), emphasised the role Sport England was expected to play in relation to community sport for health while other bodies were deemed responsible for PA. For Milton et al. (2019), however, it was the combining of the sport and health agendas in the DCMS’s 2008 Before, During and After: Making the Most of the London 2012 Games (Department for Culture, Media and Sport 2008a), known as the Legacy Action Plan, which appeared explicitly ‘to mark the start of greater collaboration between the sport and health sectors to promote physical activity’ (Milton et al. 2019, p. 99).

Since then, the increasing interdependence between the sport and health sectors has been further expressed in the current government sport policy, Sporting Future (Her Majesty’s Government 2015). In Sporting Future, the use of community sport and PA for health outcomes became a central policy concern and one which Sport England was expected to address in their policy and practice. Specifically, Sport England and its funded organisations were expected to demonstrate how they contributed to five policy outcomes (physical wellbeing, mental wellbeing, individual development, economic development, and social development), increasing individual- and population-level PA, reducing physical inactivity, and sustaining behaviour change (Her Majesty’s Government 2015). This shift away from measuring the success of sport policy simply in terms of participation figures, towards evidencing the contribution of ‘sport’ to the five outcomes, ‘appears to be driven by an increased mandate from policymakers for the sport sector to demonstrate the contribution that sport can make to public health, which might be traced back to a Sport England commissioned review of the evidence in 2012’ (Milton et al. 2019, p. 100). Indeed, it was this review of evidence which provided the context for Sport England’s investment (between 2013 and 2015) of £13.8 million in 33 GHGA projects (including Active Blues) to better understand how inactive adults (those undertaking less than 30 min of physical activity per week) could be engaged in PA at least once per week through participation in sport (Sport England 2016a).

Sporting Future also made explicit the expectations government, via DCMS, had of Sport England in meeting its health policy priorities. In May 2016, Sport England (2016b) published its own strategy, Towards an Active Nation, indicating how it would achieve these priorities through a wider range of activities, including walking, rather than the traditional NGBs. This was significant because walking has long been seen by public health agencies and policymakers as ‘the single physical activity with the greatest potential to improve physical health’ (Milton et al. 2019, p. 100) but was not always promoted by sports bodies because it was not defined as ‘sport’. Also significant was the close alignment between the priorities of Sporting Future and the strategy Everybody Active Every Day published by Public Health England (Public Health England 2014) which, in 2013, had ‘taken over responsibility for much of the physical activity agenda from a health perspective’ (Milton et al. 2019, p. 100). Many of the actions in Sport England’s Towards an Active Nation were also to be undertaken with PHE (Milton et al. 2019).

Sport England’s most recent strategy published in 2021, Uniting the Movement, further reinforced its role in health promotion. It presented community sport and PA as key vehicles for addressing ‘five big issues’, including improved health and wellbeing, with a particular focus on addressing inequalities (Sport England 2021). However, while increasing attention has been paid to the significance of health and social inequalities in community sport policy, these have remained less prominent features of health policy, which remains more dominated by concerns with individual choice, responsibility and lifestyle (Calnan 2020). These priorities have been accompanied by an increased emphasis on the integration of (rather than competition between) health services. This is evidenced clearly by the recent introduction of integrated care systems which bring together NHS providers (e.g. hospitals), commissioners and local authorities to work in partnership to improve health and social care in local communities, even though ‘focusing policy solely on equity of health service provision will not be enough to effectively tackle social inequalities in health’ (Calnan 2020, p. 104) and community sport and PA participation.

Notwithstanding the marginalisation of much community sport (as a discretionary service) following the austerity measures and health policy trajectory introduced in the last decade or so (Smith et al. 2022), for Milton et al. (2019, p. 101) the ‘recent alignment of the sport and health agendas to tackle physical inactivity presents an unprecedented opportunity for the two sectors to work collaboratively towards the common goal of improving population health through physical activity’. But how has this increasing alignment shaped the formulation of community sport-for-health policy and practices of those responsible for enacting this policy ‘on the ground’? The limited (mainly sociological) research has explored how local authority Sports Development Officers (SDOs), as ‘street-level bureaucrats’ (Lipsky 2010), have managed the changing political, policy and funding priorities, and associated organisational change, in the sports development landscape in England (Bloyce et al. 2008, Bloyce and Green 2011). Particularly relevant here is how relatively powerful organisations like Sport England, alongside the increasingly interventionist role played by government, constrained SDOs to re-orientate their work away from the promotion of sport, via NGBs, towards the promotion of health and active lifestyles through community sport and PA with strategically important health partners (Bloyce et al. 2008, Bloyce and Green 2011).

Analysing the interdependency networks in which SDOs were bound up, and the differential power ratios which characterised them, revealed how SDOs (like all community sport programme personnel) must compete with representatives of many other, often more powerful and influential, public services, such as those involved in public health promotion who might be perceived to have a more pressing claim for public funds (Bloyce et al. 2008). This often led SDOs and their organisations to champion sport-health ideologies to secure government support and investment, and to advance their own individual and/or collective interests, whilst unintentionally strengthening the already comparatively marginal policy status of sport and SDOs’ occupational standing (Bloyce et al. 2008, Bloyce and Green 2011). More recently, Thompson et al. (2021) explored the management of top-down changes by representatives from four NGBs, including SDOs, Chief Executive Officers, senior managers, and a Sport England representative with responsibility for policy formulation. Among other things, they found that the increasing relational complexity and unequal power relations, which characterised participants’ situations resulted in an unintended reduction in sport development work with voluntary sports clubs and a corresponding increase in work with partners who enabled them to meet government’s and Sport England’s, priority of increasing participation among the inactive (Thompson et al. 2021).

In this paper, we seek to extend these existing figurational analyses by moving beyond the focus hitherto on SDOs. Instead, by focusing on GHGA, we shed light on the other types of relations which characterise the increasing independence between the community sport and health sectors, and how this shaped the formulation, funding and design of Active Blues. This community-based programme was launched by EitC in late 2015 to support inactive men aged 35–50-year-old to become physically active through sport. It was part of a growing number of health and wellbeing programmes to be delivered by the charities or foundations of football clubs which have come to occupy an important part of the community sport and health policy landscape (Parnell et al. 2013, Zwolinsky et al. 2013, Pringle et al. 2018). The programme was based in four electoral wards throughout North Liverpool, which were among the most under-resourced and low-income in England. It was intended to enable men to adopt healthier lifestyles and reduce health inequalities that lead to type 2 diabetes, musculoskeletal conditions, obesity, isolation and loneliness, poor mental health and cardiovascular disease.

Research methods

Participants

The qualitative data reported here are taken from a wider multi-method, cross-sectional, study which examined the enactment of community sport-for-health policy in England via a case study of Active Blues (Duffell 2019). To explore how GHGA was developed as part of the increasing alignment between sport and health policy sectors, and how this shaped the formulation and design features of Active Blues, we interviewed strategic policy-makers from Sport England (Claire and Joanne) who were responsible for its health policy formulation, and EitC (Steve, who was responsible for the management of Active Blues). We also report the findings of group interviews held with men who were the intended target audience of Active Blues. In this regard, our sample enabled us to capture new insight into the unfolding national community sport and health policy context at the time (Sport England representatives), how these national policy priorities and Sport England’s expectations were interpreted and adapted to the local context by Steve, the ‘street-level bureaucrat’ (Lipsky 2010), and how the intended beneficiaries (Active Blues target group) responded to the design of the programme’s recruitment approach.

Procedure

Following receipt of institutional ethical approval and written and verbal participant consent, the interviews held (in 2016) with Claire, Joanne and Steve were audio recorded and lasted between 45 and 80 min. Interviews were held in a quiet meeting room or office at the interviewee’s place of work. For Claire, the interview was held via Skype to accommodate their availability. All interviewees were given verbal and written guarantee of anonymity and offered a copy of the digital recording and a typed transcript to review and edit should they wish to; none of them requested this. Interviews with Sport England representatives explored how the community sport and health policy context shaped the development of GHGA (particularly via relations with government and health bodies), the approach taken to working with funded organisations, and preferred approaches to generating evidence of the impact and effectiveness of funded programmes like Active Blues. The impact of these on the formulation and design of the programme was explored with Steve who discussed how national policy and funding priorities were adapted to address local needs, especially health inequalities, in North Liverpool.

Between May 2016 and January 2017, 14 group interviews lasting 30–45 min were also conducted with 67 men from two populations. The first group were Active Blues participants, which consisted of men who had attended weekly sport sessions provided by EitC for a minimum of four weeks at the time of interview. The second group involved men who chose not to attend Active Blues sport sessions but had participated in one of the five initial programme engagement events called Lads Night In (LNI) held at Goodison Park, the home ground of Everton Football Club. The LNI events were designed to inform men about the Active Blues programme in a non-threatening and engaging way using Everton-themed activities. These included panel discussions with former players, photo opportunities with replica cups, and raffles for signed memorabilia. Food and drink were also provided, and the programme was actively promoted by former players of a similar age to the target audience.

The LNI group were interviewed in a quiet function room before their LNI event started, while the Active Blues group were interviewed after a tour of Everton’s training ground which was included as part of their involvement in the programme. All men were given verbal and written guarantee of anonymity and offered a copy of the digital recording and a typed transcript to review and edit should they wish to; none of them requested this. The interviews explored various topics, the most relevant of which for present purposes were the participants’ thoughts about the design features and initial recruitment strategies of Active Blues. We were particularly concerned with exploring men’s ‘opinions, ideas, feelings, and attitudes’ (Sparkes and Smith 2014, p. 84) regarding the effectiveness of the brand of professional football in recruiting physically inactive men to Active Blues, and whether a health-oriented emphasis to programme design was likely to be effective in retaining men in the programme (Parnell et al. 2013, Zwolinsky et al. 2013, Pringle et al. 2018). In this regard, exploring men’s thoughts was an important part of understanding whether some of the expected benefits policymakers had of the increasing interdependence between the community sport and health sectors (i.e. improving health through increasing PA, and increasing activity among the inactive) were likely to be realised given the preferences and needs of men.

Data analysis

All interview recordings were transcribed verbatim before being analysed thematically in line with the approach outlined by Roulston (2010). Firstly, the first author conducted a familiarisation of the data set by reading through all transcripts as part of an initial search for potential codes and patterns of behaviour identifiable in the data (Roulston 2010). Secondly, the first author undertook the coding process on hard copies of the transcriptions before applying these codes in the NVivo 11 software programme to help manage the data set. During this stage, deductive ‘in-vivo codes’ which are defined as ‘words and phrases uttered by the participant’ (e.g. ‘Everton’, ‘funding’, ‘brand’, ‘partners’), and inductive ‘analytic codes’ which include ‘codes relating to the research questions posed’ and underpinned by key theoretical concepts (e.g. ‘interdependency networks’, ‘power’) (Roulston 2010, p. 151), were identified. The researcher-derived codes across all transcripts were subject to a cross-checking process, before the ‘in-vivo’ and ‘analytic’ codes were ‘adjusted, collapsed, and revised’ into larger codes, also known as ‘categories’ of data (Roulston 2010, p. 153), which included ‘health partnerships’, ‘evidence and impact’, and ‘participant engagement through brand appeal’. These categories were discussed by all authors before being revised again until the final themes were identified: (i) austerity and the growth of public health partnerships; (ii) searching for causality and building evidence the public health way; and (iii) engaging inactive men: de-emphasising health and leveraging the ‘power of the brand’.

Findings

Austerity and the growth of public health partnerships

At the time of interview, and building upon their previous health-oriented work, Sport England were being further constrained by the government to prioritise public health goals. In developing GHGA, the interdependency networks in which Sport England were bound-up became increasingly complex and incorporated a wider range and number of seemingly more powerful and influential partnerships with health organisations, including PHE and the Department of Health and Social Care (DHSC), as well as health charities from the Richmond Group. On the one hand, the creation of these new alliances enabled Sport England to navigate the shifting policy climate and use GHGA to expand upon existing work with public health and health care service partners, as Joanne explained:

Developing partnerships with the more traditional health partners … the Richmond Group of health charities has been work that we’ve been doing for a while. The Department of Health, Public Health England … creating links into organisations like the NIHR [National Institute for Health Research], NHS England, health education and much more broadly.

On the other hand, working increasingly closely with public health organisations constrained Sport England to shift the focus of their work (including GHGA) further away from achieving sporting outcomes through traditional team sports and NGBs, and more towards engaging inactive populations through PA. Claire described this as follows:

In the previous strategy period, which kicked off in 2012 … we had a very strong focus on investing … [in] the kind of traditional sports like the national governing bodies of sport and things like that, and we hadn’t been doing huge amounts on health, but we recognised the contribution that physical activity and sport made to health and wellbeing.

A key driver of the health policy climate at the time was the publication of Healthy Weight, Healthy Lives (Department of Health/Department of Children, Schools and Families 2008) and this, together with the greater ability of more powerful organisations like the DHSC to shape the prevailing policy landscape, significantly constrained Sport England to position its work towards the achievement of public health outcomes. Particular emphasis was placed upon the role of community sport in increasing PA and helping to prevent and treat population levels of obesity and other weight-related problems. The comparatively marginal status and position of Sport England meant that it sought to demonstrate its ‘contribution to anything healthy’, as Claire explained:

[The] cross-government obesity strategy, Healthy Weight, Healthy Lives … played a role … what we were trying to do was align with what the Department of Health was trying to achieve. We wanted to be able to pitch and show our contribution to anything healthy, because previously we’d been around sport for sports sake and about, essentially, probably helping getting sporty people more sporty, rather than working with those that weren’t participating.

Sport England faced an additional challenge by becoming increasingly enmeshed in complex interdependency networks where the dynamics of power were titled heavily towards public health bodies: namely, their dominant perception of walking, rather than other forms of activity (especially sport), as the primary vehicle of encouraging inactive populations to become active. Unlike previously, where Sport England and other sports bodies did not promote walking because it was not a ‘sport’, the prevailing policy and funding landscape constrained them, however reluctantly, to accept that walking was a legitimate activity they needed to promote. They also had to convince more sceptical public health agencies, who appeared to have a more pressing claim for public funds, that sport could make a legitimate evidence-based contribution to improving health by tacking physical inactivity. Joanne reflected upon how the development of GHGA emanated from the external constraints Sport England experienced from the unequal power ratios which favoured their health partners, and which underpinned their attempts to engage in public health alliance building:

When you talk to a lot of health partners there can be a perception that the only way you can get inactive people active is to get them walking. We felt that wasn’t completely true because walking doesn’t meet everybody’s needs, but where was the evidence to show what … role that sport could be playing … ? And so that’s where Get Healthy, Get Active, was born, [it] was about improving that evidence base.

We shall return to the significance of evidence production as one strategy Sport England adopted to help legitimise their increasingly complex interdependency ties with public health bodies below. One additional – and very significant – unintended outcome they encountered, however, was in supporting local community sport teams to deliver on their national policy priorities. In an already unstable policy and funding climate exacerbated by austerity cuts to local authority budgets and workforces, many community sports personnel were being relocated to local authority public health departments and health care services where funding was prioritised and protected. On the one hand, this repositioning enabled Sport England to address government’s public health priorities and help preserve the existence of some community sport organisations in its relational networks. On the other, it simultaneously constrained the amount of sports development work those organisations did, as Joanne noted:

The austerity measures, the cuts that are happening, [mean] that there’s a retraction of people that are perhaps in that space at local level, and there’s a lot of difficult decisions having to be made locally … We’ve seen traditional sport and physical activity kind of development teams perhaps moving into public health as this was where budgets existed.

The relational constraints experienced by Sport England and local community sport teams were generated by the closer ties they were developing with more powerful local public health commissioners, and the emerging policy and funding priorities given to collaborative approaches which support the localisation and integration of community-based health services. Joanne, for example, emphasised how:

There was a push for collaborative approaches that were aligned to health and wellbeing strategies and had [to be] … support[ed] and sign[ed]-off … [by] public health commissioners. So it was very much about it needing to meet local commissioners’ wants as well as kind of what we were looking for … [being] tailored to inactive people.

Searching for causality and building evidence the public health way

We noted earlier that one consequence of the increasing interdependence between the community sport and health sectors was the need to generate not only more evidence of the contribution sport could make to public health but evidence of a particular kind which would be acceptable among influential public health organisations and health care services. Although there is plentiful evidence of the health benefits of PA and of engaging populations who were previously inactive or sedentary, PA is not the same as sport. The evidence base to support the role community sport plays in increasing PA, reducing physical inactivity, and improving individual and population health, is much weaker. The generation of more persuasive and scientifically grounded evidence, rather than a reliance on overwhelmingly positive sport-health ideologies, was thus regarded as representing a ‘new start’ for Sport England insofar as it led them to be more concerned with ‘what the evidence says about sport’s role in supporting inactive people to be more active’ (Claire). To help strengthen their relational ties with health partners, and especially the particularly powerful DHSC and PHE, Sport England commissioned a systematic review (Cavill et al. 2012) of the existing evidence base to demonstrate the contribution community sport could make to increasing PA and inactivity. Joanne described this process thus:

We started the whole [GHGA] process by commissioning a systematic review into the evidence base for sport’s role in tackling inactivity and improving health … to find out what already worked. And what we found was, there weren’t a huge number of studies that had really focused on that.

Notwithstanding the lack of evidence identified by the systematic review, and since Sport England were particularly dependent upon public health bodies to realise its policy goals, it nevertheless remained committed to delivering community sport-for-health programmes for inactive populations via GHGA. Reflecting upon the comparatively weak evidence base for sport’s assumed contribution to engaging the physically inactive, Claire said:

It wasn’t as well developed as the evidence around wider physical activity, but there was a kind of general sense that sport probably could play a role in this … The recommendations were that Sport England should develop programmes to target the least active, or what we tend to call inactive, [and] that we should train project managers to deliver these programmes and make sure that people have the right skills and information to properly evaluate the programmes.

Attempts to improve the quality and quantity of the evidence base through programmes funded as part of GHGA, including Active Blues, were, however, dominated by a concern with producing biomedical forms of quantitative evidence judged against accepted hierarchies of evidence which are common in public health. Influenced strongly by the preferences of the DHSC and PHE, Sport England regarded randomised controlled trials (RCTs) as the gold standard of evidence since these were perceived to best demonstrate causality and behaviour change. As Joanne explained:

The [GHGA] projects fit into different levels of the hierarchy of evidence … some are more traditional pre- and post-, to be honest, but then there’s some time series kind of approaches in there as well…We want to understand causality and things like that, which wasn’t part of what we were asking our initial [GHGA] projects to do. And that in part, I think, has been driven by the way that Public Health England have been doing things … There’s [also] a strong element of process evaluation … very much following on from Public Health England evaluation regional events.

One consequence of the increasingly complex interweaving of the actions of the many different groups (especially health bodies) who constituted Sport England’s interdependency networks was that Sport England felt compelled to use quantitative indicators in GHGA. The most politically important indicator – in policy and funding terms – was the proportion of the population who were active (defined as engaging in at least 30 min of moderate intensity physical activity/sport per week; the so-called 1 × 30 indicator) and inactive (defined as less than 30 min of moderate intensity physical activity/sport per week). Claire explained how the DHSC and PHE definitions of inactivity informed GHGA and Sport England’s wider work thus:

It always was the definition of inactivity. Inactive people were people that were not getting at least thirty minutes of moderate intensity physical activity once a week. So that’s what we did, with the Department of Health and Public Health England, we chose to focus on the inactive, and the agreed definition of inactivity … Also we didn’t actually know how much activity could be created from somebody that was previously inactive by an intervention. So that’s where the one times thirty [indicator] came from.

As a condition of funding, the evaluation teams in the GHGA funded programmes were also required by Sport England to use the International Physical Activity Questionnaire (IPAQ) for establishing baseline and follow-up data on the proportion of participants who were inactive and who had transferred from being inactive to active. In relation to Active Blues, Steve said:

In terms of the actual questionnaires, I think it’s [power] certainly with Sport England, our hands are tied. It’s a case of they’re the questionnaires you have to use, so there’s nothing we can do about that. We can feed back to Sport England, but [making] … changes, it’s out of our hands.

While funded programmes like Active Blues were constrained to use Sport England’s preferred validated measures, Steve nevertheless recognised the potential benefits of those measures for shaping the design of Active Blues and how its effectiveness could be understood:

With this work, it’s all validated questionnaires, so they’re a lot more accurate, so you can then compare it with local, national data, so you can get a lot more out of it … As the investment increases and the research and evaluation needed increases, then … [we need] more validated [measures], you know, perhaps we might use WEMWEBS or EQ5D or some of those tools in the higher levels of evaluation.

However, since EitC did not have the existing expertise or knowledge of these validated measures, or the time to dedicate a full-time resource to monitoring and evaluating the programme, a Ph.D. student was recruited to enable them to fulfil Sport England’s requirements. In this regard, despite the expectations Sport England had of funded programmes in relation to evidence production, this nevertheless increased research capacity in their funded organisations and provided partners like EitC with an opportunity to learn from the insight gained. As Steve noted:

I know we’ve somewhat questioned the questionnaires, in terms of the length of them, but just having comprehensive in-depth questionnaires, having the semi-structured interviews, having the focus groups, a huge amount of data collection, and having someone compile that, analyse that, and then report back on that, that’s way, way above anything else that we’ll do … [there will be] just be so much more that we can learn from this.

The production of such evidence was equally important for another notable feature of the developing interdependence and congested relations of power which characterised sport and health policy. This involved the greater ability of government, via DCMS, as a more powerful group to constrain Sport England to demonstrate the return on its investment in sport by evidencing the progress made by its funded programmes (including GHGA) in relation to the five Sporting Future outcomes. Commenting on how Sport England sought to respond to government’s changing priorities and concern with value for money, Joanne said:

As we moved out of the Olympic cycle and further away from London 2012, the government certainly started to look at why should public money be invested in sport. So not that sport isn’t good, but actually why would we invest public money when public money’s hard to come by, why would we do this? Those are the five outcomes with the strongest evidence base that are now in the government strategy and then play through into ours.

The increasing figurational complexity which characterised Sport England’s work, and relations with government, involved them developing collaborative community-based approaches to public health and closer ties to local health and wellbeing strategies approved by public health commissioners. The shifting power dynamics in local areas which began to tilt further in favour of health, rather than community sport (e.g. EitC), organisations and their priorities meant GHGA (and other) projects needed to have longer-term investment strategies, linked to local priorities, to support their sustainability and efficiency. They were also constrained to demonstrate how they could effectively become part of future health systems change while contributing to public health outcomes, including the promotion of PA and reducing inactivity. Although this status enhancing work proved difficult, one approach taken by Sport England to access monies held by more powerful local health bodies (e.g. Clinical Commissioning Groups) in their interdependency networks was to require GHGA projects to secure partnership, or matched-funding, as a condition of applying to the fund. This approach to developing closer ties and relations with local health partners, as part of the prevention agenda, was intended to help community sport organisations develop a stronger business case for funding. As Claire explained:

We know that prevention’s being pushed up the agenda, but the budget for it is incredibly hard to access in the majority of cases … by using some of our funding, we’ve helped to unlock some of that … For every pound we’ve invested in the programme, there’s been 82 pence in partnership and in-kind funding returned, and some of that is from clinical commissioning groups. So we have been able to use that funding to help unlock things locally.

For Active Blues, Sport England’s requirement that one-third of all funding should be obtained from partnership funding prompted EitC to develop a consortium of local organisations (including the City Council) to help fund and deliver the programme. Aligning Active Blues to Liverpool’s local (as well as national) PA and health priorities were critical in securing the necessary funding, as Steve outlined:

It was myself pushing it, because we needed partnership funding to get the actual funding off Sport England, so a third had to be partnership funding, with 50% of that being cash. So my kind of pitch to the council was, if you can provide us with funding, we can bring in three times that amount into the city to meet your aims and objectives. At the time, and it still is the case, Liverpool have got a massive push around physical activity, so this is kind of meeting their target perfectly.

The collaborative approach favoured by government and associated focus on illness prevention, cost savings through withdrawal of state provision for healthcare and the provision of matched-funded locally provided programmes, thus came to characterise Sport England’s approach to developing GHGA.

Engaging inactive men: de-emphasising health and leveraging the ‘power of the brand’

To adequately understand how the increasing alignment of the sport and health policy sectors shaped the formulations of community sport-for-health programmes like Active Blues requires us to consider how the intended beneficiaries responded to the design of the programme’s recruitment approach. Rather than extolling the health benefits of becoming physically active, the inactive men in our study were more likely to engage in Active Blues and its recruitment events if these leveraged the socially valued ‘power of the brand’ of professional football. The emotional appeal, and associated socio-cultural significance of ‘the brand’, was described by Steve:

I’d say Everton had a lot more appeal [than health promotion], certainly amongst Evertonians … some of them would be wanting to have any involvement with the club. For other football fans, it just gives them the opportunity to be involved with the whole environment at our football club, have the opportunity to potentially rub shoulders with a player or see the stadium, to see the pitch … From previous work that we’ve done as well, it does show that people have said that the reason they engaged in the first place was down to being involved with the Football Club.

Many LNI attendees also explained that it was the informalisation of the event, and provision of appropriate settings in which to listen to former players, which were important in shaping their initial engagement with Active Blues rather than apparently rational and moral arguments – as articulated in much policy – about the health benefits of being physically active. As Jack (LNI), said:

It was relaxed, you know. It was casual dress; it was comfy and all of that. It was no formal suits. But just having a chance to listen to some of the former players, and their views on things in the past, and obviously in the present. And obviously we sat there in the terraces every week, and we’ve got our views on what’s going on, who’s playing and who shouldn’t be playing and stuff. So just to hear them, and obviously to share some of our thoughts as well, so it was interesting, really.

The importance of using former players and leveraging the power of the ‘Everton brand’ to attract men to the programme’s start-up recruitment events was also recalled by Arthur (LNI):

Graham Stuart … the ‘85 era. Graeme Sharp … I thought, ‘Fantastic’. So we enjoyed it, we had a good laugh, and it’s a good opportunity for me and my son to come along, because we love this place. We’ve got season tickets … it’s just a nice little get together, and it’s comfortable. There’s no tension or, you know, it felt like you were in a pub and you’re having a pint, and it’s nice to hear stories and have a laugh.

Daniel (LNI) also discussed how having the opportunity to listen to former players’ stories and experiences, and their thoughts about Active Blues, influenced him to attend LNI: ‘Listening to the players, the ex-players talking about their experiences. I love listening to all that’.

The importance of Everton’s club and charity brand were similarly important for other interviewees who overwhelmingly reported that these, rather than simple individually oriented health messages, were among the key motivations for attending the programme. Arthur (LNI), for example, said: ‘I prefer it to be run by Everton in the Community … that’s what it’s [community programmes like Active Blues] all about’. The emotional attachment men had to Everton and the PA opportunities which engaging in Active Blues provided for them, alongside other like-minded participants, was also explained by Jack (LNI) who said:

That [Everton brand] makes it more of interest, because if it was something that I’d just seen on a flyer or something I read in the paper, I’d take a second look, but it’s not something I’d pursue, but because it is like linked to Everton in the Community or it’s got Everton in the title, it carries a little bit of weight, I’d say, yes. [to attending]

David (AB) similarly commented on the opportunity to play walking football with other men:

Because Everton in the Community’s part of Everton Football Club anyway, it’s the same brand. That’s a big part, because in the office I’ll brag about playing on the pitch, doing the footie, the lads. When you’ve been a season ticket since you were like ten, Everton’s a big, big part of my life … most of the guys’ lives.

Recalling perceptions shared with other men, David went on to juxtapose the appeal of attending an ‘Everton’ programme with men, rather than a traditional health improvement or weight management service which were felt to mainly target and attract women, as follows:

The weekends were just the match, drink. I never tried. My missus, her sister runs Slimming World, so they did that, but I never, ever took part in it. Not for me, you know, I’m … like narrowish … it was only the pull of Everton [that] made me stop. [and take notice about his health needs]

Alan, an LNI interviewee, similarly emphasised that if Active Blues had been advertised by a health-related organisation, such as the NHS, he would have been less inclined to attend because of his ‘sense of pride’ in being active in a socially valued football context:

I’m more focused on the fact it’s Everton in the Community, because that’s what it’s about … Let’s say it was for the NHS, and I decided to go along, probably my commitment wouldn’t be there as high as it should be, but I wouldn’t be as inclined to talk about it as much as I would, in a work scenario, just saying, ‘Oh, I’m going to the academy tonight, walking football with Everton’ … You know, and that, to me, is more, there’s a sense of pride in that.

Discussion

The purpose of this paper has been to provide new evidence on how the increasing interdependence between government community sport and health policy has shaped the formulation of community sport-for-health programmes in England via an analysis of Sport England’s GHGA initiative and one of its funded programmes, Active Blues. The evidence indicates how community sport was provided through increasingly complex, and largely unplanned, networks of interdependency where Sport England were highly dependent upon the actions of other, more seemingly powerful groups, including local (e.g. health commissioners) and national (e.g. DHSC, PHE) health organisations (Bloyce et al. 2008, Elias 2012a, 2012b, Dunning and Hughes 2013, Smith et al. 2019). Indeed, by analysing the GHGA initiative, it was clear that Sport England were becoming increasingly enmeshed in complex interdependency networks where the dynamics of power were heavily skewed in favour of public health bodies. Given the political, policy and funding salience of public health (Bloyce et al. 2008, Mansfield 2016, Weed 2016, Smith et al. 2019, 2022), much of Sport England’s associated work was thus being significantly oriented towards achieving the policy goals of more powerful groups, including government and health bodies, at national and local level. However, while government and health bodies, as the more powerful groups, had a greater capacity to make crucial decisions over the health policy priorities to be pursued, the nature and complexity of their interdependency ties meant that whether they were able to achieve their objectives was highly dependent upon the actions of other, seemingly less powerful, groups including Sport England and other community sport organisations (Bloyce et al. 2008, Smith et al. 2019, 2022). Sport England was indeed simultaneously enabled to attractively position itself as an important part of the public health policy landscape. It sought to legitimise its role in public health promotion while protecting and advancing its own interests in strategic-level policy making by developing GHGA, via contractual arrangements with government (from the DCMS), and via the requirements it had of its funded partners (e.g. EitC) involved in GHGA.

Sport England’s adoption of organisationally neutral approaches to cross-sector partnership working in areas including health promotion (Smith et al. 2022) also meant seemingly less powerful partner organisations involved in GHGA, including EitC, were heavily constrained to accept that their work must address Sport England’s – and thus government’s – preferred policy outcomes. As a condition of funding, these outcomes were to a large extent to be evidenced using validated tools and measures which were preferred by powerful health bodies, and which produced key quantitative outcome targets. Indeed, PHE, as an influential part of Sport England’s interdependency networks and the body who assumed much of the responsibility for PA in the health sector (Milton et al. 2019), particularly constrained Sport England to seek causal forms of evidence through GHGA. Government’s concern with demonstrating the benefits of investing scarce public money in sport for wider social benefit (Bloyce et al. 2008, Smith et al. 2022), and addressing the rising incidence and costs of non-communicable diseases, were additional features of the economisation and simplification of the interdependent relations which characterised this work (Gibson and Malcolm 2020).

One consequence of the rather unequal power relations which characterised the increasing interdependence of the sport and health sectors, typically in favour of the latter, was the growing willingness of some sporting organisations to generalise their interests towards health in their policy and practice (Misener and Misener 2016, Smith et al. 2019, 2022). However, as Malcolm and Gibson (2019, p. 175) have noted, ‘a significant unintended consequence of the success of sports organisations’ health-related arguments that convinced governments to develop policies and invest in sport was that states ultimately directed investment beyond the sport sector’. Given the relatively powerful position occupied by some parts of the medical profession, much of that investment is often directed towards medical health care services, and particularly PA promotion as an aspect of work linked to the NHS and other health organisations, which continues to dominate government policy approaches to health following the introduction of the Health and Social Care Act 2012 (Hunter 2016, Calnan 2020). In public health policy, however, ‘the limited involvement of the powerful medical profession in public health policy might … account for the lack of resources being allocated to this area’ (Calnan 2020, p. 115), including for population-level PA promotion and prevention, despite the well-established health benefits of PA. This is perhaps unsurprising given that public health has often been seen and treated as a Cinderella discipline, while physical inactivity is typically regarded as ‘the Cinderella of NCD risk factors, defined as “poverty of policy attention and resourcing proportionate to its importance” (Bull and Bauman 2011, p. 14; emphases in original). In this regard, PA promotion as an aspect of public health – like community sport – is often left to seemingly less powerful local authorities and communities, but without the protected or ringfenced budgets afforded medical health services (Baggott 2015, Hunter 2016, Calnan 2020).

It is clear, then, that any explanation of the increasing interdependence between community sport and health policy in England needs to account for the different status hierarchies which exist in the differentiated health policy sector, and their implications for PA promotion, as well as the respective status of community sport policy which has become enmeshed in the intersections of these complex policy spaces. As we noted earlier, and as our findings reveal, community sport policy has occupied a relatively vulnerable and marginal position which has led sporting organisations increasingly to claim for sport a whole range of positive outcomes, including health promotion, to strengthen their position in the policy landscape. This vulnerability of community sport policy can be related to the fact that

in few if any countries is sport policy a self-contained sub- system: indeed in most countries sport policy is significantly affected by policy change in other more politically salient sub-sectors such as education, diplomacy, tourism and health. A recurring problem for sport policy-making is its permeability and its vulnerability to policy spillover from much more powerful policy sectors.

(Houlihan 2012, p. 130)

In this case, the policy spillover has disproportionately come from the aspirations and priorities of policy actors across the health sector (Houlihan 2012): from within the health care services policy community and from those who occupy the public health landscape, with PA existing as a cross-cutting priority afforded variable policy priority. Sport policy priorities have also spilled over into the health sector, though to a much lesser extent, and often in the form of references made to ‘sport’ as a catch-all term, which often refers to a broader range of activities, including PA, and perhaps strengthening the policy status of PA as a result.

Conclusions

In this paper, we have provided novel evidence which helps explain the increasing interdependence of community sport and health policy in England, an area which has typically been ignored in research. Our findings indicate strongly that this increasing interdependence, especially since the early part of the twenty-first century (Milton et al. 2019), has been characterised by tightly contested and congested relations of power at local and national levels (Elias 2012a, 2012b, Dunning and Hughes 2013). Any sociological understanding of the complex linkages between the community sport and health policy sectors thus requires a critical analysis of the complex networks of interdependent power relations between the various, individuals, groups and bodies involved (Malcolm and Gibson 2019, Smith et al. 2019, Gibson and Malcolm 2020). Our analysis suggests that particularly important were the diverse interest groups including government, the public health and health care service professions, sports organisations including Sport England and their various delivery partners, and the intended beneficiaries of community sport-for-health programmes. Although Sport England were the lead organisation which coordinated and was accountable for community sport, it was nevertheless highly dependent on organisations outside of the sector, including health organisations, to deliver their community sport goals. This was indicative of the relatively vulnerable and marginal position which Sport England, and sport policy, occupied in the policy landscape and the associated generalisation of interests from sport to health policy goals. One consequence of the policy spillover from more powerful policy sectors, such as health to comparatively less powerful ones like community sport has been the constraint on Sport England and its delivery partners to incorporate non-community sport objectives, including health promotion, and prevention and early intervention approaches, into their work. This unintentionally runs the risk that community sport priorities get ‘lost between the cracks within the complex agendas of multiple agencies’ (Bull and Bauman 2011, p. 21), especially the more powerful health bodies on whom organisations like Sport England are highly dependent. Such an approach also raises questions about the degree to which government can realistically expect to achieve their formal community sport and health policy goals. This is because even a group as powerful as government are highly dependent on the actions of many other people, especially the street-level bureaucrats (Lipsky 2010) in community sport organisations like EitC who enact policy ‘on the ground’ with people in local communities. The complex interweaving of these actions may thus make it more difficult for those groups to achieve the government’s community sport and health policy goals, an outcome which it seems fair to assume is neither intended nor desired by government (Bloyce et al. 2008, Smith et al. 2019)¹.

Acknowledgments

We are grateful to the two reviewers for their very helpful comments on the original version of this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

We wish to acknowledge funding received by Sport England from the second round of GHGA to support the evaluation of Active Blues

Notes

1. Although we are unable to explore this in more detail here, an additional feature of any sociological account of the increasing interdependence of sport and health policy sectors necessarily involves locating these interdependent relations in the context of wider social processes. Central among these are the medicalisation of life and sport, and contemporary neoliberal approaches to surveillance medicine and public health policy and programming which privilege and value highly individualised forms of self-care and health management, and often downplay the significance of structural inequalities (see Malcolm 2017, Gibson and Malcolm 2020).