Boundaries for Life: lessons learnt from health checks at sporting events

By Dr Chetan Trivedy BDS FDS (RCS) MBBS PhD MCEM MFMLM

NIHR Academic Clinical Lecturer in Emergency Medicine, Centre for Applied Health Research Delivery, Warwick Medical School

Background

I was never a huge fan of cricket, nor of seeing my GP, so it was by complete chance I became the crowd doctor at the Kia Oval in 2007. Many a day was spent in our medical room tending to the numerous bumps, bruises, sunburn and occasional near fatal consequences of alcohol toxicity. All in a day’s work for the medical team. With the unpredictability of the British weather there would often be long spells of break in play where over 20,000 fans would look for ways to entertain themselves. Although consumption of alcohol was most favoured, many fans would sneak in to see us in the medical room for a bit of advice from the doctor or to have their blood pressure checked. Although this was not our primary remit, we would often oblige.

Cricket has an immense following among the ethnic minorities and at no other sport will you see so many Indian, Pakistani or Sri Lankan fans in one place. Cricket is almost a religion in some of these countries and generations of supporters will pack cricket stadia to see the likes of Sachin Tendulkar occupy the crease.

In addition, unlike other sports like football or rugby which are over in a matter of hours, a game of cricket can go on for five days allowing fans more opportunity to explore the ground.

Data from Public Health England has suggested that

“each year NHS health check could prevent 1,600 heart attacks and save 650 lives, prevent 4,000 from developing diabetes and detect 20,000 cases of diabetes or kidney disease earlier”

Furthermore, identifying risk factors such as smoking, physical inactivity, alcohol overconsumption, raised cholesterol and high blood pressure could help reduce or prevent diseases such as Type 2 diabetes, coronary heart disease, dementia and strokes. It has been estimated that the cost of treating these conditions in secondary care is £5-11 billion and may add an increased £34 billion burden annually to the tax payer.

Considering the higher prevalence of Type 2 diabetes, coronary heart disease and mouth cancer amongst the ethnic minorities from the cricketing nations, this was an ideal opportunity to develop a health promotion and intervention initiative, especially if young individuals with high risk factors could be identified and signposted to engage with their GPs.

‘Boundaries for Life’

In 2010 Boundaries for Life was born and teams of health care professionals volunteered to run checks at the England v Pakistan One Day International at the Kia Oval in London. We were encouraged by the queues of participants who waited patiently to have their free health MOT. Our aim was to offer blood pressure, diabetes, cholesterol, body mass index (obesity), mouth cancer screening, and to raise awareness on dementia.

In the 2013-14 season we performed over 600 health checks in four venues (Edgbaston, The Oval, Old Trafford and Lords) finding that:

· up to 32% of the users were obese having a BMI of more than 30 

· 26% had high random cholesterol of more than 5 mmol/L and

· 37% at one venue had high blood pressure (140/90 mm/Hg).

Although some of these users may have been self-selecting as they had a pre-existing illness, many were not previously aware of their abnormal results and were advised to follow up with their doctors. The feedback from the users was exceptional and applying the ‘family and friends’ test 100% of users stated they would recommend the service.

Why do people not visit their GP?

During these checks, some very interesting underlying narratives surfaced.

Firstly, lack of access to similar one-stop NHS services had prompted users to have the checks at the cricket.

Secondly, they did not need to take time off work, plus all checks were free.

Finally, having a health check outside of the traditional medical setting (GP surgery, hospital or pharmacy) gave users greater control and ownership of their health and health information without becoming completely submerged into the medical model.

The first two made sense, given the pace of life these days; the opportunity for a free health check is a potent incentive. However, as a doctor committed to helping my patients I could not appreciate the issues of being part of the medical model until I, too, became a patient.

Personal experience

On 18^th February 2015 I was diagnosed with a small brainstem stroke, Type 2 diabetes, high blood pressure and high cholesterol. Not having seen a GP for over 15 years, the irony of having a full house of risk factors, given the checks I was performing on others, was a definite ‘do as I say and not as I do’, moment.

Attending numerous outpatient clinics has given me a better appreciation of what we put our patients through once we find they have an illness or an abnormal blood test. As health care professionals we have an inherent urge or need to ‘fix it’ and often without realising we take complete control of the situation. However this often comes with loss of autonomy for the patient on dealing with blood pressure, blood sugar or high cholesterol and this is what had put off many from having checks in more traditional settings, and why a health check at cricket match where they had complete control over the information given was greatly valued.

Next steps

Further work is ongoing to explore reasons and barriers related to health behaviour amongst people attending cricket matches and whether cricket can play a role in not just providing entertainment but also in helping to improve the health and wellbeing of supporters.

What makes this initiative unique is the interest and support from sporting venues and governing bodies who have pushed this scheme at grounds across the UK. It is hoped that by 2020 every cricket ground in the UK will run one free health check for its fans and staff annually.

It will be interesting to see what impact this may have on the health of users and whether these initiatives can be more cost-effective than traditional NHS checks.  A direct comparison of health check costs at the cricket is not possible as these are done on a voluntary basis with a small budget for consumables

Work is in progress to build a research team interested in looking at the evaluation of this work and we are keen to develop a multi-disciplinary team from across the University.  

For further information, please contact Dr Chet Trivedy email: c.trivedy@warwick.ac.uk