Defining safety in Canadian Sport: Moving from ‘outcomes’ to ‘process’ for injury prevention

By Tanenbaum, B.E., Cowle, S., Forbes, S.L., Banfield, J.M.

Background

 The Canadian Sport Policy (CSP) is a product of collaboration among the 14 federal, provincial and territorial governments and other key stakeholders (e.g. Sport Canada). The current version of the policy, CSP2012, provides direction (for the next ten years) for stakeholders to realize positive impacts of sport for individuals, communities and the country. Policy implementation will occur through corresponding action plans developed by governments individually and collectively, and by non-government organizations in sport and related sectors

Colliding_playersSafety as a core value

CSP2012 identifies seven core values comprising “the foundation of participation in sport by all Canadians” (CSP 2012: 5). These values inform policies and programs with consideration for context-specific interpretation and application. One of the seven values is safety.

Given that sport- and recreation-related injuries are a leading cause of children’s hospitalization in Canada (Public Health Agency of Canada, 2011) safety is indeed fair game for analysis. It is exciting to see safety receive a higher profile at the policy level of Canadian sport. In 2002, the words “safe” and “safety”, hereafter referred to as “safe(ty)”, appeared only three times in CSP. Ten years later, CSP2012 mentions safe(ty) twenty-two times.[1] Is this language shift indicative of an evolution in sport and sport policy? As the mere mention of safe(ty) is not sufficient, let’s consider how the term is being used by policy makers.

Despite being named a core value of CSP2012, “safety” is never clearly defined in the context of the policy. Safe(ty) is an ambiguous term at best, so this is no great surprise. For the most part, “safe” is understood traditionally as the absence of physical injury (Haddon, 1968). But the notion “I didn’t get hurt, therefore the activity is safe,” is shortsighted. It positions safe(ty) as an outcome rather than a process (Haddon, 1973). As a result, the active component of safe(ty) – injury prevention – is neglected by relevant stakeholders and may absolve organizations of actively reducing the risk of and severity of injury.

Recognizing safety as a process not just an outcome

Injury, like infectious disease, is predictable and preventable (Davis & Pless, 2001). Reducing injury risk is a multi-faceted process involving active and passive approaches that interrupt and stop, or lessen the severity, along the path of injury. When safety is seen as a process, not an outcome, the inevitability of injury as an acceptable part of the sport experience becomes unacceptable.

The importance of safe(ty) in the context of sport activities is so complex that without a comprehensive definition and universal understanding, the words just become a commonplace add-on to something more tangible. After being named as a value, safe(ty) does not appear as a standalone concept anywhere else in the document. Instead, it is consistently partnered with something else. This grouping creates potential for the reader to gloss over safety and focus instead on what they recognize as more achievable goals and objectives – like fun, excellence and inclusion.

Used in a nonspecific manner, the words “safe” and “safety” are potentially misleading, creating a false sense of action and protection in activities where there are very few elements of prevention. Is a “safe” sport expected to be absent of injury or injury risk? If so, is this a realistic (or even desired) outcome for an organization to deliver? If not, what are the criteria?

The most effective prevention efforts are normalized in everyday life. We expect roads to have speed limits, new cars to have airbags and drivers to go through a licensing process. Do we have similar expectations for sport? This may be more challenging because the world of sport is not a homogenous, “risky” environment. Different sports carry varying levels of injury risk depending on a number of factors, not the least of which is the actual type of sport (e.g. contact vs. non-contact). Sport organizations are also diverse in their structure, funding, operations, and capacity to undertake new projects like injury prevention. It is important to recognize that safety in one organization may look and feel different to another, yet at the same time there must be overarching elements common across organizations. If safe sport participation is the goal, how do we define the active component of safe(ty) so it is applicable across all sport activities in a way that makes sense, is measureable and achievable by every organization?

Adoption of a consensus definition of safety: important next-steps

Without a clear vision of safe(ty), we are ultimately left to wonder how safe experiences can become part of the Canadian sport fabric. The authors believe a consensus definition of safe(ty) is the first step toward the adoption of safe(ty)-minded approaches within the Canadian sport system. Our aim is to prompt an agreed-upon definition of safe(ty) that policies like CSP2012 can draw on, so everyone is speaking the same language.

In an upcoming community engagement exercise led by the Play Safe Initiative and through an extensive network of sport, recreation, education and health organizations across Canada, stakeholders will be asked what safety means to them. Evidence of thematic similarity may point to an early consensus platform. The results will be shared at the upcoming Interdisciplinary Symposium on Injury Prevention in Sport and Recreation hosted by the Play Safe Initiative in Toronto on February 4, 2015.

***If you are attending the Canadian Sports Medicine Conference June 19-21st  (CASEM), share your thoughts there with blog coauthor Joanne Banfield. Both CASEM and the FIMS World Congress in Quebec City (June 18-21st) are important venues in which to generate discussion and move this issue forward. BJSM also welcomes further discussion via Twitter, Facebook and blog submissions (send to karim.khan@ubc.ca)***

Play Safe Initiative is a collaborative approach to reducing injury in sport and physical activity, led by Sunnybrook Health Sciences Centre, Lakehead University, the Dr. Tom Pashby Sport Safety Fund and funded in part by the Ontario Trillium Foundation. For more information please visit www.playsafeinitiative.ca.

References

Canadian Sport Policy (CSP). (2012).

Davis, RM., Pless, B. (2001). Accidents are not unpredictable. BMJ. Jun 2, 2001; 322(7298): 1320–1321.

Gielen, AC., Sleet, DA. (2006). Injury Prevention and Behavior: An Evolving Field, in Gielen, AC., Sleet, DA., DiClemente, RJ (Eds.). Injury and Violence Prevention: Behavioral Science Theories, Methods, and Applications. Jossey-Bass: San Francisco.

Haddon Jr, W. (1968). The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. American Journal of Public Health and the Nations Health,58(8), 1431-1438.

Haddon, W. (1973). Energy damage and the ten countermeasure strategies. Human Factors: The Journal of the Human Factors and Ergonomics Society,15(4), 355-366.

Purdy, G. (2010). ISO 31000: 2009—setting a new standard for risk management. Risk analysis30(6), 881-886.

Public Health Agency of Canada. Fact Sheet: Investing in child and youth injury prevention in sports and recreation. Retrieved on April 24, 2014 from: http://www.phac-aspc.gc.ca/media/nr-rp/2011/2011_0316a-eng.php

[1] This number includes the policy body and logic model. The Executive Summary and Annex are excluded from the count.

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