There is no doubt that sport plays a very important role in society; all over the world you will see children and adults engaging in some form of sport, whether it be soccer, boxing, mountain biking, ice hockey, running or any number of other activities (Box 1.1). People participate in sport not only through playing it, but also through involvement in its infrastructure—the coaching, volunteering, security, grounds management and club level organization that play an essential role in making sport happen. In the UK alone, football has over 500,000 volunteers in addition to being played by over seven million adults and a further five million playing in schools [1].

The reach of sport is immense—the Olympics, Tour de France, Rugby World Cup, New York Marathon and Cricket World Cup, for example, all attract huge global audiences, with the 2010 FIFA World Cup being watched by over 3.2 billion people around the world (46.4 % of the world’s population) [5, 6]. According to a recent market analysis, fans in Europe and the United States spend an average of 4–8 h per week consuming sport; in Brazil the average is over 10 h per week and in China over 11 h per week [7]. Interest in sport transcends age, often providing the only occasions in which all generations of a family come together for a common purpose. Overall audience demand for sport has grown as increased use of the internet, social media, and mobile technology, such as smart phones and tablets, have brought major changes in the way that sport is consumed, while at the same time television viewing figures have remained undiminished [7]. Sport has one of the most developed communication platforms in the world, with the potential to reach nearly all populations globally [8]. It enjoys extensive horizontal webs of relationships at the community level and vertical links to national governments, sports federations, and international organizations [8], such that when something happens in sport its effects can ripple out locally, nationally, and internationally.

Sport has been described as a “global language” [9] through which an understanding of shared rules and underlying philosophy of fair competition—of “sportsmanship ”—resonates around the world. The idea that sport is a universal good, with fair play and the idea of competition open to all, transcends many social, cultural, and political divides [10]. Sport can communicate powerful messages about the need to come together as one community—perhaps seen most strikingly in the idea of the “Olympic Truce ” which, every 4 years, allowed athletes and spectators from all city-states in Ancient Greece to come together in one setting in a spirit of peace. The concept of the Olympic Truce was reintroduced to the modern Olympic Games in the 1990s and led to the establishment in 2000 of the International Olympic Truce Foundation and the International Olympic Truce Centre to promote a culture of peace, cultivate international understanding, facilitate the observance of the Olympic Truce, and mobilize the youth of the world in the cause of peace [11]. The modern Olympic Movement also promotes a message of equality—the London Olympic Games in 2012 were the first in which every country had a female representative and now for a sport to be considered for inclusion in the Olympics it must have both a male and female equivalent.

The unique role of sport in society and its ever-strengthening capacity to reach people across the geographical, social, and political landscape give it huge potential as a vehicle for communication and engagement. Sport’s power to deliver a message makes it a highly valuable, but underutilized, public health tool—one which can be used in tackling a wide range of public health problems.

Public health in the twenty-first century is concerned with a very broad range of issues which affect our physical and mental well-being—from lifestyle factors and social determinants of health such as crime, education, and community cohesion to outbreaks of infectious disease, wars, and natural disasters. Although extremely broad in its scope, public health has one simple defining characteristic which sets it apart from other fields of medicine—a focus on the health of populations rather than individuals. Whether the population in question spans several continents or comprises a small group of people, the principle of acting on the basis of the health needs, or the threats to the health, of the collective remains central.

A growing number of health challenges are facing the global population today, many of which, ironically, are as a result of advances in public health and social reforms. Efforts to tackle the traditional root causes of many diseases (sanitation, clean water, food quality), and improvements in obstetric and child care, have led to reductions in premature death from communicable diseases. As life expectancy has increased, however, so have the opportunities for non-communicable diseases, such as heart disease and cancers, to have an impact on our lives [12]. Many populations are experiencing growing levels of obesity due to westernization of the diet and increasingly sedentary lifestyles. Physical inactivity also directly raises the risk of coronary heart disease, type-2 diabetes, and breast and colon cancers, and can shorten life expectancy, accounting for 9 % of premature mortality worldwide (5.3 million deaths) [13]. In China, physical inactivity contributes between 12 and 19 % to the risks of developing the five major non-communicable diseases (coronary heart disease, stroke, hypertension, cancer, and type-2 diabetes), and is responsible for over 15 % of the country’s yearly healthcare costs and lost economic output due to poor health or premature death [14]. In many countries, alongside this growth in non-communicable disease remains the burden of communicable disease, with AIDS, polio, tuberculosis, malaria, diphtheria, and dengue, for example, still major causes of death and disability in low- and middle-income countries [15, 16].

Many populations suffer war or natural disasters, such as earthquakes, draught or flooding, with a huge impact on both physical and mental well-being [17]. Climate change is predicted to make disasters related to extreme weather more frequent and widespread occurrences [18], as well as having broader implications for public health (for example, through its anticipated impact on food prices) [19].

Broader public health issues, such as crime, poverty, unemployment, lack of decent housing, and poor education, continue to be important determinants of physical and mental well-being [20], with high levels of deprivation associated with numerous health problems and a growing health divide in developed countries between the wealthy and the poor [21].

Current health systems in many countries are already incapable of meeting the needs of the populations they serve [22], while the increasing global population² and greater numbers reaching old age³ mean others are set to follow suit if action isn’t taken to tackle the world’s burden of poor health. Greater effort must be put into tackling public health problems “upstream” through preventative action focused on effective, low-threat interventions that can truly engage the populations they target. Sport’s potential to be utilized in this endeavor is now increasingly being recognized by a broad range of professionals, athletes, and organizations around the world.

The emergence in the twenty-first century of sports-based public health initiatives has been underpinned by a growing recognition, reflected in the policies of key international bodies, of the need to find more effective ways to engage the public with health issues, to build partnerships across sectors and of sport’s potential as a vehicle for development work.

There are a great many well-established benefits to both physical and mental health of engaging in solitary or team sport (Chap. 2 in this book discusses the health benefits of sports participation). Certainly, there is no doubt that getting more people engaged with sport would pay a great public health dividend. It has been estimated that in England, for example, if a million more people across the country played sport each week, it would save the taxpayer £22.5 billion in health and associated costs over the course of their lifetimes [36].