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The 2014 World Cup: Scoring a goal for public health?

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Beginning today, Brazil will play host to the world’s most-watched sporting event, the football World Cup. 3.7 million Brazilian and foreign tourists are expected to travel throughout Brazil during the World Cup, and nearly half the world’s population is anticipated to tune in for the tournament. Some effects are intuitive: worker productivity plummets, while hungry (and thirsty) viewers consume more snacks and TV dinners. Less well explored are the World Cup’s public health impacts. This post summarizes some of the more significant public health issues posed by the Beautiful Game’s most important event.
1. Violence
 The emotional toll of a favorite team’s loss could be expected to lead to an uptick in violent crime. However, a British case study found that levels of domestic violence increased following both losses and wins. Similar results occur in relation to violent crime outside the home, with hooliganism and post-match violence taking place regardless of who wins the match. Violence at the 2014 World Cup could be exacerbated by FIFA’s insistence that beer “must be sold” in stadiums, forcing Brazil to overturn a 2003 liquor-free stadium law designed to promote public safety. (See below for John Oliver’s entertaining discussion of this issue, and others).

2. Cardiovascular Health
The link between stressful events and heart attacks is well-documented, including in the context of the World Cup. A study in the New England Journal of Medicine conducted in the Munich area during the 2006 World Cup found that “[v]iewing a stressful soccer match more than double[d] the risk of an acute cardiovascular event.” Another study conducted in England and published in the British Medical Journal found a similar effect, but only for a particularly stressful match (in which England lost narrowly to Argentina). 
3. Sex Work 
The media often plays up the projected surge in sex work in the run-up to international sporting events. Sensational headlines raise the specter of increased exploitation of women and girls, but the truth is more nuanced. One study conducted after South Africa’s World Cup in 2010 showed that a predicted influx of foreign sex workers never occurred—and fears of greater HIV transmission following the tournament were largely unfounded. Similar media hype came to naught during Germany’s World Cup in 2006. These results suggest that advocates for sex workers’ rights should focus  on the ongoing hardships faced by sex workers in everyday life and away from media attention, such as the risk of violence, exploitation, or acquiring a sexually-transmitted infection.
4. Infectious Disease
Large gatherings of people always present an inviting target for infectious diseases, particularly when people from all over the world congregate in one place. The world’s largest sporting event creates just such a group, providing a critical opportunity for the spread of infectious disease. The World Health Organization (WHO) and Pan-American Health Organization (PAHO) have issued a joint health alert urging travelers to ensure vaccination against measles and rubella before traveling to Brazil. The U.S. Centers for Disease Control and Prevention (CDC) has issued a travel watch urging both vaccination and precautionary measures while in the country. Less likely, but more severe, threats could include the spread of a deadly emerging infectious disease, such as Middle East Respiratory Syndrome (MERS) or a novel strain of avian influenza (H7N9).

Reducing the risks and reaping the benefits of the World Cup
The health risks posed by this year’s World Cup can be ameliorated by effective policies. A larger police presence would deter violence, focusing on large gatherings and stronger domestic violence taskforces.  In future, FIFA should support national policies that promote public safety, rather than those serving corporate or popular interests. Awareness campaigns should educate people about the signs of acute heart problems—at the same time gearing up hospitals’ emergency departments for an influx of patients on days of stressful matches. Host countries could require proof of vaccination for entry, undertake education campaigns and provide countermeasures to prevent disease transmission, such as convenient hand washing stations.
Despite these challenges, the World Cup’s public health risks are outweighed by its important benefits. The World Cup builds social cohesion and social capital by bringing people together with a common interest, both of which improve mental health. By celebrating physically fit players, it may inspire children—and perhaps even a few adults—to adopt a more active lifestyle. Finally, the World Cup increases goodwill between countries, making cooperation on other issues, such as global health, just a little bit easier. Boa sorte a todos!

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The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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