The nature of health

Athletes who power down a track, carve their way through the snow or lift three times their own body weight generate powerful images that clearly establish the relationship between the body, movement and health. Engaged in wholesome physical activity, these well-crafted, fit and taut specimens appear to be the epitome of health, as their sculpted bodies represent wellbeing, progress and control. Inactive bodies, on the other hand, seem slothful and selfish, as children are dislodged from their computers and nudged outside into fresh air to engage in energetic play. The enfeebling of the world’s youth is thought, in large part, to result from a declining level of physical activity and a preference for more sedentary entertainments. For this reason, fitness and health movements have, since the nineteenth century, reminded citizens that it is their social obligation and personal responsibility to fashion a healthy body, free from disease and other contaminants. Physical education has been central to such health promotional activities, and it is fair to say that by the twenty-first century, sport, exercise, fitness and health have become so thoroughly integrated, and their relationship so completely naturalised, it is now difficult to conceive of sport as anything other than an antidote to a range of social and physical ills. Yet, organised sport, particularly at the elite level, is anything but heal-

thy. Athletes risk their bodies each time they step out onto the field to play or train. In sports such as boxing, it is expected that the competitor will sustain some form of injury, given that the purpose of the sport is to physically incapacitate one’s opponent, whilst it is not uncommon to see bodies stretchered from the field in heavy contact sports such as rugby union, rugby league or, despite the extensive protective padding, American football. Playing whilst in pain is largely normalised, and ‘no pain, no gain’ is an athletic mantra that seems unlikely to disappear from the sporting parlance as young athletes are taught not to question the authority of coaches and trainers, even when their own physical well-being may be jeopardised through intense regimens (Howe 2004). Heat illnesses, exhaustion, chronic pain, mechanical injuries and in extreme cases, malnutrition and death, can

result from the extreme physical and psychological demands placed on sportsmen and women. Furthermore, numerous studies confirm that the early onset of some diseases and potentially premature death await former elite athletes who have dedicated their lives to the pursuit of ‘healthy’ sport (Waddington et al. 2006). Even junior and recreational sports are notoriously dangerous, with millions of children presenting at emergency rooms around the world each year with sprains and other more serious injuries that may have long-term consequences (Adirim and Cheng 2003). Given its risky nature, it may even be more appropriate to suggest that sport is not particularly healthy, and that the strain placed on, and the injuries sustained by, athletes’ bodies require the relationship between sport and health to be fundamentally reconceived. Nevertheless, health and sport remain closely aligned such that sports

medicine and other industries have developed to ensure an athlete’s body remains in good working order and, if damaged, is quickly restored to its competitive best. Professional and national teams each have a growing number of medical support staff whose primary purpose is to ensure that their ‘patients’ remain in peak competitive condition, ready and able to perform. In addition, sporting federations authorise rule changes and permit the use of safety equipment to further protect athletes, suggesting that health, despite the inherent risks in sport, remains highly prized. Indeed, it would seem that anything that jeopardises an athlete’s well-being is quickly contained to ensure that, as far as possible, sport remains a wholesome endeavour, and it is for this reason that the proscription of illicit performance enhancing substances and methods seems justified. Doping practices have, since the 1960s, been outlawed, in part, to protect

athletes’ health. Long lists of side effects are presented as evidence of the irreparable harm that is wreaked upon an abuser’s body, offering a useful justification for the prohibition, and eventual eradication, of specific substances and methods from sport (Mottram 2003). Furthermore, international anti-doping policies reinforce the sanctity of physical well-being. The Australian Sports Anti-Doping Authority, for example, suggests doping to be ‘the use of a substance or method, potentially dangerous to athletes’ health, and/or capable of enhancing their performance’ (ASADA 2006), whilst the Tough on Drugs policy reveals that doping ‘carries serious health risks for individuals’ (DISR 1999). The German Nationale Anti-Doping Agentur refers to the increased ‘health risks’ facing athletes who dope (NADA 2006); the Canadian Policy Against Doping in Sport is similarly committed to ‘protect[ing] the health of individuals’; and the US AntiDoping Agency seeks to ‘ensu[re] the health of athletes’ (USOT 2006). Throughout the world, sporting federations and governmental agencies confirm that alongside their concern for the ‘integrity’ of sport, they are particularly troubled by the potential impact of banned substances on an athlete’s health. That questions of morality and health are given equal billing in the ‘war on drugs in sport’ suggests that this issue is framed by a

medico-moral discourse that regards drugs as not merely a threat to individual health but to the broader institution of sport and, potentially, other collective identities as well. Despite global accord, prohibiting doping because it may damage ath-

letes’ health is not sustained when examined more critically, particularly as the sweeping assumption that all substances taken into the body to promote performance are necessarily harmful is simply not supported by rigorous scientific analysis (Dawson 2001; Black and Pape 1997). Yet, this chapter does not seek to examine individual performance technologies to assess their health implications, but is instead more concerned with establishing how the nature of health offers a further insight into how such substances and methods generate discord in the sports and broader communities. It draws on a growing critical theory that recognises health not to be merely the ‘absence of disease’, but a socially, politically and economically crafted concept that reveals more about accepted cultural boundaries in society than it does about infections that risk individual biological borders. Furthermore, health is not simply a physical concern, but a moral issue, and bodily well-being is equated not merely with desirable character, but, more broadly, with social order. Within the context of sport, then, the health and physical purity of athletic bodies can be read as a marker of national worth, so that anti-doping strategies need to be interrogated as part of a discourse of societal well-being and stability. Yet, before examining its relationship with sport or the effect that performance technologies and doping practices may have, it is critical to understand the meaning and significance of ‘health’.