[MUSIC PLAYING] – I want to welcome you back
to our second panel, which is on gender, sports,
health, and wellness. And it's my real pleasure to
introduce our moderator, Dr. Cheri Blauwet, who I know
from organizing on the panel and who I knew already as a
doctor of physical medicine and rehabilitation
at Harvard Medical School, my own hospital– Brigham Women's Hospital–
and Spaulding Rehabilitation Hospital, where she's a
principal investigator for the Kelley Adaptive
Sports Research Institute. What I didn't know, until I read
her biography just yesterday, that she also has
seven Paralympic medals and has won both the Boston
and the New York marathons. [APPLAUSE] Cheri has also addressed
the United Nations on behalf of athletes. So, please welcome me
in welcoming Cheri. [APPLAUSE] – Thank you very much, Janet. And thanks, everyone, for
returning for our second panel of the morning. The focus of our
session will be a bit of a deeper dive on the topic
of gender, sports, health, and wellness. And I'd like to take a brief
moment to encourage everyone, on the back of your program
is the social media handle, the hashtag, etc.

For today. So, please feel free to
be active on social media. We really want what
we're doing here to get out in the broader
public discourse via some of those outlets, as
well as via the webcast. So, thanks for
engaging in that way. So, when we first
initiated planning meetings to bring this
conference together, it became very
clear, very quickly that topics related
to health and medicine were some of the
hottest topics that are out there in the public
discourse, in the media, and what people
are talking about. And we then realized that,
indeed, really health wellness is quite broadly
defined, when we think about the interaction
of gender and sport. And it encompasses concepts
like gender disparities in common sports injuries,
like ACL tears and concussions, for example– both in terms of
their incidence, or how much they
happen, but also how they're treated, so,
who ends up having surgery or not after an ACL
tear, and who returns to play after a concussion.

And it's more likely that
in this post-Title-IX boom, with over three million
high school girls competing in sports, as was
noted this morning, that these topics are going to
become more and more important. How we address treatment and
issues related to sports injury according to gender is going
to become even more important over time. It also encompasses
the impact of gender on youth sport participation
as a measure of wellness. And, you know, these days,
the childhood obesity rate is estimated at up to 30%.

So, when we think about
how gender impacts things like implicit bias and
unconscious perceptions of who we expect to be active,
who do we expect to engage in physical activity in sport
as a means of healthy lifestyles as they move into
adulthood, we can see that that is a critical
component of when we think about health and wellness. And last but not least,
in our elite athletes, how much is too much? And we know that athletes
often feel the pressure to win at all costs, despite the
potential for adverse health outcomes, related to things
like packed competition schedules, over-training,
and even when athletes are tempted to cross
the line into use of performance-enhancing
substances, and prohibited methods,
and other mechanisms. So we're thrilled to host
these three esteemed panelists to help us work through some
of these challenging and very timely themes all related
to health and wellness.

And each of these
three individuals really works at the
intersection of what's going on, in terms of how we're
interacting with athletes. And I think we'll provide
very interesting insights and perspectives on how we
grapple with these issues and also the way
forward into the future. So, as with earlier
in the morning, you'll note that
the full biographies are in your conference program. So, just very briefly, I'll
introduce our speakers. Dr. Brian Hainline is
the chief medical officer for the National Collegiate
Athletic Association, and also clinical professor of
neurology at Indiana University School of Medicine at NYU. And I think Dr. Hainline
provides a very amazing example of blending a clinical career
with leadership and policy change. He's been active with the
American Academy of Neurology Sports Section, as far as
the International Tennis Federation. And with tennis more broadly,
as a sport for many years, he also oversees the NCAA
Sports Science Institute, so blending that issues of research
as they impact athletes. So welcome, Dr. Hainline. Our next speaker
will be Travis Tygart from the chief executive officer
of the US Anti-Doping Agency, or USADA.

And Travis is really at the
helm of helping USADA carry out its mission of preserving
integrity of competition, inspiring true
sport, and protecting the rights of clean athletes. He's also been at the helm of
many important investigations and, of course,
been very prominent in public and in the
media, such as the BALCO investigation, the
US Postal Service, and Lance Armstrong, etc. So, under his leadership,
USADA has really led the way, and also been really
involved in what happens at the grassroots
level with the issues related to true sport and how we impart
ethics in our young people as they progress through
their sports career. So welcome, Travis. And our third speaker
will be Dr. Parissa Safai, who's an associate professor
at the School of Kinesiology and Health Science and
the Faculty of Health at York University in Toronto.

And Parissa will really bring
us a very unique and important lens for the morning, as
her research has focused on the sport at the intersection
of risk, health, and health care, including topics such
as the culture of risk, social determinants
of athlete's health, and the impact of various
inequalities related to gender, socioeconomic disparities, and
ethnic, cultural issues on how we access physical activity and
how these impact our society. So welcome, Dr. Safai. So without further
ado, in our panel. And just a brief
reminder on mechanics, we'll hear from each
speaker for 15 minutes. We'll then open it up for
intra-panel Q&A and a bit more discussion on some of
the topics that come up. And then we'll open
up for audience Q&A, as well, prior to
heading into the lunch. So, thank you very much. And without further ado, we'll
invite Dr. Hainline's comments.

[APPLAUSE] – Well, thank you, Cheri. And thank you, everyone,
for this great conference. And I'm really fired up just
being here and listening. And it was a little difficult
for me to prepare for this. It wasn't your
typical medical talk. I had to really step
outside of the box and think about what
I was going to say. And so, the first thing
I did was a little bit of history checking. And I came up with
this great photo. This is the Radcliffe crew team. It is the only Harvard
varsity sport team which carries the
name "Radcliffe" and which wears the
Radcliffe colors, so– [APPLAUSE] Go Radcliffe Crew. So, I'm the chief
medical officer of the NCAA, the first
chief medical officer.

I've been at his job for a
little more than four years. The NCAA, for those
of you who don't know, is the governing body
of college varsity sports for 1,100 schools,
500,000 student athletes. We were formed in 1906. Really, it was
President Roosevelt at the time who decided that we
needed to have a governing body to really oversee football
because there were 18 football deaths the year
before, and there was an existential crisis. So, flash forward, 90% of my
headaches for the 23 sports and 90 championships that
we oversee is football.

membership-driven organization. It's bottom-up. So, when we read
in the newspaper, the NCAA didn't do this,
the NCAA didn't do that– it's the membership. We are the opposite of
top-down organizations, such as the NFL and
the Catholic church. [LAUGHTER] I have no disclosures. [LAUGHTER] Although I did go to Notre Dame. So, there's a
Catholic disclosure. I'm going to just give a very,
very brief overview of things that I believe are
pertinent to the NCAA because, after all,
that's my world. We won't take a deep
dive into any of these. We really don't have the time. So, let's look at
participation rates. We've talked about this briefly.

And we could look and say,
wow, participation rates for women's sports have really
been increasing considerably over the years. And, yay, Title IX. And, yay, society. We're really getting
our act together. And when we talk to the
women who are in sport, they get a lot out of it. They really love being athletes. And it drives them for
the rest of their life. And so it is a reason
to truly celebrate. But we can look at these same
statistics and say, well, is this a reason to celebrate? Or is this a reason to
look at our barriers? Because, well, look at this.

Yes, there has been a great
increase in women participation in sport. But also, for all those
naysayers of Title IX, look at the growth
in men's sport. Title IX has done nothing
to diminish that growth. And look at the more recent
statistics about women in college compared to men. And they are the majority,
but the statistics are more than reversed
for women participation in college sports. So, there is still a gap. There are barriers
that still exist. I want to talk a little bit
about one aspect of sport injury that we've heard a lot
about, and that is concussion. And I will say very clearly– I've said this publicly
on many occasions– concussion is the
elephant in the room. But the single most
important aspect of care that we need to address
for our student athletes is mental health.

The student athletes have told
me that, time and time again. And I've visited over 100
schools, including Harvard, and I meet with the
student athletes. This is their number 1 concern. But what about concussion? So, we hear about concussion. We hear about football. And this is a study,
it was actually published just recently. And the rate of
concussion is determined by athletic exposures. The highest-risk sport
for rate of concussion is men's wrestling. But look at the
four women's sports that have virtually the same
rate of concussion as men's football– women's soccer, women's ice
hockey, women's basketball, woman's lacrosse.

Now you should be shocked
that women's lacrosse is there because the rules
of woman lacrosse is that this is a
non-contact sport. Well, what about concussion? For every single major
aspect of health and safety, we must do a gap analysis. And the real gap analysis
is that we don't even know the natural
history of concussion. We have no idea what
neurobiological recovery is in concussion. And we know very
little about women who get concussed
because 95% of the world literature on concussion
is dominated by men's football and men's ice hockey. So, when we have a gap
analysis like that, we have to take action. We have to advocate. The NCAA partnered with
the Department of Defense, and we have put together the
largest prospective clinical longitudinal study ever done
in the history of concussion.

It's currently with 30
schools, and our recent data tell us that we've now
analyzed over 30,000 athletes. We've tracked 2,000 concussions. And we're taking an
exceptionally deep dive into several
high-contact, risk sports, including women's ice hockey,
women's soccer, women's lacrosse, where the athletes
are wearing had accelerometers. They're getting genetic testing
blood biomarkers, genomics, and brain MRIs. So, we are going to understand
the neurobiology of concussion. I will say that of these
2,000 concussed athletes we've studied, 40% are women. A large study
before that was 20%. It's an exceptionally
intense study. I won't go into
the details of it. But athletes are
tested at baseline and then at subsequent
intervals over six months. On average, most athletes return
to play after a concussion by three weeks. If we sort that out– and this
is not yet published data. It has not been vetted in
peer-reviewed literature.

And by the way, in all
the literature that is going to come
from this study, I will only be on the
first two studies, the methodological studies. I will not be part of
any of the data analysis. And these studies are
being run independently by our member schools. But the athletes that return
the quickest after a concussion are our contact-sport athletes. I'm not going to give
you the why of that. We can talk about that. We can hypothesize about that. But it's the non-contact
sport athletes that take the longest
to return to play. And women, in general,
are taking two days longer to play– to return to play, after
a concussion than men. I will tell you
right off the bat, women concuss
differently than men– neurophysiologically
and biomechanically. That's just a fact. It's not a statement of saying
women and men do mathematics differently.

It's saying that women
concuss differently. And part of it, in
childbearing ages, is because of the
profound influence of estradiol, which prepares
the woman every month to receive a fertilized egg. And that has a
profound effect on what we call spreading ways
of electrical depression in brain activity, which is
one of the pathophysiologic mechanisms of migraine and
also for a prolonged concussion recovery. Women, in general, also,
they have more symptoms to report than men. These are just facts. And at some point, we are
going to take a deep dive into the why. Moving to sexual
violence, the NCAA has put out just recently the
Sexual Violence Prevention Tool Kit. Every member school
has this toolkit. It has been endorsed by 12
higher education organizations. And our goal is to
widely socialize this. The Board of Governors, who is
the highest ranking committee for the NCAA made
of 16 presidents, they just appointed
a special commission to look deeper into
this, and to come up with policy that will be
independent of Title IX and Clery.

Why? Because Clery, as we know
it, may be gone soon. Violence Against Women Act,
as we know it, may be gone. Title IX may shift to
the Department of Justice from the Department
of Education. We must be actively
prepared for the future. And we are addressing
this with sexual violence. Looking at a recent study that
looked over 25,000 college students– so the rate of sexual
violence, even in one year, it varies from school to school,
but it is still astoundingly high up to 20% in some schools.

And we will look
at these college students and their lifetime
incidents of sexual violence. It's astoundingly high. This is part of our society. This is humanity. This is Homo sapiens. And when we look at
those individuals and talk to those individuals
who have been victims, they are much more likely to
be hopeless, to be depressed, and to actually suffer with
psychiatric conditions. And I'll just take
a pause right now because I have treated
thousands of victims of the most horrendous sexual
and interpersonal violence ever. That was part of my
subspecialty as a neurologist– working with
Holocaust survivors, working with survivors of
other profound violence. And when you talk to
these individuals, and you try to
understand, you realize that free will, as we
may hypothesize about it, as we may think
metaphysically about it– it no longer exists.

It doesn't exist at the
moment of sexual violence and from every
moment thereafter. Because it changes
your physiology. It changes your
perception of life. And unless there is a
miraculous, neurobiological reconciliation,
peacefully, and almost with what we call
unconditional love, your physiology is
forever changed. Free will no longer exists. Moving to some
lighter subjects– [LAUGHTER] –anterior cruciate
ligament tears, we know that females have a
much higher rate of ACL tears than males.

Why? Well, there are a few reasons. But let's look at
the societal reasons and the neurobiological reasons. Because an ACL tear is
not a mechanical issue. It's a neuromuscular,
maladaptive response. It is, when you look
at the women who are landing in their
ready position, and if they're landing
repetitively like this, with poor neuromuscular
control, that's a profound stress on the ACL. It is not the proper
land, like this. And when we have,
in our society, people who are
specializing in sport before the age of puberty– despite all of the data that
it is the wrong thing to do– and then, when you look at
what happens at puberty, and testosterone
takes over in men, and that goes right
to the muscles, it gives the men an advantage. And when you have someone who is
highly specialized, who doesn't know how to land,
who doesn't have testosterone receptors
in their muscular system, and you have a repetitive,
maladaptive response, you have data like this.

It is simply not acceptable. Now, we talked about tennis. I'm not going to go
through all of these. But the tennis injury
rates are similar. And I do agree,
tennis is not perfect. But we should study
tennis because it's pretty close to perfect. You go to the US Open
tennis championships, and on any given
day or night, we are paying equal
amounts of money, and the women are getting
equal amounts of pay, for the single largest annual
sporting event in the world. But I won't talk
about tennis anymore, other than that, when
I visit every school– and I'm a former tennis
player, and I still compete– I always meet with
the tennis team. And I tell them in silence,
behind closed doors that, yes, there
are 23 NCAA sports, but tennis is definitely
the greatest sport. [LAUGHTER] And what about what's
happening since Title IX? Who's overseeing all of this? Who's overseeing the
care of our women? Because it does
make a difference. Pre-Title IX, when we
looked at coaches, well, women's athletics were
separate from men.

So, the vast, vast
majority– close to 100%– of coaches for women's
teams were female. We've been stuck at about
between 40%, 45% for years. Does it make sense? Well, ask this question–
does it make sense that we've been
stuck at this amount, at this rate of athletic
directors across the NCAA? We should be as
complacent with this data as we are with the data
of the number of females in the current President
Trump's cabinet, or with the number of females
who have been president of the United States. We cannot be complacent
with this data. The NCAA has recently sent
out a presidential pledge. It has gone to the president
of every one of the 1,100 NCAA schools. And 75% have signed on to this
to make a concerted effort to shift the gap for
diversity, for gender, for all of the things that
truly matter to us. So, that's my brief,
very brief overview of some various aspects of
gender issues and sport.

And I'm going to take
another giant step back because I'm really
listening very carefully. This first panel was nothing
short of exceptional. And again, I really thank you
from the bottom of my heart for allowing me to be here
and to learn from you. So, thank you. [APPLAUSE] – Well, thank you. It's great to be here. I'm Travis Tygart of the
US Anti-Doping Agency, and just want to first
thank Radcliffe institute for the invitation to be here– Liz, Rebecca, Jessica,
all your hard work in putting this together.

It's truly an honor for me. And I'm thrilled to be here. I guess the only exception to
me being thrilled to be here is having to follow Brian
Hainline, who likewise, compared to this
morning's panel, gave a fantastic opening
remarks to this session. I also wanted to say
thank you to Cheri, who's been a personal hero
of mine, and really took simply a phone call, or
it might have been an email, from Cheri, asking me to come. And I said, absolutely
I'll be here. Anything for Cheri. And if you don't know
Cheri, I strongly encourage you to
get to know her. What she's done not only
on the athletic field, but off the field is just
flatly incredible, and one of the role models that all of
us should look to and honor. So, Cheri, thank you for
reaching out and having me here. [APPLAUSE] So, I'm going to
dive right into it.

And I heard, I think, Donna said
she speaks fast because people retain when you speak faster. And that's good news to me. I always assumed I spoke
fast mainly because I'm a middle child, and I assume
at my house my parents never listen to me. And I never got
what I asked for. So, I'm glad to hear the
research has caught up.

And I'll continue to speak
as fast as I possibly can and, particularly,
given the short 15 minutes that we've got here in
our opening remarks. Let me just say that the United
States Anti-Doping Agency, we're not a government
organization. We're not for-profit
organization. We are recognized by Congress
as the independent national anti-doping agency for
Olympic, Paralympic, and Pan American sports in
the United States. We also do run some
of the pro programs– UFC, specifically,
I'm happy to talk about that in the
discussion if it's relevant to any of you all.

What is our job? We're here to protect
the athletes right. And you heard a little
bit of a discussion on the first panel about
privilege versus right. We could get into the
constitutional definitions under the 14th Amendment. I'm a lawyer by training. Whether or not it is a
constitutionally-protected right here in the United
States, you heard Anita talk about the right to
work laws that apply to athletes over in Europe. Bottom line– however you
want to define "right," it is a right. And athletes who
agree to the rules– and let's remember, and this is
a little bit of the philosophy major in me coming
out– but sport is an agreement to a set
of rules by the competitors and to agree to
abide by the rules that all competitors
have agreed to abide by. And in our world– anti-doping– when someone
uses a prohibited substance– might be an anabolic steroid,
might be human growth hormone, might be whatever the rule says
is not allowed that ultimately gives them a
performance-enhancing advantage under the rule– well, the person that
they're competing against is harmed by that.

Their rights under the rule
aren't equally enforced. And they become, I think, in a
lot of people's mind, a victim. There is a global
set of rules that apply to all athletes
in the Olympic movement. It's called the WADA Code. This deals with the anti-doping
question within millions of athletes who compete
on a daily basis, literally hundreds of
sport organizations, with the exception of the
pro sports here in the United States, with the
exception of the NCAA– unless those athletes also
compete within the Olympic movement– so the NBA Dream
Team, for example, or now, Redeem Team that
won a gold medal in '08, and '12, and again in
'16, despite losing in '04– they are all held under the
standards of our program that apply to athletes
like Cheri, like Stephanie, you heard earlier,
day in and day out within the Olympic movement.

But right in the preamble
of the global rules– and by the way, relevant
for a short video I'm going to show you at the end– there is also an
international treaty that the United
States government has signed, ratified as
the Constitution requires by the Senate Foreign
Relations Committee, signed by President
Bush at the time. Close to 200 other
countries around the world have also signed that UNESCO
treaty against doping in sport, including Russia. And that's received
a lot of headlines recently with the
state-run doping that Russia has
perpetuated on the world. And I'm going to show
you a short video of it. But I think it's also
really important that there is an international treaty. There are sport
rules that all define how the global
stage for athletes is supposed to be conducted.

So, you hear right–
you see right in the preamble, "to protect
athlete's fundamental right to participate in
doping-free sport, and thus promote health,
safety, and equality." And I think that is
at the heart of what you sought us here to do. We're simply the rules enforcer. While we have a big say
in what the rules are, when it comes time to those
rules being implemented in the United States
for our athletes, that's our job to ensure
that they're evenly, fairly, and thoroughly,
and robustly, enforced.

Listen, I can give you
all the legalese you want and show you the language right
from the mouths of athletes. There's a UNC Tar Heel
grad, which I am– we're all very happy these
days after Monday night– but also, Marblehead, Mass.,
athlete who, just last week, and was confirmed
again yesterday, was upgraded from the bronze
medal in the '08 Olympic games to silver medal in
the Olympic games. Unfortunately, it
was nine-plus years later that she got wind of that. But you see her
tweeting out, I think, the sentiment that we hear
from our athletes day in and day out, which is– you know, and good for her of
putting her own interests aside and being willing to speak
for others because there were other athletes who
also got elevated and will receive
metals that were taken by other athletes
who doped at the time. And she says, I think
very eloquently, I'm gutted for those athletes
that had theirs stolen. So, in addition to
protecting our elite athletes within the Olympic, Paralympic,
and Pan Am movement here in the United States through
testing, research, education, and results management,
we also, from time to time, where appropriate
for our mission, embark on some research.

And I think, academics in the
room, please go to our website. You can find this "What
Sport Means in America," as well as companion
study, "True Sport, What We Stand to Lose in
Our Obsession to Win." I'm not going to spend
a bunch of time on it. But I there's some really
important findings. You know, sport– as I think
you all probably agree, which is likely why you're here,
or you heard it from the first panel this morning– it touches our society
and our communities like almost no
other institution.

Our research shows 162 million
here in the United States, roughly 3/5 of the population
have some relationship to sport-related activities. Parents overwhelmingly cite
personal and social values when describing their
hopes for their children in playing sport. And I was really struck
by Brian's statement about the mental health issue. And I think we have to ask
ourselves the question, what lessons are our
children learning when they get to the elite level? And Brian has access to
them through their surveys at the NCAA. Well what lessons
are they learning? What factors are causing
them, at that level, to have the mental health issues
that they're so willingly, apparently, to describe? Coaches also rank as the number
1 influence on today's youth who are involved in sport. And listen, I've frequently
said my children– daughter, two sons– all of
whom play sports at the youth level– they'll learn more
watching the Broncos play and seeing Peyton
Manning and how he acts off the field than
they'll ever learn from me. But the reality is,
they're probably learning more from
the coach that they spend quite a bit of time
with on a day-to-day basis.

And the fact that there's
no national coaching accreditation, certification–
you've seen some of the recent news on the sexual abuse– it just simply has to be dealt
with in a more effective way. 2/3 of America agrees
that sport over-emphasizes the importance of winning. And I have just
two quick graphs. And I know that might
be tough to read. And I don't want you to try to
read all that in the short time that we have.

But at the top,
this is a question from the survey that asks
those that took the survey– and over 6,000 people, it
was done through an IRB, robustly put together– what
values, as a participant in sport, do you want to see? And I think it's,
if you can see– so this is what people
want out of sport, OK. Honesty, that's a
value they want taught. Fair play, this is in
order of importance to those that were surveyed. I think you see in
one of the main points is down here at the bottom,
winning and competitiveness. And by no means am I saying we
don't want to be competitive. We just have to be
realistic about what are we willing to do in order to win.

And "win at all costs"
culture is a real, live issue, all the way down to
our youth sports. So, when you then
ask the question, what is sport
actually reinforcing? Not that it's completely
turned on its head, but you see a pretty
dramatic difference in what sport, at least what
the perceptions are from parents and others who were
involved with this research, competitive winning
is at the top.

And I think it's no
wonder we're seeing some of the manifestations
of that culture, as Brian described. But you also see a big drop
off from kids playing sport at that 12- to 14-year-old
level because it's simply not fun anymore. And they don't
like what they have to do– the specialization, the
professionalization, and what they have to do
in order to please the number 1 influence in
their life, their coach, is just simply not
fun for them anymore. We've tried to address
it through a program– TrueSport. I'd encourage you, if you're
interested, please go and take a look at it.

I think we would be remiss if
we didn't at least acknowledge this issue. And I heard earlier about the
"head in the sand," I think, or the "elephant in the room." We might describe this one
as the "head in the sand" if we don't address it. Because sport is addressing it. And I want to be
really clear, these are not issues that we deal
with on a day-to-day basis. And I'm certainly
not the expert on it. But I think this conference
should examine these issues.

I think sport has to deal with
it in a fair, objective way to ensure that all athletes'
rights are protected in the way that they should be protected. You know, frankly, if
you follow these cases– and there were very popular
in the headlines in 2012 for the Games, in
2016 for the Games– I think it should
break all of our hearts to see how some of these
individual athletes have been treated
and humiliated. And I think we should all
take steps to ensure best practices and policies
that are in place, so that individual
athletes don't have to go through the
type of humiliation that some have
had to go through. I think, good for these
athletes, frankly, for not backing down, and
being tough to push back on that potential humiliation
and things that otherwise might cause people to cower away,
and truly be role models for us all. And listen, the rules are
set by the sport federations. I think it's fair to say they've
done a very poor job in even attempting to get their
arms around these issues. The IOC has put out a policy– it passes, or punts, on
the inter-sex question until sometime,
probably this summer.

So I'd encourage you,
if you're following these issues, to pay attention. What ultimately will happen
on the gender question, whether a transitioning
athlete can participate, those rules are
pretty well-developed. The one area where that
touches anti-doping is where you have a
transitioning female who wants to compete, can compete
as a man under the IOC policy. Frequently that
transition will require the use of testosterone,
which as I've said previously, is a violation, potentially,
of the anti-doping rules. Fortunately, the
anti-doping rules have a process to
deal with that. We've had two
cases where someone in a transitioning
environment has a decision, has come forward and
disclosed, and since disclosure received permission to
use that testosterone.

So, I think the
anti-doping rules where it interfaces slightly
deals with it directly in a very robust way. But happy to talk about
that more as we can. Lastly, let me end with
just a quick video, and it may go one minute over. I'm not sure what the
opportunity for women to compete in Russia is. Honestly, I don't know. It's a really
fascinating question that I ask myself after
hearing the first panel. My guess is they don't have
a Title 9-type provision that gives the same
opportunities that we have here in the United States. But thank goodness
this particular woman competed in Russia and rose
to the elite level ranks.

Some of you may have
heard this story, but it's the Russian
whistle-blower, a female. She was named BBC Most
Influential Woman in the World, and I think you'll find her
story compelling of what good women can do when
they do participate. Let's see if we
can get us to work. [VIDEO PLAYBACK] [END PLAYBACK] Incredible courage that
this female competitor has showed for the good of
athletes around the world, including many here
in the United States. Thank you for your attention. [APPLAUSE] – Good morning. I would like to first
start by recognizing that we're gathered today on the
traditional lands of a number of different
indigenous communities and that I am grateful for this
opportunity to work on this.

Land I'd also like
to add my thanks to Dean Cohen and all the
members of the planning committee for, first of
all, this tremendous event and for inviting me
to be part of it. Now, we're going to go into
far different direction than what my co-panelists
have initiated in this particular
session, as I will be focusing on gender health and
community or grassroots sport. I'm also, I think,
representing– the only representative
of Canada here. So, we'll be going
international a little bit. Now, because I am the last
panelist before lunch, I'm just going to go straight to
the key points here of my talk. [LAUGHTER] Health is a political issue and
a right of social citizenship. These are the key points that
I will be coming through, throughout my entire talk. Two, that access to
equitable community sport is an access-to-health issue
in that the negative health consequences of inaccessible
and inequitable community sport is far more substantial for
vulnerable and marginalized individuals and groups, in
particular low-income girls and women.

I suspect– I hope that
these points may seem obvious to most of us here. But if not, I will unpack each. In Canada, as in many
other neoliberal regimes, preoccupations with
individualized and behavioral approaches to disease
prevention prevail. And they in fact act as barriers
to more critical conversations about our health,
despite the fact that there's a tremendous
amount of evidence of the social
determinants of health. And a key question
then becomes, how do we go past our fixation
on our waistlines? How do we go past these
behavioral approaches to think more concretely
about health and health care? Certainly, raising
awareness of health as a political phenomenon
is one approach. And to this end, Bambra
et al.'s explication of the political nature
of health is quite useful. These are folks from the UK. This is how they define the
political nature of health. Health is political because some
social groups have more of it than others. It's a resource that some
enjoy more so than others. Its social determinants
are amenable to political intervention
and political action– more often than not,
political inaction.

And health is political
because the right to a standard of
living and well-being is or should be a
right of citizenship and a human right–
something that was raised in the first panel session. In this conceptualisation,
health is not simply about our genetics,
or our lifestyles, or our medical systems. It's not about how
long is the wait time for a particular procedure
or who's going to pay for it. Those downstream-type
questions and the debates that they engender
are critical, yes. But they also keep the
priority on this very individualized and medicalized
approach to health. Rather, this
conceptualization here sees health as
fundamentally linked to power and to the distribution
of resources in our lives, as well as also to the quality
of the social relations within our communities. And this third point
clearly emphasizes that health is a right of
social citizenship, which refers to a right of us
to share fully in life.

To go beyond just
economic welfare, but to be able to participate
in life fulsomely and robustly. Whereas civil and
political rights protect us from unwarranted
interference from others, a person's social
right of citizenship emphasizes equality,
a sense of solidarity, and mutual dependency. So, this emphasis on
collectivity and community leads to my second
point, that access to equitable,
community-based support is an access-to-health issue. Let me offer you two very
well-established facts. The first is that social
cohesion and social connectedness– some of us may
use the term "social capital," it depends on us– but social cohesion,
social connectedness has profound implication
on our health. The greater our sense of
connection with one another, the greater our sense
of compassion for one another, the more we trust
in one another, and engage in one another, the healthier
we are, the happier that we are. The World Health Report
2017 came out two weeks ago. The Scandinavian countries
are back up at the top again, right. And why is that? Because of, well the
Danes have a concept, they call it "hygge." I don't know if anyone
is Danish here– forgive me for my Danish.

[LAUGHTER] What it means, it
translates to "coziness"– this element of coziness
in their communities. That's one of the reasons why
they rank at the top, year after year. The reverse is true. The greater the sense
of social isolation and social polarization,
the greater our illness, greater our injury
and ill health. This is one of the core things
that we're finding with regards to, let's say, the opioid crisis
that's happening in the US and across Canada. The second fact is that,
when done well and equitably, community sport fosters social
connectedness and belonging. I want to emphasize what I
said there– when done well. In its best moments,
community sport is a site where one can
share fully in social life. It's inclusive and integrative.

It is a resource that, when done
well, can boost health, right. And so, therefore,
access to community sport is an access-to-health issue. And yet, the provision and
delivery of community sport is more often than not quite
disconnected from health and health care systems. In the city of Toronto,
Parks, Forestry & Recreation, which is the
division responsible for publicly-funded,
publicly-accessible community sport, that which is
available to Torontonians– it's completely separated
from public health, the Department of Public Health. It's completely separated
also from Children's Services, Economic Development
& Culture, Equity, Diversity, and Human
Rights, Shelter, Support & Housing, and Social
Development, et cetera. In other words, in
the siloization– which is a word– in the siloization
of governance, community sport gets
isolated into one department with very little dialogue
or sustained conversation between these departments. This compartmentalization
is matched by the too-common relegation
of community sport as just a frill, or just
fun and games for the kids. And we hear this narrative
by civic leaders, but also from community
residents too. Outside of those occasions
when a major sporting event is being hosted, with all
of the politics that happens and the fanfare, rarely is
the provision and delivery of community sport
discussed or debated with the same visibility
and sustained sort of energy as, let's say, budgets,
property taxes, police-community relations,
infrastructure troubles, or public transit.

Of course, those
issues are critical. But the near-complete
silence or the dismissal– outright dismissal
of community sport as just not as
important as whatever XYZ is very problematic,
given its health consequences. This is particularly the case
in this contemporary moment in time when public sectors
are being hollowed out and when community
sport programs are often the first to be sacrificed in
the name of cost containment. Closing an outdoor hockey rink– ice hockey rink– may seem
the lesser of two evils when compared to cutting
funding for community housing or public transit. But for the more vulnerable
groups in our communities, those resources–
community sport resources– are just as necessary
and meaningful as shelter and transit. Why? Because they offer spaces
and places to get beyond, even if just momentarily,
the stark challenges of life. These are the spaces and
places where people connect, where they get relief– stress relief, where
they have pleasure, where they attend to
health and well-being.

Then this leads to
my third key point. The reduction of public services
has impact on all of us, but has heightened consequence
for those who are vulnerable. And low-income girls and women
are one such vulnerable group. Even though the
data that we have on sport participation, at least
in Canada, is quite imprecise, there is consistent
empirical evidence that the rate of participation
among girls and women is consistently less
than boys and men. And that the trend or the
gap is more pronounced as you go up the
socioeconomic ladder– or should go down, I should say. Low-income girls and
women disproportionately bear the burden of
inaccessible community sport. While the fight for
gender equality continues, sport still remains a
school for masculinity. And a majority of community
resources still go to boys' and men's sport,
helping to reproduce the likelihood that boys are
more likely to participate than girls.

And this becomes
even more complicated when we go back to the issue of
the closure of community spaces and places, like a
hockey rink, right. For families with
the financial means, the loss of that
neighborhood hockey rink can be managed,
can be mitigated. They have the means
with which to then get their sons and daughters into
a private sport club, right. But for low-income families,
the evidence suggests that once those community
spaces are closed, it is the son's participation
that gets more supported than the daughter's. Now, these are not
cruel families. These are folks who are
living in very precarious financial situations. And these are folks who,
more often than not, have quite different
ingrained perceptions about the value of sports
for girls and women, as compared to boys and men. In other words, even the
meaning of sport participation is different as you travel
down the social gradient. And to use the most
Canadian of examples, we know that Canadian girls
playing ice hockey– again, I come back to like ice hockey.

I was a rugby player. I don't even know how
to skate, but anyway. [LAUGHTER] We know that Canadian girls
who are playing ice hockey tend to have parents who have
higher socioeconomic status. Not only do these parents
have greater economic capital, but they tend to offer
greater encouragement for their daughters to break
out of traditional gender boundaries. For them, it is much
more organic a thought that, if my son can do
it, my daughter can do it. What we know is that when
you go to the other end of the socioeconomic spectrum,
the meaningfulness of sport changes, as well
as the exposure to, the competence in,
and the access, right. And this is some information
coming out of colleagues from the UK, Jay
Coakley and Anita White. This is not just about
children and youth. The hollowing out
of the public sector contributes to the
inaccessibility of community sport for women of all ages. This is a quote
from a participant, a woman that I spoke to from a
study I did a number of years ago, living in one of Toronto's
high-risk neighborhoods– "high-risk" being code
for very racialized– high number of immigrants,
low socioeconomic status.

She was from Sri Lanka, living
in a high-rise department. The city of Toronto,
because they needed to shrink
the budget, decided that they wouldn't be shoveling
the sidewalks as often when there was snowfall. And she said, "When the City
decides to no longer shovel the sidewalk around
my building, how can my mother and I
go for a daily walk when that's all I can afford?" We're so good about preaching
health promotion– you know, be physically active, it's
good for you, da, da, da, da, da. This woman knows physical
activity as good for her. What this is, is commentary on
some of the systemic barriers she's facing, right. And if we had time to go into
the complexities of gender, ethnicity, health,
and community sport, we would see the marking
of racialized difference and otherness entwined
with material conditions, such that struggles around the
politics of identity cohere through processes, as much
economic as ethnocultural.

Still to this day in Canada,
it is recent women immigrants who are probably at
the lowest levels of the socioeconomic ladder. They are still– even
though their education rates are higher, greater than ever
because of Canada's immigration system, they are earning
a fraction of what Canadian-born women are earning. And Canadian-born women
are earning a fraction of what men are earning. Again, where does community
sport fit into this? Now, I don't want to end
my talk with doom and gloom because I'm just
before lunch, right. Because there is
also good news here. There are some incredibly
innovative and thoughtful programs out there,
all across Canada, and I suspect across
the US, too, as well as other parts of the
world, that are trying to prioritize accessibility
and equity for low-income girls and women. So what are the common
characteristics? I'm only going to highlight two. There's challenges, I can
address that afterwards if anyone's interested. One is that they
take into account a priori that low-income
girls and women may have different prerequisites
for participation.

And they factor in those
different participation prerequisites into the
design and the delivery of the program. The other one is that they
ensure that key individuals are at the decision-making table. They ensure
representational access. Who are the key individuals? The low-income girls
and women themselves. That they are there to inform
how different programs get developed and then delivered. So for example, in British
Columbia a number of years ago, city officials,
program developers, and academics from the
University of British Columbia gathered together
because they wanted to develop a program
that would ameliorate the conditions for low-income
girls and women living in some parts of the city. And it was a flop. They went to the girls and
women in the community, and they said, please
come to the table. It was women, in
fact, excuse me. They said, please tell us,
let us know what's going on. The women came to the
decision-making table and said, we have children. Two things– we don't
have money for childcare, and the other thing is
if our children can't find opportunities
to play sport, we're not going to
engage in sport.

The program revamped. And they developed
free childcare for the women, free sport
programs for the children, and it was a huge success. And the women said, we know
that we were socially isolated. We know this is
going to help us. And thank you for
hearing our voices. In a Toronto-based
program, it was in fact a group of Somalian
recent immigrants, women who came to the city. And they said, hey,
city of Toronto, we want to engage in sport. By the way, we want to
engage in field hockey.

Why they chose field
hockey, I don't know. They said, we will
bring the women if you can attend to our
participation prerequisites. We need a space where
there is security, so that we can learn,
train, and figure out field hockey in private. And we need a female coach. City of Toronto said yes. So, here we have
bottom-up approaches. And what that ends up doing is
it breaks a very vicious cycle. Most community-sport
providers still believe that if you
build it, they will come. So, they develop a program
that's not informed. It fails to take in the material
conditions of these women's lives into account. The women don't participate. Then the program
officials blame the women for not taking advantage
of the opportunity. And then some
stereotypes keep getting reproduced– the
apathetic poor person, or just the stigma of poverty. Bottom-up approaches
get rid of this cycle. So, let me leave you
citing here Jane Jacobs– from New York, but then
transplanted to Toronto, so I claim her as Canadian. [LAUGHTER] But let me change her
words a little bit.

"Community sports
have the capability of providing something
for everybody, only because, and
only when, they are created for everybody." Thank you very much. [APPLAUSE] – So, thank you so much, to
our panelists for these really insightful remarks. And, you know, I was talking
to Parissa before our panel, and I said, well,
I hope we get some of those fist-pump moments,
like the first panel had, where people in the
audience are saying, yeah, it is a
rights-based issue.

And I think that what
we've seen with this, is that even when we talk about
health-wellness, even if it's something as concrete
as a concussion, it's still a rights-based
issue at the end of the day. And it is a right to be
able to participate and play sports safely, and in
a fair environment, and to have access to identify
as an athlete or someone who wants to live an
active lifestyle, as Dr.

Safai so
poignantly noted. So, I'd like to open it
up for some discussion now amongst the panel. And I'm going to kick it off
with a question focusing on, I think that we realize when
we talk about wellness-health in medicine that
very frequently we're quite reactive in our approach. So, the health care
system here in the US is known to be very reactive. We're very good at treating
disease when it happens, but we're very terrible,
or we don't focus enough on prevention. So, maybe we could
talk a little bit about what we're doing
in terms of prevention, and how we're trying to
move the needle on that, whether it's sports injuries,
or people being pressured for doping, or
thinking about being more proactive for communities. – Well, I think we start
by understanding that sport is a microcosm of society. In the United States, 95%
of our health care dollars are spent on treating
disease, and 5% is prevention. So, that's one social issue.

The other, I
mentioned it briefly, is that we're not doing sport
right at the youth level. Even girls are
playing in traveling soccer leagues all year round. And we think that that's good. And it's bad, because we know
that the way we're doing sport is leading to a 75% drop-out
rate at the age of puberty.

So, we have to really
take a giant step back. But I see, well, Nelson
Mandela, I think, said it right. He said, you can
measure a society by the way it treats sport. And the way we treat
sport in the United States is that we replace the one
day of worship in church with a day of worship
on the football field. And that's a metaphor. And we have to acknowledge that. So, I don't have the
answer, other than that I believe so deeply in sport that
I'm devoting my life to it.

And I think it is really an
access to equal opportunity. But we're not doing it
right at the youth level. And that's where
it has to start. – I have a bit of
a different tack. As an academic, as also a
sociologist, I'm a little bit– I just am going to be
more critical here. So, the challenge that we
actually face with regards to this piece around
prevention versus action, is the fact that we
don't have good data. We really just don't
have great data. I said already, I intimated
in my presentation that, when it comes to sport
participation, the data that we have is really
quite imprecise. Because the data is coming
from who is playing– how many people are tuned in
and going through the turnstiles to get into the facilities
or to get into clubs. What we don't have great
data on our the folks who are absolutely
turned off of sport, and why are they
turned off of sport.

The other challenge
that we face, too, is that we
also are really– we don't have very
good information on the number of
folks who are not necessarily interested in
organized competitive sport, but who– I think about kids and girls– who will happily go into
their room, lock the door, turn on the music,
and dance like there's no one watching, and are
getting physical activity in that sense. So, to come back to this
question around prevention and action, it's a
very challenging one because we don't
have very good data. The other challenge
is that there's a lot of rhetoric about
how sport is good for you. And yet, some of the data
that we just saw today really puts a pause on
that thinking, right. How good is sport for us? Do we really want to democratize
some of the highest levels of sport that we're seeing? I don't know.

I played rugby for 20 years. It was powerfully
transformative in my life. It was absolutely meaningful
in so many ways, contributed to who I am today. But I also have the body
of a woman who played rugby for 20 years, with all of
the screws, and the pins, and all of that sort of stuff. Do we– is it part of
our prevention strategy that we want to really support? I think there's some good,
thoughtful critical debates around that need to happen.

I may have gone on a
tangent there, but. – Yeah, I guess
I would just say, and I don't disagree
at all, Parissa, with what you just said. I mean, there's
been many moments after sitting in long
interviews with athletes who have succumbed to the
temptation to dope where we– myself and an attorney or two–
would walk out of the room and say, you know,
it's too bad we don't– aren't filming these to
then show to parents.

Because I think there
were a lot of parents out there that never would want
their son or daughter to be an elite-level athlete if they
have to go through the things that these athletes have had
to go through and then make in our world decisions
that compromise the values that they were taught, couldn't
look their parents in the face, kept secrets from their spouses
to break the rules of sport, just to gain an advantage. So, I think there's
some real truth to that that we certainly see
at the ground level. From– and just one topic,
and I'll only mention it around this health
question– and Brian, I think, actually, on
one of our phone calls, asked me to talk
about supplements.

But one area that's also a real,
live issue for us, that I think is elite athletes
are bombarded– as are, I think, young
athletes– you know, I saw supplement
powder drinks being used at my daughter's
10-year-old swim meet a few years ago. And this is an area where we
have very poor regulation. Some would argue
there's no regulation on the dietary
supplement market. There is some
legislation out there that attempts to control it. But it's a $30-plus
billion industry, and $8 to $10 billion of that
is on this performance category. And it's a pretty easy sell,
if you can have more energy, and you can build bigger
muscles, and you can be faster, and you can be better
in bed, and you can pay attention at
conferences like this easier.

You know, it's a
really easy sell. And unfortunately,
there's not a whole lot to give good advice to athletes. And they're risky. And what we tell
our athletes, we've developed the website
"Supplement 411"– we pull supplements off
store shelves and test them. And, you know, there's
been a prenatal vitamin that hasn't contained
the amounts that it says on the labels and has
contained significantly more amounts of
certain vitamins that would be harmful at the
levels that they're taking.

And that's just one example. There's also synthetic drugs,
and some of them as well, that have caused athletes
inadvertent positive tests that we have to deal with. So, I think we, having a
captive audience in our 2,500 athletes that compete
within the Olympic movement on a daily basis,
attempt to do what we can do to address
some of these issues and supplements as one that's
right in the cross-hairs of us having to really give good
advice to those athletes at that level, to make
informed decisions around it. – Absolutely, thank you. So, and feel free to pipe in
if you have other questions for one another, too.

One thing that I'm very
curious about, we've seen recent commercials
and media pieces focused on trying to change that, I
guess you could say, stigma– or the bias that we have about,
particularly, young girls being active. So, there is a recent
campaign about, you know, throw like a girl. What does that mean
to throw like a girl? And you know, I'm curious
to hear whether you think, particularly you, Parissa,
whether we're moving the needle one on when we
conceptualize and when we have that first
thought of, like, what are the differences
between young men and women? And whether or not our bias
about our expectations– do we think it's
changing at all, with some of these campaigns
that are coming out? – So, the pragmatist
in me will be quick to say that any sort of
campaign that, at some level, sort of seeks to boost girls'
and women's participation in sports should be applauded.

The more critical
scientist in me, though, is very quick to start
to see some of the places where those are
really quite limited. There was a campaign,
the "throw like a girl." A few years ago, they had the
"if you let me play," right. I wonder if some of
you may remember that. The big challenges with
these types of campaigns is that they do nothing
to actually destabilize the stereotypes that are faced
by girls and women in sport. They're not about
saying, whoa, what we say about girls and
women in sport is false.

It's not supported
by any of the data, physiological all the way
to social to cultural. It actually reproduces
all of that. All it says is, well, let's
just have more opportunities for girls and women to do it. And that's a disservice
to girls and women, but also to boys and men. The reproduction of
these stereotypes are just about what
girls and women can do on the sporting field
are just as damaging for boys and men, who need to be
seeing more and more sort of competent, capable women
on the fields, off the fields, in the coaching roles, in
the administrative roles. And they're not seen it. So again, it's a,
yay, more campaigns, more commercials– excellent. But we need to be very
sort of controlled with how much
applause we give them. They're very, very,
very double-edged and– – Potentially one piece,
but certainly not– – Yeah. And the fact that
they reproduce these, they're not destabilizing the
boxes of sex and gender, right. They're not shifting them. Even though, in other areas,
they are being shifted.

I think of what's happening
in the transgender movement, right, and some
of the varied nuances that are being explored there. But those kinds of
nuances are being supported in other
spheres and not in sport. – Excellent, thank you. So, we'll have time
now to open it up to questions, prior to lunch. So, we have about 25 minutes. And I invite everyone,
please, to use the mic in the center of the room. If you have a question,
please introduce yourself, and try to be brief, and be
sure to keep it to a question. And we'll get through
as many as we can and use the wisdom
on the panel here to the best of our ability. So, yes, thank you. – Hi. I'm Tori Clay. Before I make my
comment, I'd like to thank the unsung
heroes here, the people in the back of the room because
I wear two hearing aids, and this is so rare for me to
come to something like this and be able to hear every word.

– Yay! [APPLAUSE] – Really appreciate that. [APPLAUSE] Obviously, I'm
transgender female. And when, Brian, you had
that pledge up there, I just want you to know I
have a little issue with it. I felt excluded
because it said, it was a phrase, something like,
racial and ethnic diversity. And then after gender
was the word "equality." And I'd much prefer
gender diversity be included in that pledge. – Yeah, so I think
that's a fair point. And actually that's
a point I'm going to bring back to the people
who put together that pledge. So, how the pledge
came about, is the head of diversity and
inclusion at the NCAA, and it's a staff initially
written thing, and then the Board of
Governors, they have to approve that for it to
become open policy like that. And I think that's
a very fair point. I think another fair point is– and this isn't just because
I'm part of the NCAA, it's because I
truly believe this– I think if you follow some of
the politics of what's happened recently, and because the
NCAA was unwavering in certain aspects, that we have seen
some laws change particularly in North Carolina–
imperfectly, very imperfectly– because the standard was set at
still a bar that many believe is unacceptable.

But that's a standard
that exists in– – It is unacceptable. – a considerable number
of states in this country. But with regard to certain
transgender issues, I think we are learning, and
we are trying to be a model. But your point's
very well taken. – Thank you. And I'd like to
thank the whole panel for mentioning transgender
in a lot of the things that you mentioned it today. I appreciate that. – Thank you. [APPLAUSE] Please. – My name is Sam Bachelor. I have a question particularly
about performance-enhancing drugs and that the language
around the use of them is always couched, or often
couched, in terms of fairness. Whereas it often
really seems it's a matter of health or
safety for the athletes, and that you're basically
asking the athletes to choose between their long-term or even
short-term health and a higher performance level. And I'm curious why you think
that hasn't taken more hold and hasn't been pitched or even
championed more by athletes as an issue of
safety, as opposed to an issue of fairness? – Yeah, well, thanks
for your question, Sam.

You know, listen, I
think, first of all, for a particular substance
or method, so a transfusion or an IV, whatever the case
may be that's prohibited, it has to meet two
of three criteria. One, is it enhances performance,
or has the potential to. Two, it violates
health or safety of the individual
athlete taking it. But there's also a concern, and
some of the Supreme Court cases have dealt with, when you
have a high football player, let's say, on cocaine– they're more reckless,
inhibitions are down, they might cause
injury to other people that they're competing against. So there's kind of a double
facet there from a health and safety standpoint. And then this more
nebulous spirit of sport– you know, I think part of the
problem is young athletes– and some of you will remember
there was a Sports Illustrated study that was done.

I think it's since been
refuted as not credible. But the exaggerated
point it makes– the point, I think,
is the biggest hurdle in getting athletes to
recognize this issue is, they said, if you can
win a gold medal– take a drug, not get
caught, win a gold medal, but die within five
years, I think– you may remember the study– and a majority of the people
said, yeah, they would do it. So, I think you're dealing with
a population of young athletes who really aren't
fearful of something bad happening to their health.

And if they can get
a short-term glory, maybe it translates into
millions of dollars, and they can take
care of their family. They're not necessarily thinking
ahead, a few years, too. But I think you
also– that said, I think you're also seeing
a generation of athletes who are coming off the
field, who have participated in the era where these synthetic
pharmaceutical drugs have flooded the market like we've
never seen before in a very concentrated time period.

And I think you have to
look at some of the injuries that these players in
their 40s, 50s, and 60s are now suffering from,
if they're still around. And let's have a
candid conversation about what else, other than
the contact of the game, for example, is causing
some of these injuries. And very many of them seem
to be textbook, classic side effects of the abuse of
androgenic-anabolic steroids, for example. So, I think we'll see
ongoing discussion about those very issues.

– Thank you. – Thank you. – Hi. My name is Kira Healey. I appreciate you
mentioning North Carolina. I am currently working at Duke. And I would also like to point
out, as a rival to tennis, that roller derby is
a fast-growing sport for both men,
women, and children. And it's played
coed at many levels, though not at the elite level. For the policies and for
testosterone as a kind of doping, or potentially
as a kind of doping, as a performance-enhancing
drug, I would like to encourage
you to study sports outside of the ones that
are legitimized by the NCAA and the Olympics,
and look at sports that, in fact, have gender
policies that are quite broad.

For example, the Women's
Flat Track Derby Association, if you identify as a woman,
or you are "gender expansive," you may skate. For the Men's Derby
Association, their policy is, we do not interfere
in the privacy of skaters. Their presence on the
track is enough to say they can skate with the men's team. Same for Junior Derby, which is
coed, all the way from 7 to 17. Boys and girls play
together, and there are adolescents who
are transitioning from one way or
the other, or are considered gender expansive. So, if you would like to
inform yourselves regarding gender expensive skater,
skaters in transition, athletes in a full contact
sport that play coed at many levels of
the game, I recommend that you look at that sport. – Thank you. – Thanks. – I'll just comment. I think we've seen– so, I don't know sport very
well outside of this country, but I'm exceptionally
data-driven when I look at things.

And sport has been
transformative in terms of opening up opportunities,
at some level, racially and for women participation. I think where we are
really missing the greatest opportunity– and if we look at the
data we understand this– is that there is a
phenomenal segregation of sport from our
public high schools and public grade
schools in this country. It's phenomenal. And it actually is cited
as one of the five most important reasons why
there is sport dropout.

And we can argue whether
a sport is good or bad, but the data are unequivocal as
well, at least from the NCAA, that those who
participate in sport– and we do quality-of-life
studies 10, 20, 30 years later– and even when we look at
the mental-health aspects in college, sport
offers something that non-sport does not. And that's just looking
at sport, not exercise. I think we have to get a
better dive into exercise. But at the grade
school level, there is an exceptional opportunity
to break all of the barriers with equal participation. And the greatest
thing that I saw– and there are pretty good data
on this in New York City– it was, when a single person
brought ballroom dancing into New York City public
school and then expanded it to I think over 50,000 kids
who were participating.

And you track these kids, and
they become dancers for life. But more importantly, they
learn how to interact together at the most profound level. They learn how to
touch one another, and to lead, and to follow. And so, we need more
examples like this. But it's not– in
this country, it's not happening at the grade-school
level, where it must start. – Yes? – Hello. My name is Connor, and I'm a
senior at Tufts University. I just wanted to ask you guys
a question about something that wasn't really
brought up on the panel. And I was kind of
surprised about that. How do you feel that eating
disorder is impacting women and men, as well? And how is that being combated
at the higher-up level? – Do you want to start? – Go ahead. – Yeah, go ahead. – So, just to be clear, you want
to know about high-performance sport? – Right. – And so, from a
research perspective– and I don't specialize
in the area, or I don't do a great deal of
research in the area of eating disorders. But what we do know is
that, yes, the higher up you move up the competitive sporting
ladder, the greater tolerance for just what's
called, as shorthand in the sociology of sport,
the "culture of risk," which is more specifically
about tolerance for health-compromising
behaviors, including eating disorders,
or excessive exercise.

Part of that is part
and parcel of what it means to be a
high-performance athletes– folks who are putting in 40,
50 hours to train, let alone get ready for competitions. How is it being managed? I can't speak with confidence. But if I may throw a
little bit of a spanner into the works, a different
way of thinking about it, I do do research
looking at poverty amongst high-performance

And one of the
repeated messages I hear from athletes, most of whom
are living below the poverty line, it's very– they
are the exceptional ones, are the ones with
the sponsorship, with the commercials, et cetera. Most of them are actually
really quite impoverished. And it's almost like
forced starvation. I've spoken to many
athletes who speak about, many nights, having peanut
butter and jelly sandwiches. And that's the only meal
that they can afford. It's not what you've asked. But it is a different way
of thinking about some of the determinants of
a very dangerous, sort of health-compromising
behaviors and practices. But maybe Brian can speak
with greater confidence about your question. – Yes, so what was really the–? – Eating disorders,
disordered eating, and like, female athletes
and disordered eating. And like, it being an
issue with regards to– – For the athletes.

– The competitive athletes. – Yeah, so, just because I'm not
sure I completely understood. So, the competitive athletes at
the elite level, the question is–? – Just what has been done at the
higher-up level to kind of look into this, and how
it's being reconciled? Just, like, how much
research has been done? – It's not. [LAUGHS] Sorry, I
shouldn't be laughing. I apologize. – Is it a main focal point? – Yeah, at the
highest level, or so, addressing, say, the
female athlete triad is, so, I think the
International Olympic Committee took a great lead
in that when, what they do is they– and Travis and I
talking about this beforehand– they organize these
two- or three-day symposium where they address an issue.

So they address an issue
of female athlete triad. And it spun into
a differentiation of female athlete triad
and energy deficiency, and saying that
those are really– it might be a continuum, but
there are two separate issues. So, energy deficiency
means you're simply not getting the energy
requirements for what you need. And and we see that that
is very high in sports where there is a certain
uniform that's worn. And so, like, in
men's wrestling, or in women's swimming,
women's track and field. And so, that's one aspect. Energy deficiency
does not mean that you move to female
athlete triad per se, which is the combination of
not menstruating, and having an eating disorder,
and bone loss. And that has a much
higher morbidity and even mortality rate to it. I think the IOC took
the lead in trying to then educate the entire
sports body about that.

I can just say, we're trying
to do that at the NCAA level. But here is the block. And Travis actually, I think,
insightfully, made a comment that we must understand
because the block is happening at the coaching level. The coaches say, this is
what you must look like. This is what you must do. And the United
States of America, as great as we may be, to be
a coach, all you have to do is hold up a shingle
and say, I'm a coach.

In Europe, you are
required to take hundreds of hours of in-class
and experiential learning. So now, there are
some governing bodies that are moving to requiring a
master's level certification. And I'll speak out, because
tennis just started USTA U. But there are others. I just had a meeting last
week with the PGA tour, and they're thinking of
doing the same thing. Wrestling is thinking
of doing the same thing. We have to have a movement
in this country, where if you're going to be a
coach, you must understand what it means to be a coach. You must understand
the sport sciences. And we are so far away from
that that it's dangerous. And that gets to
the level of, so, how do we influence our athletes
about the female athlete triad and eating disorders? When Travis also said the
number one influence on athletes is the coach, there
is the disconnect. – And I'll add,
briefly, as well, I think that I certainly know
from transitioning in my role as an athlete to now
practicing sport medicine, that there's certainly been an
evolution in the recognition of eating disorders, and
that evolving into concepts like the female
athlete triad or what the IOC titled "relative
energy deficiency" in sport.

And it's better
than it used to be, in terms of relative
awareness of the fact that that as an entity is
just as dangerous as some of the other things
that we did describe, like concussion and ACL tears. It's yet another
health-related issue that does show some
propensity towards impacting female athletes
disproportionately. Although it does
impact males, as well. And we just have a
lot more work to do to educate athletes–
the entire entourage, as well as even our colleagues
in the medical community. We are trying to
kick off some work on looking at these issues,
the female athlete triad, et cetera, in
Paralympic athletes, for example, where there's
nothing known currently. So, it's very much
an evolving area, and I appreciate– that
was a great question. – I just say, just real quick– clearly, not enough
is being done.

And I think we have to
be realistic about why some of these issues
aren't being addressed by athletic programs, whether
it's in a college setting, whether it's by
international federations. Because it cuts
against the money that could be used to
win, quite frankly. And I think we just have
to be realistic about that from an enforcement standpoint,
which is where I come from. I'm not a sport organization. We're independent of
sport organizations. I think we see a couple
of disturbing trends, that one clearly being one of
those trends that we see, particularly where prohibited
substances or supplements might be introduced to help combat or
provide the nutritional needs that someone otherwise needs. Also, what we're seeing is
this abuse of non-prohibited, so they're drugs that are
allowed to be used in sport– like tramadol, for example– like thyroxine, for example– thyroxine, a
classic one that can be used for weight loss,
where if someone doesn't have, at least, under our US medical
guidelines and particular state guidelines, reason enough to
use them, they're abusing them, in fact, for sport performance.

And there's serious
questions around health. It falls outside of our
enforcement jurisdiction. Some sports have put in a
code of conduct violations that might capture some
of those pressures that are being put on athletes
to starve themselves or abuse prescription
medications for performance purposes. I think the US is in the
process and has just– there's a bill pending in
Congress, the Feinstein Bill on the US
Center for SafeSport, the USOC has announced it
opening earlier this month, or maybe by March 1, I think. And it's going to deal with,
from an enforcement standpoint, things like bullying,
harassment, sexual abuse. And we'll see where some
of these trends that we're seeing that aren't
in our jurisdiction from an enforcement standpoint
end up being covered. Because they have to be dealt
with in an effective fashion to protect athletes. If we truly care about athletes'
health and safety and fairness, we have to deal with these
in a more effective way. – Thank you.

That was really great from all
the different perspectives. I appreciate it. – Yes? Please. – Hi. My name is Annie Brown. I'm an alum of Harvard College
and that Radcliffe rugby team. And I also had my third
ACL reconstruction at the age of 19, so I was
particularly interested in some of the data you were
showing about, like, sort of biomechanical
injuries for girls, and whether you're sense
of the solution to that is just that girls
aren't getting access and support to go to
strength and conditioning, kind of lateral movement,
that sort of coaching? Or whether there's actual, kind
of female-specific programs that need to be researched
further and developed, that treat women's
mechanics differently? – Well great question.

, So we're in the middle
of actually our first round of data analysis of 30
million data points. And the articles
are probably going to be coming out, the
more definitive ones, in about a year from now. But a couple of highlights–
so, if we look at soccer, the biggest concussion
risk in soccer is actually in the
act of heading. But for men, it's head-to-head
and elbow-to-head. For women, it's head-to-ground. In ice hockey, the
biggest singular event that causes more concussion in
women in ice hockey than men, is head-to-ice.

And ice is more
unforgiving than concrete. For men it's head-to-board
and elbow-to-head. So something fundamentally
different is happening. Also, if we analyze soccer– and we must think this way. And I had mentioned
testosterone, and so it shifts
even your ability for scapulothoracic control. And if you analyze how
young women head the ball, it's more often up here. Whereas men, young men, are
heading the ball properly here. When you are heading
the ball up here, you have a sudden rotational
force that you should not have. Now, we don't understand all of
the biomechanics of that yet. So, I think we're early on. And we are actually
putting sensors in it a large number of individuals
that are playing soccer.

And I think we'll have
that data in two years. But but the most
important thing I can say is that fundamentally
concussions in women has been ignored, largely. And this study is
addressing that. We have I think 800
concussion in women that we were studying
in great detail. But the final thing
I'll say is, I'm not certain concussion
is the right metric. It may be repetitive
head impact exposure. And so, we have to be
mindful of that, as well. – My name is Vicky. I'm a freshman at the college. I had a question
about transitioning from playing sport for
fun into an elite level.

You mentioned how, like,
it's bad to specialize. But I feel like when
you do, ultimately, if your goal is to
play for the Olympics, or to play for varsity
college, if you look at, like my friends who
were on varsity teams, you have to start
at a young level in order to be able to
compete at that level. And I was wondering,
I could be wrong, but it's like, for
a lot of students, you do have to start young. And I was wondering, in terms of
addressing this issue, in terms of, I guess not
specializing, are we supposed to change the
whole way we view sports, in terms of winning
and competitiveness? And I feel like,
because the thing is, this whole body of the
Olympics, it's like, why do people compete? And then it's like, you compare
countries by how many medals you have, which is
defined by winning.

And then, I think that
just trickles down to like you have to start
playing a sport when you're really young and
specializing in order to ultimately reach that level. And what are the
ways to address this? – So it's a great question. Again, being data-driven, if you
look at the Olympic medalists, most of them were multi-sport. And so, there's a
difference between– and there's a great American
football coach at Ohio State, and he said, how
does he determined who he chooses as athletes? The number 1 thing
he looks at first, is those that played
five sports or more. So, that's Urban Meyer. But let's go to the
fundamental question. There is a difference
between early initiation and early specialization. And if you want to be an Olympic
athlete, there's no question. You have to initiate in
sport at a young age.

But playing multiple
sports allows you to develop what's called
"athleticism," as opposed to being a player. So, look at data again– if you wanted to be a great
baseball player, and you look at ESPN Little League World
Series over the last 30 years and track every single one
of the pitchers at age 12. They all had beards. They were all throwing
100-mile-an-hour fastballs. And they were winning the
World Series at age 12. Not one has pitched
in major league baseball on a regular basis. So that's the development
of a player at a young age, versus an athlete.

And USA Basketball just came
out with an exceptional document on how you can become an
elite-level basketball player. It's early initiation, but
you don't start totally specializing until
you are really beyond the age of puberty. So, that's the American
development model, as well. And all 47 NBGs in this
country have signed on to it. But we just haven't gotten
beyond the hype and the craze of the parents and the
kids who think they have to specialize at a young age. The data don't support that. – That's right. Thank you. OK, I think we need to wrap up. So I want to thank our panelists
for a fantastic discussion. Many thanks to the audience. They were really great
questions, great discussion.




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