Sports Medicine

, Volume 49, Issue 4, pp 637–639 | Cite as

Comment on: “Equity in Physical Activity: A Misguided Goal”

  • Oli Williams
  • Stephanie E. Coen
  • Kass GibsonEmail author
Letter to the Editor

Dear Editor,

As three self-identified ‘equity advocates’, we read “Equity in Physical Activity: A Misguided Goal” [1] with great interest. Nuzzo argues equity in physical activity promotion is misguided and, therefore, interventions should aim to “increase physical activity in groups that are most sedentary and/or at greatest health risk to a level that is as high as is feasible and possible, irrespective of how that new level compares with other groups”. Here, we demonstrate that the influence of social inequalities means achieving Nuzzo’s goal actually relies upon equitable intervention. Far from misguided, equity is fundamentally misconstrued in Nuzzo’s commentary. We begin by clarifying the central tenets of equity and then respond to Nuzzo’s three key claims that equity approaches are (1) aimed at achieving equal physical activity levels across demographic groups; (2) characterised by flawed underlying assumptions; and (3) bettered by more objective and less politically motivated...


Compliance with Ethical Standards


Oli Williams was supported to write this letter by the UK National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands. At the time of writing, Stephanie Coen held a Postdoctoral Fellowship from the Canadian Institutes of Health Research (CIHR). No sources of funding were used to assist Kass Gibson in the preparation of this letter. The views expressed in this letter are those of the authors and not necessarily those of the National Health Service, NIHR, or the Department of Health and Social Care.

Conflict of Interest

Oli Williams, Stephanie Coen and Kass Gibson declare that they have no conflicts of interest relevant to the content of this letter.


  1. 1.
    Nuzzo JL. Equity in physical activity: a misguided goal. Sports Med. 2018. (Epub 2018 Jul 13).Google Scholar
  2. 2.
    Marmot M. The health gap: the challenge of an unequal world. London: Bloomsbury; 2015.Google Scholar
  3. 3.
    Williams O, Gibson K. Exercise as a poisoned elixir: inactivity, inequality and intervention. Qual Res Sport Exerc Health. 2018;10(4):412–28.CrossRefGoogle Scholar
  4. 4.
    Coen SE. Connecting qualitative research on exercise and environment to public health agendas requires an equity lens. Health Place. 2018;53:264–7. Scholar
  5. 5.
    Coalter F. Game plan and the spirit level: the class ceiling and the limits of sports policy? Int J Sport Policy Politics. 2013;5:3–19.CrossRefGoogle Scholar
  6. 6.
    Williams O, Fullagar S. Lifestyle drift and the phenomenon of ‘citizen shift’ in contemporary UK health policy. Sociol Health Ill. 2018;41(1):20–35.CrossRefGoogle Scholar
  7. 7.
    World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.Google Scholar
  8. 8.
    Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258–71.CrossRefGoogle Scholar
  9. 9.
    Smith KE, Hill S, Bambra C, editors. Health inequalities: critical perspectives. Oxford: Oxford University Press; 2016.Google Scholar
  10. 10.
    Hill S. Axes of health inequalities and intersectionality. In: Smith KE, Hill S, Bambra C, editors. Health inequalities: critical perspectives. Oxford: Oxford University Press; 2016. p. 95–108.Google Scholar
  11. 11.
    Fisher RA. Cancer and smoking. Nature. 1958;182:596.CrossRefGoogle Scholar
  12. 12.
    Hasson RE, Brown DR, Dorn J, Barkley L, Torgan C, Whitt-Glover M, et al. Response. Med Sci Sports Exerc. 2018;50(6):1342–3. Scholar
  13. 13.
    Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216–21.CrossRefGoogle Scholar
  14. 14.
    Wilkinson RG, Pickett K. The spirit level: why equality is better for everybody. London: Penguin; 2010.Google Scholar
  15. 15.
    Engels F. The condition of the working class in England. London: Penguin Books Ltd; 2009.Google Scholar
  16. 16.
    Scott-Samuel A, Bambra C, Collins C, Hunter DJ, McCartney G, Smith K. The impact of Thatcherism on health and well-being in Britain. Int J Health Serv. 2014;44(1):53–71.CrossRefGoogle Scholar
  17. 17.
    Beenackers MA, Kamphuis CB, Giskes K, Brug J, Kunst AE, Burdorf A, et al. Socioeconomic inequalities in occupational, leisure time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act. 2012;9(1):116.CrossRefGoogle Scholar
  18. 18.
    Farrell J, Hollingsworth B, Propper C, Shields MA. The socioeconomic gradient in physical inactivity: evidence from one million adults in England. Soc Sci Med. 2014;123(1):55–63.CrossRefGoogle Scholar
  19. 19.
    Mielke GI, da Silva ICM, Kolbe-Alexander TL, Brown WJ. Shifting the physical inactivity curve worldwide by closing the gender gap. Sports Med. 2018;48(2):481–9.CrossRefGoogle Scholar
  20. 20.
    Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63.CrossRefGoogle Scholar
  21. 21.
    Rasanathan K. 10 years after the Commission on social determinants of health: social injustice is still killing on a grand scale. Lancet. 2018;392(10154):1176–7.CrossRefGoogle Scholar
  22. 22.
    Hitchings R, Latham A. On lenses and blind spots in qualitative exercise and environment research: a response to Stephanie Coen. Health Place. 2018;53:268–70. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of LeicesterLeicesterUK
  2. 2.University of Western OntarioLondonCanada
  3. 3.Plymouth Marjon UniversityPlymouthUK

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