This journal recently published a paper titled “Achieving Equity in Physical Activity Participation” (1). In the paper, Hasson and colleagues (1) reported rates of physical activity (PA) for various demographics. When rates of PA were lower in one group compared to another, the authors deemed this an “inequity.” The authors identified many inequities, and their position was that inequities are bad, whereas equities are good. Consequently, the American College of Sports Medicine has developed an initiative to improve PA equity to achieve “health equity.” The first step of the initiative is to raise awareness of these inequities. The final step involves assessments to ensure the initiative does not maintain or increase inequities.
The purpose of my letter is to explain why PA equity is a misguided goal.
First, maintained or increased inequities could occur simultaneously with increased PA in groups targeted by the initiative. For example, if the number of males meeting muscle strengthening guidelines increases from 34% to 36%, while the number of females (target group) increases from 25% to 32%, this represents a substantial improvement for females, even though inequity still exists.
Second, the equity goal does not consider how equity is achieved. For example, equity could occur if the rate of females participating in strengthening exercise increases from 25% to 29%, while the male rate decreases from 34% to 29% (also a net loss of 1% participation).
Third, the PA rate of the more physically active group is automatically set as the goal for the more sedentary group. However, this goal may be unrealistic (too high) or undesirable (too low). Moreover, a hugely successful initiative might cause a target group’s PA rate to exceed that of another group. This success would create a new inequity and oddly mean the initiative was a failure.
Fourth, the equity goal ignores absolute rates of PA. It is concerned with how groups compare to each other. Thus, groups with equal, yet low, rates are overlooked, as are groups with PA rates that are relatively high but low in absolute terms.
Fifth, groups with relatively high PA rates are disregarded based on the assumption that higher rates indicate lower health risk. This assumption is usually correct, but not always. It depends on the group and the health outcome. If longevity is the outcome, the initiative should, for example, target males not females. Males have higher PA rates (2), but they typically die younger (3).
Sixth, individuals are part of multiple groups. Thus, when targeting one group (e.g., females), the initiative will inevitably increase PA in nontarget groups (e.g., Whites, young adults), exacerbating some inequities.
Finally, groups of people can always be split into smaller groups. Thus, inequities will always exist.
Equity is an ethical and political concept. Its insertion into the realm of PA is unnecessary and unsound. The American College of Sports Medicine’s initiative should aim to increase PA in individuals who are most sedentary and/or at greatest health risk. However, this can, and should, be done without the equity narrative.
James L. Nuzzo
Neuroscience Research Australia
Randwick, New South Wales, AUSTRALIA
1. Hasson RE, Brown DR, Dorn J, et al. Achieving equity in physical activity participation: ACSM experience and next steps. Med Sci Sports Exerc
2. Center for Disease Control and Prevention. Adult participation in aerobic and muscle-strengthening physical activities—United States, 2011. MMWR Morb Mortal Wkly Rep
3. Center for Disease Control and Prevention. Deaths: final data for 2014. National vital statistics reports. Natl Vital Stat Rep