32/33 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
Document Type: Final Report
Date: 2016 Apr
Session: 32nd Regular Session (2016 Jun)
Agenda Item: Item3: Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development
Human Rights Council Thirty-second session
Agenda item 3
Promotion and protection of all human rights, civil,
political, economic, social and cultural rights,
including the right to development
Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
Note by the Secretariat
The present report, submitted pursuant to Human Rights Council resolution 26/18,
explores the obligations of Member States of the United Nations and non-State actors
regarding sport and healthy lifestyles as contributing factors to the right to health, with a
focus on sport and physical activity. The Special Rapporteur recommends that States
review their laws, policies and programmes concerning sport and healthy lifestyles to
ensure compliance with the right to health, immediately removing those that are
discriminatory or exclusionary, and implement or enforce mechanisms to protect the health
rights of amateur and professional athletes. States should also take positive steps to fulfil
the right to health by facilitating or providing access to safe spaces in which all people can
participate in sport and physical activity.
United Nations A/HRC/32/33
Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
Contents
Page
I. Introduction ...................................................................................................................................... 3
II. Sport and healthy lifestyles and the right to health ......................................................................... 3
III. Obligations of States regarding sport and healthy lifestyles and the right to health ......................... 5
IV. Sport and healthy lifestyles and the right to health of key populations and groups ........................ 11
A. Children ................................................................................................................................... 11
B. Lesbian, gay, bisexual, transgender and intersex people ......................................................... 13
C. Women..................................................................................................................................... 15
D. Elderly people .......................................................................................................................... 17
E. Persons with disabilities........................................................................................................... 18
V. Obligations of non-State actors regarding sport and healthy lifestyles and the right to health ....... 20
VI. Good-practice approaches to sport and healthy lifestyles ................................................................ 21
VII. Conclusions and recommendations .................................................................................................. 22
I. Introduction
1. In its resolution 26/18, the Human Rights Council requested that the Special
Rapporteur prepare, in consultation with relevant stakeholders, a study on the theme of
sport and healthy lifestyles as contributing factors to the right of everyone to the enjoyment
of the highest attainable standard of physical and mental health, and requested that the
Special Rapporteur undertake a consultation process exploring those themes. The present
report is submitted in accordance with that resolution, and was prepared on the basis of a
questionnaire sent to States and relevant stakeholders1 and an expert meeting that was held
in Geneva in November 2015.
2. The present report explores the obligations of Member States of the United Nations
and non-State actors regarding realization of the right to health and sport and healthy
lifestyles. The Special Rapporteur has chosen to focus on the evidence and the relevant
obligations that arise in relation to sport and physical activity, building upon the important
work carried out by the previous mandate holder on unhealthy foods, non-communicable
diseases and the right to health.2
II. Sport and healthy lifestyles and the right to health
3. In its 2011 resolution on the prevention and control of non-communicable diseases,
the General Assembly, in reaffirming the right of everyone to the highest attainable
standard of mental and physical health, acknowledged that the global burden and threat of
non-communicable diseases constituted “one of the major challenges for development in
the twenty-first century”. The General Assembly recognized that many non-communicable
diseases are linked to common risk factors, including tobacco use, harmful use of alcohol,
an unhealthy diet and lack of physical activity.3 Non-communicable diseases have a
disproportionate impact on women’s health and are the leading cause of death in women
globally, killing around 18 million women a year.4
4. In order to combat the growing threat of non-communicable diseases effectively,
and to equitably realize the highest attainable standard of mental and physical health across
populations, all people must be enabled to adopt healthy lifestyles. Article 12 of the
International Covenant on Economic, Social and Cultural Rights refers to the highest
attainable standard of physical and mental health, which the Committee on Economic,
Social and Cultural Rights has confirmed is not confined to the right to health care, but
embraces a wide range of socioeconomic factors that promote conditions in which people
can lead a healthy life;5 these include the readily modifiable risk factors for non-
communicable diseases identified by the General Assembly.
5. In other United Nations documents, participation in sport and physical activity is
recognized as a stand-alone right. The recently revised International Charter of Physical
Education, Physical Activity and Sport (of the United Nations Educational, Scientific and
1 Replies to the questionnaire are available as received at
www.ohchr.org/EN/Issues/Health/Pages/HealthyLifestylescontributions.aspx.
2 See A/HRC/26/31.
3 See General Assembly resolution 66/2.
4 Union for International Cancer Control and others, Non-communicable Diseases: A Priority for
Women’s Health and Development (2011).
5 Committee on Economic, Social and Cultural Rights, general comment No. 14 (2000) on the right to
the highest attainable standard of health.
Cultural Organization) recognizes that the practice of physical education, physical activity
and sport is a fundamental right for every human being, without discrimination. Equal
participation in sport as a right has also been recognized in article 13 of the Convention on
the Elimination of All Forms of Discrimination Against Women and in article 30 of the
Convention on the Rights of Persons with Disabilities.
6. Moreover, in 2004, the World Health Assembly endorsed the Global Strategy on
Diet, Physical Activity and Health, of the World Health Organization (WHO), which
outlines actions that must be taken by various actors to foster participation in physical
activity.
7. The present report primarily considers participation in sport and physical activity,
and the right to health. Other lifestyle factors, such as the avoidance of unhealthy foods, are
beyond the scope of the report, and will be discussed to the extent that they are connected
to sport and healthy lifestyles.
Sport, physical activity and health
8. It has been estimated that over 7 per cent of deaths annually are attributable to low
levels of physical activity, along with more than 4 per cent of years of life lost due to
disability (disability-adjusted life years).6 Physical inactivity is estimated as being
responsible for up to 25 per cent of cases of breast and colon cancer, 27 per cent of cases of
diabetes and 30 per cent of cases of ischaemic heart disease.7 Conversely, participation in
physical activity and sport has numerous beneficial effects. Physical activity reduces the
risk of developing cardiovascular diseases, diabetes and cancer, improves levels of high-
density cholesterol, reduces blood pressure, and improves blood glucose level control
among the overweight.8 Physical activity also reduces the risk of depression and is a vital
aspect of energy balance and weight control.9 Accordingly, WHO has developed the Global
Recommendations on Physical Activity for Health, which are designed to provide guidance
on the optimal and the minimum levels of exercise that individuals should partake in to
accrue these health benefits.
9. There is no universal definition for “sport”, as a separate concept to that of physical
activity. Sport has been defined as “all forms of physical activity that contribute to physical
fitness, mental well-being and social interaction”, including play, recreation, casual,
organized or competitive sport, and indigenous sport or games.10 In the present report,
“sport” refers to competitive or organized sport involving physical activity; it is considered
a subset of “physical activity”, which refers to bodily movement that is not necessarily
competitive or organized (e.g. walking or cycling for transport or recreation).
10. The benefits of sport, over and above unstructured physical activity, have not yet
been fully ascertained, and more research is required in this area. However, preliminary
findings indicate that a larger quantum of health benefit is gained from low-to-moderate
participation in team sports than in more individual activities such as walking or
gymnasium use.11 Positive psychological outcomes, including improved well-being and
6 Institute for Health Metrics and Evaluation, The Global Burden of Disease: Generating Evidence,
Guiding Policy (Seattle, 2013).
7 WHO, Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks
(2009).
8 WHO, Global Strategy on Diet, Physical Activity and Health (2004).
9 WHO, Global Recommendations on Physical Activity for Health (2010).
10
UNICEF, Protecting Children from Violence in Sport (2010).
11 Rochelle Eime and others, “Does sports club participation contribute to health-related quality of life?”
Medicine and Science in Sports and Exercise, vol. 42, No. 5 (December 2009).
social functioning and reduced stress, are reported more frequently among sports
participants,12 as is improved life satisfaction.13 Additionally, although any form of daily
physical activity is associated with a lowered risk of psychological distress, the strongest
effect is seen in sport (as opposed to other activities such as walking or domestic work).14
11. However, overtraining, doping and the performing of unnecessary medical
procedures can have negative health impacts on individuals, and may represent rights
violations in some instances. Moreover, certain types of sport or physical activity may
produce positive effects in some subpopulations and negative effects in others.15 For
instance, participation in sporting activities where physical appearance is an important
factor may increase the risk of developing female athlete triad, a syndrome suffered by
female athletes which may involve eating disorders, delayed or interrupted menstruation,
and osteoporosis (low bone mass). This syndrome is usually caused by self-imposed or
externally driven pressure to maintain an unrealistically low body weight. For these
reasons, a nuanced approach is required when considering sport and physical activity as a
tool for realizing the right to health.
III. Obligations of States regarding sport and healthy lifestyles and the right to health
12. In its general comment No. 14 (2000) on substantive issues arising in the
implementation of the International Covenant on Economic, Social and Cultural Rights, the
Committee on Economic, Social and Cultural Rights confirmed that certain aspects of
human health cannot be addressed solely within the relationship between States and
individuals, and noted that various factors may play an important role in relation to human
health, such as genetic factors or the adoption of unhealthy or risky lifestyles. However, this
does not absolve States of any obligations in this regard. Just as a State may implement a
genetic diseases screening project to improve the health of the population despite being
unable to modify genetic risk, an obligation also arises for States to attempt to reduce the
extent to which individuals adopt unhealthy or risky lifestyles, even if they cannot directly
influence individual behaviour.
13. There has been a troubling tendency to view engagement in physical activity as an
individual or moral obligation, and to characterize a sedentary lifestyle as a personal failing,
to be overcome with willpower. This ignores the powerful role that social or structural
determinants of health play in dictating supposed lifestyle “choices”, and the vital role of
the State in mitigating the effect of such negative determinants by promoting, facilitating
and encouraging the adoption of healthy lifestyles through education, social policy and
public investments.16 Illustrating this principle, the Committee on Economic, Social and
Cultural Rights has expressly stated that the obligation to “fulfil” requires States to
disseminate appropriate information relating to healthy lifestyles and nutrition and to
12
Rochelle Eime and others, “A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through
sport”, International Journal of Behavioral Nutrition and Physical Activity, vol. 10 (December 2013).
13 Runar Vilhjalmsson and Thorolfur Thorlindsson, “The integrative and physiological effects of sport
participation: a study of adolescents”, Sociological Quarterly, vol. 33, No. 4.
14 Mark Hamer, Emmanual Stamatakis and Andrew Steptoe, “Dose-response relationship between
physical activity and mental health: the Scottish Health Survey”, British Journal of Sports Medicine,
vol. 43, No. 14.
15 Melinda Asztalos and others, “Specific associations between types of physical activity and
components of mental health”, Journal of Science and Medicine in Sport, vol. 12, No. 4. 16 WHO, Report of the Commission on Ending Childhood Obesity (2016).
encourage and support people in making informed choices about their health;17 this
encompasses provision of appropriate information regarding sport and physical activity,
and ensuring the availability, accessibility, acceptability and quality of certain goods,
services and facilities.
14. Additionally, article 12 of the International Covenant on Economic, Social and
Cultural Rights requires States parties to take steps necessary for the prevention, treatment
and control of epidemic, endemic, occupational and other diseases. As overweight and
obesity reach endemic levels in much of the world, and are becoming increasingly
prevalent in developing countries,18 States should address the underlying determinants of
these diseases — such as a sedentary lifestyle — in fulfilment of their obligation pertaining
to prevention. This conclusion is supported by the General Assembly, which recognizes
prevention as the “cornerstone” of the global response to non-communicable diseases, and
the “critical importance” of reducing people’s exposure to modifiable risk factors related to
diet and physical inactivity.19
15. In order to discharge these obligations that are accrued under the right to health,
States should take varying actions depending on their particular state of development and
availability of resources.
Respect
16. The obligation to respect the right to health by refraining from denying or limiting
access to health services and by abstaining from enforcing discriminatory practices as a
State policy extends to participation in sport and physical activity. All people should be
permitted to access State-run sporting facilities on an equal basis. Discrimination in access
on grounds such as gender, race, ethnicity, religion, sexual orientation, gender identity, sex
characteristics, or legal and health status (including HIV/AIDS status) is not permissible.
States should conduct an inclusive, participatory and transparent audit of practices, rules
and by-laws relating to sport and the right to health in order to determine their compatibility
with human rights standards and should remove any which are discriminatory.
17. Moreover, sport and physical activity should be taken into account in all
governmental policies, in accordance with the Helsinki Statement on Health in All
Policies.20 States must ensure that relevant laws, policies and programmes in non-health
sectors, which are de jure or de facto discriminatory, are not adopted, or are amended or
rescinded. For example, States should refrain from implementing and enforcing laws and
policies that limit equitable access to goods such as affordable and nutritious food and clean
water, and allow people to adopt healthy diets and fully participate in physical activity.
Similarly, States should revise planning policies that inequitably allocate communal spaces
for public recreation and exercise, or that concentrate infrastructure for active transport,
such as walking, cycling and skating, in affluent areas.
18. Finally, States should refrain from interfering with athletes’ health rights by means
of laws, policies or programmes involving forced or coercive medical treatments or
experimentation, such as doping, conducted in order to enhance sporting ability among
athletes.
17
See general comment No. 14. 18 WHO, Global Status Report on Non-communicable Diseases (2014).
19
See General Assembly resolution 66/2.
20 See www.who.int/healthpromotion/conferences/8gchp/8gchp_helsinki_statement.pdf.
Protect
19. States should ensure full compatibility between sport policies, rules, programmes
and practices, and human rights law, and should intensify their efforts to prevent systemic
and ad hoc rights violations perpetrated by third parties. States should develop policies that
incorporate international human rights standards, and should require public and third-party
providers to adopt policies that are compatible with human rights standards, making
funding or support contingent on that adoption, where appropriate. For example, sport
policy programmes could require national sports organizations to respect the Convention on
the Rights of the Child and to conduct mandatory monitoring of child rights in sports.
20. States should also provide training and materials to sports organizations on the
adoption of rights-based approaches to health in the sporting context. These should include
information on protection against physical, sexual and psychological abuse, exploitation
and violence, on protection against discrimination and on gender equality, on appropriate
limits for intensive training, especially for children and young people, on protection against
coercive/forced doping and medical procedures, and on other rights connected to the right
to health and sport, such as young athletes’ right to an education.
21. Protection of the human rights of those participating in sport and physical activity is
a State obligation under the right to health. There are numerous documented instances of
health rights abuses within competitive sport: the General Assembly has acknowledged
with concern “the dangers faced by sportsmen and sportswomen, in particular young
athletes, including, inter alia, child labour, violence, doping, early specialization,
overtraining and exploitative forms of commercialization, as well as less visible threats and
deprivations, such as the premature severance of family bonds and the loss of sporting,
social and cultural ties”.21
22. Such practices also exist at the amateur level but are less well researched. For
example, injury, illness and violence arising in the context of organized children’s sport is
frequently documented, but the extent to which it occurs globally is still unknown.22 In
some instances, breaches of the health rights of athletes occur with the knowledge or tacit
consent of the State, especially in the competitive context. However, such violations of
athletes’ human rights are rarely addressed in a systematic manner, probably because of the
positive image of sports.23
23. Many rights violations stem from a “winning at all costs” mentality that is tolerated
or actively encouraged by States, particularly in competitive sporting contexts. A certain
level of “healthy” sporting competition can foster participation, encourage individuals to
strive for excellence, empower women and girls, and in many instances, increase individual
enjoyment. However, appropriate safeguards should be implemented to ensure the
protection of all amateur and professional athletes. As a broad, overarching principle, States
should create an inclusive sporting environment wherein an optimal level of
competitiveness is reached, and those participating in sports are protected from the harmful
effects of overly competitive environments.
24. States should provide mechanisms through which normative review and legal
enforcement, as pertains to alleged health rights violations, can occur. There should be no
barrier to the investigation and prosecution of such incidents, as competitive and amateur
sports are as subject to international human rights law as any other activity undertaken
within a State’s jurisdiction. As an interim option or an alternative, it may be necessary or
21
See General Assembly resolution 58/5.
22 UNICEF, Protecting Children from Violence in Sport.
23
Paulo David, Human Rights in Youth Sport (London, Routledge, 2005).
most effective for States to create independent complaints and monitoring mechanisms,
potentially using existing human rights institutions, that people can utilize in the event of an
alleged breach of their right to health in the sporting context. These could allow for redress
and remedy through alternative dispute resolution mechanisms, such as mediation and
arbitration. However, this should not preclude the referral of serious violations to national
courts, especially allegations of criminal activity, which must be treated as criminal activity
as in any other setting.
Fulfil
25. States should take action to ensure that sufficient resources and infrastructure are
devoted to enabling people to access and participate in sport and physical activity, as part of
a broader strategy to encourage the adoption of healthy lifestyles. Three primary steps must
be taken by States in this regard. Firstly, States should immediately include the facilitation
and promotion of physical activity and healthy lifestyles in national planning, if this has not
already been done. Secondly, quality physical education programmes, including in school
and health-care settings, should be established (or updated) in accordance with human
rights standards. Finally, progressive implementation, expansion and/or improvement of
goods, facilities, services and information provision relevant to sport and healthy lifestyles
should be undertaken, subject to resource constraints.
26. The incorporation of physical activity and healthy lifestyles into existing national
health plans, or the development of such a plan, should be a foremost priority of States
under the right to health, as a core obligation that is not subject to the principle of
progressive realization, alongside non-discrimination. The Global Strategy on Diet,
Physical Activity and Health encourages States to build on existing national strategies and
action plans concerning aspects of diet, nutrition and physical activity, and to create a
national coordinating mechanism that addresses diet and physical activity within a
comprehensive plan for preventing non-communicable diseases and promoting health.24
However, in many countries, there is alarmingly little planning: WHO has noted a paucity
of national physical activity guidelines in low- and middle-income countries, and has
confirmed that the public health significance of physical activity warrants the development
of such guidelines.25 Such guidelines must be developed in reference to prevailing evidence
and good practices in the region concerned.
27. Multisectoral collaboration can be a successful means of achieving national physical
activity goals; for this, communication and cooperation between different parts of the
government is vital. Some States have achieved multisectoral collaboration through formal
cooperation agreements between relevant ministries; for example, Greece reports using a
“cooperation protocol” between the ministries concerned in order to implement common
physical activity interventions in schools, the workplace and public places. What is
appropriate will vary according to national circumstances, but some framework or
mechanism must be established in order to ensure that the collaboration occurs.
28. The importance of multisectoral collaboration is reflected in the Helsinki Statement
on Health in All Policies, and in the 2011 Political Declaration of the High-level Meeting of
the General Assembly on the Prevention and Control of Non-communicable Diseases
wherein the General Assembly encouraged implementation of the Global Strategy on Diet,
Physical Activity and Health through the introduction of policies and actions aimed at
promoting healthy diets and increasing physical activity in the entire population, in all
aspects of daily living. The General Assembly also noted that implementation of the Global
24
WHO, Global Strategy on Diet, Physical Activity and Health.
25 WHO, Global Recommendations on Physical Activity for Health.
Strategy on Diet, Physical Activity and Health in this way could include giving priority to
regular physical education classes in schools, and the increased availability of safe
environments in public parks and recreational spaces to encourage physical activity.26
29. The provision of education is a State obligation under article 13 of the International
Covenant on Economic, Social and Cultural Rights, which should include physical
education. The right of the child to education is also recognized in article 28 of the
Convention on the Rights of the Child. Physical education is not limited to people of school
age, however; it is confirmed in the International Charter of Physical Education, Physical
Activity and Sport that every human being has a right to physical education, and that
physical education, activity and sport programmes must inspire lifelong participation. This
is bolstered by other human rights instruments, including the Convention on the
Elimination of All Forms of Discrimination against Women which explicitly obliges States
to provide women with the same opportunities to participate actively in physical education
as men.27 Accordingly, all States should take steps to update school curricula and other
relevant policies to ensure compatibility with the relevant human rights instruments and the
International Charter of Physical Education, Physical Activity and Sport. States should also
take steps to facilitate or provide access to physical education for people who are not
enrolled in formal education.
30. In considering the other steps necessary to increase participation in physical activity,
State obligations to facilitate, provide and promote the right to health can be considered
separately.
Facilitate
31. States should implement measures to facilitate the use of sporting goods, services,
information and facilities. This facilitation can be considered in terms of availability,
accessibility, acceptability and quality, and may take the form of economic assistance, or
direct interventions or training. Consultations carried out for the present report suggest that,
where appropriate, a State might financially partner with private entities to build facilities,
in order to improve availability in certain areas or regions. Or, where accessibility is
constrained on financial grounds for certain members of the population, subsidized access
to sporting goods, services and facilities should be considered. A State might achieve this
by implementing a voucher system (Georgia) or by adopting a policy allowing free or low-
cost access to group sport or classes (Israel). Other interesting examples include waiving
taxation on sporting goods (Brunei) and implementing taxation exemptions for bicycle use
(Finland). Finally, States may take steps to improve both the acceptability and the quality of
existing resources, by training and sensitizing personnel at sporting facilities within its
jurisdiction and by engaging the populations concerned in the design, monitoring and
evaluation of sports-related policies, programmes and services.
32. States can take other steps to facilitate the adoption of healthy lifestyles, with a view
to ensuring policy coherence and effectiveness. One such measure is the adoption of laws
limiting the marketing of tobacco and unhealthy food and beverages in the context of
school-based sporting activities and at professional sporting events. Food advertising is
frequently geared towards children, and much of it concerns foods with high levels of
saturated fat, trans-fatty acids, sugar or salt (referred to hereinafter as “unhealthy foods”);
this influences children’s preferences, purchase requests and consumption patterns.28 WHO
has recommended that settings where children gather should be free from all forms of
26
See General Assembly resolution 66/2.
27 See art. 10 (g).
28
See General Assembly resolution 66/2.
marketing of unhealthy foods; this includes settings in which sporting or cultural activities
for children are held.29 Regulating or banning the advertising, promotion and sponsorship of
tobacco30 and alcohol31 in these contexts is also recommended by WHO.
33. States should ban the advertising, promotion and sponsorship of all children’s
sporting events, and other sporting events which could be attended by children, by
manufacturers of alcohol, tobacco, and unhealthy foods. States should create guidelines that
either restrict altogether, or minimize the impact of, the marketing of unhealthy foods,
alcohol and tobacco in the context of all sporting events.
Provide
34. The construction and maintenance of adequate public spaces for active transport and
participation in physical activity is a core State responsibility. Provision of these public
goods facilitates equitable adoption of healthy lifestyles, as individuals require few
resources to utilize such facilities. For example, States should ensure that safe walking and
cycling paths are available and accessible to all people to encourage increased pedestrian
and cycling activity for transport and exercise. Similarly, States should provide “green
spaces” for people to play sport, exercise, and engage in recreation, especially in the urban
context. This is in accordance with the International Charter of Physical Education,
Physical Activity and Sport, which confirms that adequate and safe spaces, facilities and
equipment are essential to quality physical education and activity, and sport (art. 8).
35. States should also make provision for groups or individuals that are unable to realize
their right to health by the means at their disposal. In relation to sport and healthy lifestyles,
what this entails will depend on country-specific circumstances and resources. Such steps
could include establishing State-run sporting facilities that cater to people unable to access
private facilities, or directly sponsoring team-based sports for key populations and groups
in vulnerable situations, in order to improve the availability and accessibility of physical
activity for those people.
36. Encouragingly, some States provide subsidized or free access to sporting goods,
services and facilities to certain groups in society. Sports activities for people with
disabilities are free in Azerbaijan, in accordance with a resolution of the Cabinet of
Ministers; similarly, in Bosnia and Herzegovina, access to sports camps for children is free.
The Special Rapporteur recommends the adoption of similar approaches elsewhere, subject
to the needs of the population and resource availability.
Promote
37. The obligation to promote the right to health requires States to take actions to create,
maintain and restore the health of the population. In order to fulfil this obligation, a State
must: (a) foster recognition of factors favouring positive health results; (b) ensure that
services are culturally appropriate; (c) disseminate appropriate information; and (d) support
people in making informed choices about their health.
38. States should engage in participatory and transparent research, monitoring and
evaluation in order to determine the strategies that most effectively foster full and equal
participation in sport and the adoption of healthy lifestyles and improve the health of the
populace.
29
WHO, Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children (2010).
30
WHO, Banning Tobacco Advertising, Promotion and Sponsorship (2013).
31 WHO, Global Strategy to Reduce the Harmful Use of Alcohol (2010).
39. The needs, experiences and preferences of target populations must be considered
when formulating policies or programmes concerning sport and healthy lifestyles, and in
constructing facilities. People are entitled to participate in the formulation of policies and
programmes that will have a direct impact upon them, and their involvement must be
secured from the design stage of any intervention. Moreover, as health behaviour is the
product of social structures and practices, interventions should be adapted for specific
groups based on the meaning that they attach to healthy lifestyles, in order to ensure
relevance and effectiveness.
40. States should take steps to disseminate information to populations on sport and
healthy lifestyles. Such dissemination takes two primary forms: physical education, and
awareness-raising through the media and other channels. States should raise awareness of
the importance of physical activity (outside of formal education mechanisms) and should
encourage individuals to participate through public health campaigns. Again, what is
appropriate will vary based on the jurisdiction, but encouraging examples are provided by
certain States, such as mass exercise on World Day for Physical Activity to promote
participation in sport.
41. Finally, States should do more than simply disseminating information on sport and
healthy lifestyles to the populace. Steps must be taken to support the adoption of healthy
lifestyles, by creating mechanisms through which healthy choices become the easier and
preferred option and poor lifestyle choices are avoided. This can occur through structural
changes to environments, for example, which create inexpensive and safe active transport
options.
IV. Sport and healthy lifestyles and the right to health of key populations and groups
A. Children32
42. Specific obligations accrue under the right to health in relation to children and the
adoption of healthy lifestyles. Pursuant to article 12 (2) (a) of the International Covenant on
Economic, Social and Cultural Rights, States parties are required to take steps necessary to
achieve the healthy development of the child; this includes steps to facilitate the
participation of children in safe and inclusive play and sport. Moreover, this is consistent
with the Convention on the Rights of the Child, which recognizes the right of children to
engage in play and recreational activities and requires States to encourage the provision of
appropriate and equal opportunities for recreational and leisure activity (art. 31).
43. The benefits of participation in physical activity and sport and the adoption of
healthy lifestyles can be especially pronounced for children. Physically active young people
have higher levels of cardiorespiratory fitness, better metabolic profiles, improved bone
health and fewer symptoms of anxiety and depression. Accordingly, WHO has
recommended that children and adolescents should participate in 60 minutes of cumulative
32
The present report defines “children” as all persons below the age of 18, unless majority is attained earlier under applicable State law, in accordance with art. 1 of the Convention on the Rights of the
Child.
physical activity daily.33 Among adolescents, there is a correlation between participation in
organized sport and an increased likelihood of meeting physical activity targets.34
44. The benefits of sport and physical activity in relation to holistic development must
also be recognized. The United Nations Children’s Fund (UNICEF) has identified sport as a
tool to help overcome children’s social exclusion. Children who have suffered violence and
abuse are less likely to participate in organized team sport.35 However, where efforts are
made to include marginalized children, the benefits of participation in sport include
changing community perceptions of the capabilities of particular groups, and creating self-
empowerment by changing children’s perceptions of themselves and their abilities.36
45. States should first respect the right to health through the avoidance of discrimination
against children as regards their participation in sport and physical activity. Goods,
services, facilities and information relating to sport must be equally available to all
children, and be safe and appropriate to their age and ability; additionally, provision should
be made for children to access separate facilities where it is unsafe for them to use adult
facilities.
46. Competitive sport is notable for being one of the few remaining areas within society
that has largely failed to integrate human rights standards pertaining to children.37 In many
sports, training must commence at a very early age in order for athletes to be competitive
when reaching majority. Eating disorders are more prevalent in adolescents than in the
general population, and are particularly prevalent among top athletes.38 Furthermore, a drift
towards professionalism in competitive sport has been associated with compromises of the
rights of child athletes, ranging from physical and emotional abuse through to doping,
sexual violence and even the trafficking of child and adolescent athletes.39 The true extent
of these problems is unknown, due to challenges in data collection and insufficient
research.
47. States should take steps to establish frameworks and minimum standards of care and
protection for children participating in sports to protect them from the risks of abuse,
overtraining and violence and should promote guidelines for healthy participation in sport
at all levels for minors. They should ensure that children and adolescents have recourse to
effective, safe and child-sensitive counselling, reporting and complaints mechanisms, in the
event of health rights violations. Moreover, children should only engage in intensive
training programmes and/or professional sport at ages when their cognitive development is
sufficient for them to understand the concept and implications of competition, in order to
avoid negative impacts on their early development.
48. International sporting actors must take more action to ensure that the rights of
children participating in their competitions or events are protected. Presently, there are no
consistent minimum age limits for competing in international adult sporting events, nor is
there any coordinated action regarding the international movement of children and
adolescents for participation in high-level or professional sport. Responsibility for the well-
33
WHO, Global Recommendations on Physical Activity for Health.
34 Stewart Vella and others, “Associations between sports participation, adiposity and obesity-related
health behaviors in Australian adolescents”, International Journal of Behavioral Nutrition and
Physical Activity, vol. 10, No. 1 (October 2013).
35 UNICEF, Protecting Children from Violence in Sport.
36
UNICEF, “Inclusive sport”, 15 May 2015. Available from www.unicef.org/sports/23619_57597.html.
37 Paulo David, Human Rights in Youth Sport.
38 Marwan el Ghoch and others, “Eating disorders, physical fitness and sport performance: a systematic
review”, Nutrients, vol. 5, No. 12 (2013).
39 UNICEF, Protecting Children from Violence in Sport.
being of young athletes is often delegated to States or national sporting organizations.
International sporting actors should standardize policies and protocols concerning the
participation of children in high-level or professional sport in order to protect the children’s
health and other human rights.
49. Finally, States should take steps to fulfil the right to health of all children by
ensuring safe access to sport and physical activity and physical education, and through
provision of the goods, services, facilities and information necessary to enable all children’s
equitable participation.
B. Lesbian, gay, bisexual, transgender and intersex people
50. Historically, sport has often involved forms of “hegemonic masculinity”: boys and
men have frequently been enabled or encouraged to exhibit aggressive, violent or
discriminatory behaviour in competitive sport, including sexism, misogyny, homophobia
and transphobia.40 A welcome shift in this paradigm has occurred in a number of regions
and countries where homophobia has decreased, where this has included the area of sports.
Nevertheless, levels of homophobia, transphobia, and discrimination against intersex
people remain high in most countries. Those who are perceived to fall outside dominant
gender and heteronormative standards, including lesbian, gay, bisexual, transgender and
intersex people, continue to face discriminatory treatment and restrictions in sport,
including discrimination, harassment and violence, and a lack of safe and welcoming
spaces for participation.
51. Numerous issues arise in respect of persons who are lesbian, gay or bisexual in the
context of sport. In a recent six-country survey, 80 per cent of respondents reported having
witnessed or experienced homophobia in sport, and nearly 20 per cent of gay men reported
having been assaulted during sports activities.41 In certain jurisdictions, lesbian athletes
have been harassed and subjected to violence, including “corrective rape”, on the basis of
their sexual orientation.
52. Acts of violence, discrimination and marginalization represent human rights
breaches that prevent individuals from achieving the highest attainable standard of health.
More must be done to secure the full and safe participation of lesbian, gay and bisexual
people in sport and physical activity. States should decriminalize homosexuality and repeal
other laws used to arrest and punish individuals on the basis of their sexual orientation, and
should protect individuals by implementing and enforcing anti-discrimination laws,42
including in sport.
53. Moreover, sex segregation policies have led to multiple rights violations in sport.
Sex segregation has historically been justified on the basis of safety and fairness, rooted in
assumptions of male physical superiority. Various legal decisions have noted that this is a
generalization and have granted individual girls and women the right to compete in male
sporting competitions — although not vice versa.43 Although it is important to preserve
40
Jennifer Hargreaves and Eric Anderson, eds., Routledge Handbook of Sport, Gender and Sexuality (Oxford, Routledge, 2014).
41
Erik Denison and Alistair Kitchen, Out On The Fields: The First International Study on Homophobia in Sport (2015).
42
Paulo David, Human Rights in Youth Sport.
43 Erin Buzuvis, “Transgender student-athletes and sex-segregated sport: developing policies of
inclusion for intercollegiate and interscholastic athletics”, Seton Hall Journal of Sports and
Entertainment Law, vol. 21, No. 1 (2011).
spaces for girls and women to confidently participate in sport, this should not result in
exclusion of others, such as transgender people.
54. States should identify groups that are currently excluded from sport and physical
activity, and through participatory mechanisms, create an inclusive culture wherein lesbian,
gay, bisexual, transgender and intersex people and other historically excluded groups and
individuals can fully and safely participate in sport.
Intersex people
55. Current and historic policies have resulted in intersex people — those born with sex
characteristics that do not fit with typical binary sex categorization — experiencing
multiple rights violations. Sex testing has frequently been conducted to avoid the apparent
threat of “sex fraud” (participating under an assumed gender to obtain a competitive
advantage).44 However, no single test “determines” gender. In the recent past, women
athletes have undergone chromosomal testing, only to discover that they do not possess two
X chromosomes. This has led to stigmatization and to spurious exclusion from competitive
sport.45
56. Recently, certain international and national sporting federations have instead
introduced policies banning women with testosterone levels exceeding a certain threshold
from participating in competitive sport. However, there is insufficient clinical evidence to
establish that those women are afforded a “substantial performance advantage” warranting
exclusion.46 Although currently suspended, following the interim judgement in Chand v.
Athletics Federation of India and the International Association of Athletics Federations,47
these policies have led to women athletes being discriminated against and forced or coerced
into “treatment” for hyperandrogenism. In fact, a number of athletes have undergone
gonadectomy (removal of reproductive organs) and partial cliteroidectomy (a form of
female genital mutilation)48 in the absence of symptoms or health issues warranting those
procedures.49
57. Sporting organizations must implement policies in accordance with human rights
norms and refrain from introducing policies that force, coerce or otherwise pressure women
athletes into undergoing unnecessary, irreversible and harmful medical procedures in order
to participate as women in competitive sport. States should also adopt legislation
incorporating international human rights standards to protect the rights of intersex persons
at all levels of sport, given that they frequently report bullying and discriminatory
behaviour,50 and should take steps to protect the health rights of intersex women in their
jurisdiction from interference by third parties.
Transgender people
58. Participation in professional sport is often deliberately or effectively denied to
transgender people, and people of non-binary gender. There remains uncertainty regarding
44
J.C. Reeser, “Gender identity and sport: is the playing field level?” British Journal of Sports Medicine, vol. 39, No. 10.
45 Erin Buzuvis, “Transgender student-athletes…”
46
J.C. Reeser, “Gender identity and sport: is the playing field level?” 47 CAS 2014/A/3759, Court of Arbitration for Sport.
48 J.C. Reeser, “Gender identity and sport: is the playing field level?”
49
Rebecca Jordan-Young, Peter Sönksen and Katrina Karkazis, “Sex, health and athletes”, British Medical Journal, vol. 348.
50 Tiffany Jones and others, Intersex: Stories and Statistics from Australia (Open Book Publishers,
2016).
“classification” by sports bodies of persons as male or female within sex-segregated sport
— for those undergoing gender transition through clinical treatment and for those who are
not — as well as concerns with regard to the arbitrary nature of such classifications. The
barriers that this presents to participation are unwarranted and unfair.
59. Encouragingly, the recent consensus statement of the International Olympic
Committee on sex reassignment and hyperandrogenism addresses this issue. However,
consensus should be reached among all international sporting bodies and national
governments, in consultation with transgender organizations, on participation by
transgender people and non-binary people in sporting competitions. Policies must reflect
international human rights norms, should not exclude transgender people and non-binary
people from participation and should not require irrelevant clinical data or unnecessary
medical procedures as a precondition to full participation.
60. At the amateur level, sporting facilities and teams can be hostile spaces for
transgender athletes, including non-binary people. Barriers include poorly designed
changing rooms, requirements to wear clothing that might cause individual discomfort or
hinder bodily movement, and restrictions on the use of sex-segregated bathrooms.
61. The repeal of laws criminalizing transgender people on the basis of their gender
identity or expression, and the legal recognition of gender identity based on self-
identification (without abusive requirements) is a prerequisite for transgender people to
access sports and enjoy healthy lifestyles. States, sporting organizations and other actors
should adopt anti-discrimination policies that permit all persons to participate in amateur
sport on the basis of their self-identified gender. Practical steps to create welcoming spaces
for participation in sport and physical activity for transgender people and non-binary people
could include the installation of appropriate changing rooms, the sensitization of sporting
communities, and the enforcement of anti-discrimination laws in the sporting context.
C. Women
62. In addition to the rights outlined in the International Covenant on Economic, Social
and Cultural Rights, article 13 of the Convention on the Elimination of All Forms of
Discrimination against Women guarantees women equal rights to participate in recreational
activities, sports and all aspects of cultural life, without discrimination. This is reinforced
by the obligation under article 10 of the Convention on the Elimination of All Forms of
Discrimination against Women to take all appropriate measures to eliminate discrimination
against women in respect of education, ensuring to women the same opportunities as to
men to participate actively in sports and physical education. Article 5 of the same
Convention also requires States to eliminate stereotyped roles for men and women, which
equally applies in the field of sport and physical activity.
63. Securing the right of women to participate in physical activity can improve women’s
health. Women experience certain health risks at higher rates than men at various points in
their lifespan, which are mitigated by exercise. For example, regular weight-bearing
exercise has been shown to reduce the incidence of osteoporosis, a bone disease
experienced primarily by postmenopausal women.51 Risks of other illnesses suffered almost
exclusively by women, such as breast cancer, can also be modified through the promotion
of physical activity and healthy lifestyles.
51
Tracey Howe and others, “Exercise for preventing and treating osteoporosis in postmenopausal
women”, Cochrane Database of Systematic Reviews, Issue 7.
64. Women constitute half of the world’s population and are a highly heterogeneous
group; health risks are not shared equally among all women. Overweight and obesity are
increasingly prevalent among adolescent girls from highly urbanized areas, certain ethnic
minorities, and those living with disabilities. Moreover, adolescent girls are particularly
vulnerable to anxiety and depressive disorders, in comparison to boys.52 Accordingly, there
is a significant need to engage at-risk women and girls in physical activity and sport,
particularly at points when activity levels are most likely to drop steeply.
65. The obligation to respect the right to health requires effort in order to combat
entrenched discrimination against women in the field of sport and physical activity. Both at
the professional and the amateur levels, there remains a worrying gender differential in
participation in sport.
66. In some instances, unequal participation of women in sport is directly sanctioned by
State policies, in a clear violation of the obligation to respect the right to health. In some
countries, nearly all State-supported sports clubs and private gymnasiums are reportedly
closed to women. Although there has been a positive shift in the attitude to professional
sport recently in certain parts of the world, there is still a strong cultural assumption that
women will not engage in exercise. States should ensure that women can exercise their
right to participate in and to attend sporting events, as well as to receive physical education.
67. Elsewhere, pernicious practices and beliefs hinder women’s equal participation in
sport. Despite repeated declarations and calls for action on equality in sport since the 1994
Brighton Declaration on Women and Sport,53 women’s sport remains deprioritized and
heavily underfunded globally. Among professional athletes, there are significant disparities
between men and women in respect of incomes and prize money. One study found that men
receive more prize money than women in 30 per cent of sports.54 Moreover, men’s sport
dominates media reporting.55 , 56
68. These examples reflect deep-seated bias towards men’s sport, which diminishes the
opportunities for women in sport at all levels. States and other actors must act to shift
public consciousness away from a male-dominated sporting culture. States should review
their laws, policies and programmes, and amend or repeal those that discriminate against
women and girls and prevent them from participating in sport on an equal basis with men.
69. It is encouraging that international sporting bodies are taking steps to improve the
status of women in sport. For example, the International Olympic Committee created a
commission on women and sport in 1995, and in 2004 the Olympic Charter was amended
in recognition of the need for action on women and sport; in addition, various regional
intergovernmental bodies have promulgated recommendations and policies concerning
sport and gender equity.57
52 R. Bailey, I. Wellard and H. Dismore, Girls’ participation in physical activities and sports: benefits,
patterns, influences and ways forward (2005).
53
International Working Group on Women and Sport (1994).
54 BBC, “Prize money in sport: BBC Sport study”. Available from www.bbc.com/news/uk-29665693.
55
Cheryl Cooky, Michael Messner and Robin Hextrum, “Women play sport, but not on TV”, Communication and Sport, vol. 1, No. 3.
56
Claire Packer and others, “No lasting legacy: no change in reporting of women’s sports in the British print media with the London 2012 Olympics and Paralympics”, Journal of Public Health, vol. 37,
No. 1.
57 Sport for Development and Peace International Working Group, “Sport and gender: empowering girls
and women”, in Harnessing the Power of Sport for Development and Peace: Recommendations to
Governments (2008).
70. Specific issues also arise for women in connection with sport and the obligation to
protect. There is an alarming broader trend within certain societies towards the controlled
feminization of women in the context of sport, including through violence and reprisals
against female sportspeople. Women in certain countries, simply by engaging in sport and
physical activity, are seen as challenging traditional notions of gender roles in society and
become victims of hostility and ostracism by the general population.
71. These attempts to control the behaviour of women through violence, and to dictate
what an acceptable body image and acceptable activities are, represent clear violations of
their human rights. States should take steps to protect the rights of female athletes, for
example through the enforcement of criminal laws against perpetrators of violence and
through the development of sensitization and education initiatives to combat negative
images and attitudes around women’s participation in exercise and sport.
72. States may not directly deny women access to sporting facilities, as this would be in
breach of the obligation to fulfil. Nevertheless, it is the case that, in some States, there is a
failure to create conditions wherein women can participate effectively in sport and physical
activity. Traditional cultural or societal norms may mean that women cannot exercise in
public spaces, or are inhibited in doing so. Some women may even risk physical harm or
assault when exercising in public. States should take active steps to create safe, gender-
sensitive spaces in which women can exercise, appropriate to the country context; these
may range from the installation of secure changing facilities to the enforcement of criminal
laws that are breached in the sporting context.
73. Moreover, as women’s motivations for engaging in exercise often differ from those
of men, greater attention to acceptable forms of organized sport may increase female
participation. Research has indicated that women frequently place more importance on
social aspects of physical activity than on performance outcomes.58 In order to promote
physical activity and sport, States should inform their policies with research, and adopt best
practices adapted to the country and to the preferences of women, with meaningful
participation by women in the design, implementation, monitoring and evaluation of
policies and programmes.
D. Elderly people
74. In its general comment No. 14 (2000) on the right to the highest attainable standard
of health, the Committee on Economic, Social and Cultural Rights recognized the
importance of an integrated approach to the health of older persons, including preventive,
curative and rehabilitative health treatment. Promotion of participation in sport and physical
activity is among the most cost-effective interventions that States can undertake in order to
prevent morbidity and mortality among older persons and to ensure that they achieve the
highest possible standards of physical and mental health.
75. Physically active older people have lower rates of all-cause mortality than their
sedentary counterparts, and experience many health benefits, including healthier body mass
and improved bone health, and lowered risk of coronary heart disease, high blood pressure,
diabetes and cancer. Moreover, regular exercise plays an important role in preventing
depression and cognitive decline.59
76. In addition to the above-mentioned biomedical benefits, participation in organized
sport may have significant benefits for older adults as regards increased social interaction
58
VicHealth, “Female participation in sport and physical activity” (2015). 59 WHO, Global Recommendations on Physical Activity for Health.
and connectedness. Moreover, sport can be used as a tool to promote “active ageing” —
elderly people being active and engaged in society — to combat negative and inaccurate
images of the elderly that portray ageing as an inevitable and irreversible decline in
function.
77. States should respect the right to health of elderly people by refraining from
discriminating in the form of denying access to conditions enabling them to live healthy
lifestyles, which includes their access to sporting goods and facilities. States should also
protect the right to health of the elderly by creating complaint and recourse mechanisms for
those whose rights have been violated and by sensitizing third parties to the needs and
abilities of the elderly in the sporting context. Finally, States should fulfil the right to health
of the elderly by facilitating or providing goods, services, facilities and information, in the
area of sport and exercise, that are available, acceptable, accessible and of high quality.
E. Persons with disabilities
78. Persons with disabilities should have access to, and benefit from, medical and social
services that enable them to become independent, prevent further disabilities and support
social integration.60 Moreover, persons with disabilities must be provided with
rehabilitation services enabling them to reach and sustain optimum levels of independence
and functioning.61 Furthermore, the Committee on Economic, Social and Cultural Rights
has confirmed that private providers of services and facilities, as well as the public health
sector, must comply with the principle of non-discrimination. These principles are echoed
in article 25 of the Convention on the Rights of Persons with Disabilities, which provides
for the right of enjoyment of the highest attainable standard of health for people with
disabilities, without discrimination on the basis of disability.
79. Moreover, under article 30 (5) of the Convention on the Rights of Persons with
Disabilities, States are required to take appropriate measures to enable persons with
disabilities to participate on an equal basis with others in recreational, leisure and sporting
activities. These measures include encouraging and promoting the participation of persons
with disabilities in mainstream sporting activities at all levels, ensuring that persons with
disabilities can organize, develop and participate in disability-specific sporting and
recreational activities, and ensuring that persons with disabilities have access to sporting
venues and services. The right of children with disabilities to have equal access to play,
recreation and leisure and sporting activities is explicitly acknowledged in the Convention.
In addition, the Standard Rules on the Equalization of Opportunities for Persons with
Disabilities provide guidance on the types of interventions required in relation to sport and
healthy lifestyles for persons with disabilities (see rule 11).
80. As physical inactivity is associated with deterioration in the physical and
psychological health of persons living with disabilities,62 participation in sport and physical
activity may yield more immediate benefits for them than for the rest of the population —
such as improved functional independence and overall quality of life — beyond the
amelioration of long-term health risks. Additionally, persons living with disabilities are at
higher risk of non-communicable diseases.63 For these reasons, investment in achieving
60 Committee on Economic, Social and Cultural Rights, general comment No. 5 (1994) on persons with
disabilities.
61
See E/1995/22.
62 J. Larry Durstine and others, “Physical activity for the chronically ill and disabled”, Sports Medicine,
vol. 30, No. 3.
63 WHO, World Report on Disability (2011).
equitable health outcomes for this population subgroup is particularly important. However,
persons with disabilities are consistently less likely to engage in physical activity than
others,64 and children living with disabilities have been identified as a group requiring
particular attention.65
81. Encouragingly, sport and physical activity for people with disabilities has
increasingly moved away from a “medical-therapeutic” focus on exercise as rehabilitation
or treatment66 towards a more positive, inclusive paradigm incorporating human rights,
where attention is focused on the ability and agency of people with disabilities, on better
health, and on empowerment and the attainment of new skills.67 The increased participation
of people living with disabilities also has wider societal benefits; it dismantles images of
people with disabilities as being passive, inactive and unable to participate, and can
potentially increase social cohesion and inclusion through the removal of negative
stereotypes.
82. Although it is established in the Convention on the Rights of Persons with
Disabilities that States should ensure that persons with disabilities have an opportunity to
organize, develop and participate in disability-specific sporting and recreational activities,
States are only obliged to encourage and promote the participation, to “the fullest extent
possible”, of persons with disabilities in mainstream sporting activities. What “the fullest
extent possible” means in the context of professional and amateur sport is debatable, and
may need further attention.
83. To date, it seems that the appropriateness of participation in mainstream sport at the
professional level has been determined on a case-by-case basis. For example,
accommodations can be made for persons with disabilities to participate in sports such as
golf, which do not alter the fundamental nature of the sport in question, and therefore
should be undertaken to avoid discrimination.68 In situations where accommodations cannot
be made without fundamentally changing the nature of the sport, the question of
participation of persons with disabilities remains uncertain, and should be further examined
by international organizations in consultation with persons with disabilities, to assist States
in promulgating relevant policies.
84. Regarding amateur sport, the physical accessibility of mainstream sporting facilities,
goods and services should be ensured, for example through the incorporation of appropriate
infrastructure in venues. However, physical access can equally be impeded through laws
and policies. In particular, persons with psychosocial disabilities may face barriers in
accessing what they are entitled to under the right to health, and must be given access to
sporting facilities, goods and services without discrimination. This may not necessarily
require investment in infrastructure; rather, a focus on developing acceptable services and
sensitizing service providers may be required.
64
James Rimmer and Alexandre Marques, “Physical activity for people with disabilities”, The Lancet, vol. 380, No. 9838.
65
WHO, Report of the Commission on Ending Childhood Obesity (2016).
66 Ralph Richards, “Persons with disability and sport” (3 February 2016).
67
Sport for Development and Peace International Working Group, “Sport and persons with disabilities”, in Harnessing the Power of Sport for Development and Peace: Recommendations to Governments
(2008).
68
See PGA Tour, Inc. v. Martin, 532 U.S. 661, 121 S. Ct 1879 (2001).
V. Obligations of non-State actors regarding sport and healthy lifestyles and the right to health
85. Although non-State actors do not directly accrue obligations under the right to health
as expressed in the International Covenant on Economic, Social and Cultural Rights, they
nevertheless incur indirect responsibilities regarding realization of the right. Strong
leadership from non-State actors through the incorporation of human rights standards into
operations pertaining to sport and healthy lifestyles is important in promoting realization of
the right to health.
86. Civil society organizations and national human rights institutions should advocate
for the inclusion of sport and healthy lifestyles in relevant national policies, and should
ensure that the voices of marginalized and excluded groups, including children, are part of
the policy-making process. National human rights institutions can also assist States through
information-gathering, monitoring and evaluation.
87. Private entities, including transnational corporations, should ensure that their
operations do not undermine the realization of individual health rights. In particular,
companies that produce tobacco, food or beverages should abide by industry- or
Government-led regulations on marketing products to children in the sporting context.
Companies involved in major sporting events must also ensure that their operations meet
human rights standards, and must fully implement the Guiding Principles on Business and
Human Rights69 — a responsibility shared with international sporting bodies.
88. A number of entities involved in the organization and operation of major sporting
events and competitions incur indirect rights obligations: the International Olympic
Committee, the International Paralympic Committee, and the Fédération internationale de
football association (FIFA), among others. These bodies have a vital role to play in
implementing policies and activities aimed at realizing the right to health in the sporting
context. Enhancement of protection of the human rights of athletes should not be perceived
as a threat to the continued operation of major events but rather as a means of increasing the
confidence of athletes and the public in the integrity of sporting institutions.70
89. It is encouraging that human rights are increasingly emphasized in the operations of
these organizations, for instance through the International Olympic Committee code of
ethics. The recent appointment of an independent human rights expert to review the policies
of FIFA in relation to the Guiding Principles on Business and Human Rights is
encouraging,71 as is the implementation by FIFA in 2010 of regulations on the status and
transfer of players. However, more must be done to ensure that the right to health of
athletes participating in these events is secured, particularly that of children.
90. Moreover, broader human rights concerns exist in regard to major sporting events,
including health risks faced by workers on major event infrastructure projects, such as high
rates of avoidable morbidity and mortality.
91. Given the human rights violations occurring in the context of these events, and
evidence that the interest generated by mega sporting events and professional sport does not
appear to translate into mass participation in sport or physical activity,72 more should be
69
See A/HRC/17/31.
70 Paulo David, Human Rights in Youth Sport.
71
FIFA, “FIFA to further develop its human rights approach with international expert John Ruggie” (14 December 2015).
72
Pedro Hallal and others, “Physical activity: more of the same is not enough”, The Lancet, vol. 380, No. 9838.
done to ensure that the human rights of everybody who is connected with major sporting
events are protected and that these events are not merely held as a spectacle.
VI. Good-practice approaches to sport and healthy lifestyles
92. Specific laws, policies, programmes and interventions embodying human rights
standards should be implemented to enable and encourage individuals to participate in sport
and physical activity and achieve the highest attainable standard of health. However,
selecting appropriate programmes is challenging, given that there is insufficient robust
research for a conclusion to be drawn regarding the effectiveness of many programmes
involving sport or physical activity, or the research that does exist suggests that many
programmes are ineffective. Systematic reviews have detected an absence of high-quality
evidence that could support interventions implemented through sporting organizations to
promote healthy behaviour change73 and interventions delivered by sporting organizations
to increase participation in sport.74 A recent systematic review of community-wide
interventions for increasing physical activity found minimal evidence of higher rates of
participation in physical activity at the population level.75
93. However, current research indicates that certain successful interventions share
specific common elements. Essential prerequisites, identified by WHO, to large-scale
physical activity programmes in developing countries include high-level political
commitment/a guiding national policy, funding, stakeholder support, and a coordinating
team.76 Moreover, WHO and its regional offices have developed surveillance tools and
materials to promote physical activity which can guide national governments in
strengthening and supporting efforts to increase participation.77
94. In the consultations connected with the present report, new initiatives reported by
States indicated great interest and creativity in regard to the promotion of sport and healthy
lifestyles. These included a “Health Academy” programme incorporated into a basic health-
care scheme (Brazil); the removal of taxes on sporting goods (Brunei and Mauritius);
frameworks for the inclusion of minority groups, namely Roma (Bulgaria); the recognition
of sport as a cultural right (Finland); the implementation of school sports programmes, such
as “Sports Olympiads” (Georgia); free public sports programmes, including Zumba dancing
(Honduras), aerobics classes (Malta) and “School of Health” volunteer-led exercise classes
(Slovenia); doctors “prescribing” exercise to patients (Israel); an annual “Sports Day”
(Qatar); and citizen-led cycling groups (Saudi Arabia).
95. Although the above-mentioned initiatives are welcomed, there is a paucity of
evidence on them. States should monitor and evaluate their programmes, policies and
interventions for efficacy and for compliance with human rights standards and obligations,
and should ensure that participation by the individuals affected is guaranteed in the design
and revision stages.
73
N. Priest and others, “Policy interventions implemented through sporting organizations to promote healthy behaviour change”, Cochrane Database of Systematic Reviews, Issue 3.
74
N. Priest and others, “Interventions implemented through sporting organizations for increasing people’s participation in sport”, Cochrane Database of Systematic Reviews, Issue 3.
75
P.R.A. Baker and others, “Community-wide interventions for increasing physical activity”, Cochrane Database of Systematic Reviews, Issue 5.
76
WHO, “Review of best practice in interventions to promote physical activity in developing countries”, WHO Workshop on Physical Activity and Public Health (Beijing, October 2005).
77
WHO Regional Office for Europe, “Physical activity strategy for the WHO European region 2016- 2025”.
V. Conclusions and recommendations
96. Healthy lifestyles have not traditionally been viewed as a rights issue, but their
adoption is integral to realization of the right to health. Sport and physical activity are
a vital part of healthy lifestyles, and States and other actors incur important
obligations to maximize individual capacity to exercise and to live healthfully.
97. The obligation to respect the right to health means that no person should be
prohibited from participating in sport or physical activity. States and international
sporting bodies must immediately remove discriminatory laws and policies in sport,
including those that hinder participation, and tackle discriminatory attitudes and
practices.
98. The rights of both professional and amateur athletes, including children, must
also be protected. Abuse, violence and discrimination occur too frequently within
sport; States are obliged to take steps to prevent rights violations, and to provide
adequate rehabilitation, redress and remedy.
99. States should incorporate sport and healthy lifestyles into their national health
programming, and consider the health impacts of policies in relevant areas such as
urban planning, in order to secure individual participation in sport and in active
transport such as cycling. Positive steps must be taken by States to facilitate, provide
and promote realization of the right to health through participation in sport. All
people must be enabled to access physical education, and education around healthy
lifestyles. National human rights institutions have unique roles to play in monitoring
and accountability in this area.
100. Finally, private corporations and sporting organizations (including
international sporting bodies) have a vital role to play in securing realization of the
right to health through sport and healthy lifestyles. These entities should ensure that
their policies and programmes, including those around major sporting events, do not
undermine health rights, and accord with international human rights law.
101. The Special Rapporteur recommends that States:
(a) Review all laws, policies, regulations and programmes relating to sport
and healthy lifestyles for compliance with human rights standards, and immediately
amend or remove those that are discriminatory in nature or conflict with human rights;
(b) Ban the advertising, promotion and sponsorship of all children’s
sporting events, and other sporting events that could be attended by children, by
manufacturers of alcohol, tobacco and unhealthy foods;
(c) Create or enforce national human rights protection mechanisms
applicable to amateur and professional athletes, ensuring access to justice and redress
in the event of rights violations;
(d) Create or update national health-care plans to include strategies
concerning the promotion of sport and physical activity and healthy lifestyles, as part
of a health in all policies approach;
(e) Create or update school-based physical education to ensure compliance
with human rights standards;
(f) Take steps to secure participation in sport for all and the adoption of
healthy lifestyles through:
(i) Collaboration between relevant government sectors in developing
policies and programmes with health impacts;
(ii) Construction of quality infrastructure such as walking and cycling paths
to facilitate equitable access to basic exercise and active transport facilities;
(iii) Measures to facilitate or provide key/at-risk populations access to
sporting goods, services, facilities and information;
(iv) Research into, and promotion of, the benefits of engaging in sport and
physical activity as part of healthy lifestyles;
(g) Review legislation and adopt policies to ensure that all persons, including
women, lesbian, gay, bisexual, transgender and intersex people, people living with
disabilities, children, the elderly and other populations that are underserved or face
discrimination, are able to participate in and safely enjoy sports;
(h) Require public and third-party providers of sporting and physical
activity services to adopt policies consistent with human rights standards, and create
or facilitate the production of materials designed to sensitize providers regarding the
adoption of a human rights-based approach;
(i) Protect the physical integrity and dignity of all athletes, including
intersex and transgender women athletes, and immediately remove any laws, policies
and programmes that restrict their participation or otherwise discriminate or require
them to undergo intrusive, unnecessary medical examinations, testing and/or
procedures in order to participate in sport;
(j) Ensure full participation of the individuals affected in the design and
implementation of programmes concerning sport and physical activity;
(k) Periodically and independently monitor and evaluate initiatives
concerning sport and physical activity for efficacy, and compliance with human rights
standards.
102. The Special Rapporteur recommends that national human rights institutions,
non-State actors and sporting bodies:
(a) Periodically and independently monitor and promote realization of the
right to health in the context of sport and physical activity (national human rights
institutions and civil society);
(b) Reach consensus on policies allowing for unhindered participation in
high-level competitive and amateur sport by transgender and intersex people
(international sporting bodies);
(c) Remove any policies that require women athletes, including intersex and
transgender women athletes, to undergo unnecessary medical procedures in order to
participate in competitive sport (international sporting bodies);
(d) Reach consensus on policies concerning the protection of children
participating in competitive sport, including in relation to children migrating to
participate in high-level/professional sport (international sporting bodies);
(e) Review all policies and operations concerning major sporting events and
professional sporting competitions for compliance with the Guiding Principles on
Business and Human Rights, and put in place protective mechanisms for athletes,
workers and citizenry (international/national sporting bodies; private actors).