Access to sports facilities in poor areas can contribute to measurable health improvements, but practice levels and certain social determinants differ by gender and resources, without causal effects of facilities on these gaps being established. In 2019, priority neighborhoods concentrated 4% of sports licenses for 8% of the population, which alone does not allow conclusions about total declared practice or diversity of facilities. Everywhere, physical access to infrastructure and its actual use remain two distinct variables.
The essentials
- Studies show that infrastructure improvements can modify certain physical activity indicators, without necessarily establishing a reduction in clinical health indicators, and inequalities in practice by gender and social characteristics are documented.
- In France in 2014-2016, 33.3% of girls and 50.7% of boys aged 6-17 met WHO physical activity recommendations.
- Children of manual workers are four times more affected by obesity than children of senior managers: even with accessible equipment, usage is unequal.
- Gender norms, available resources, and perceived safety are possible determinants among others, alongside facility supply and proximity.
- Since September 2025, the strategy provides for accessibility measures, guidance, and strengthening of Sports-Health Centers, without establishing a stated parity between human support and infrastructure.
The Lancet’s figures
Several studies document interventions in disadvantaged areas of Latin America combining access to sports infrastructure and support measures, with documented effects on practice and certain health indicators. These are good numbers. In communities where hypertension kills early and where each hospitalization devastates a family budget, these results deserve to be taken seriously.
But these averages hide unequal distribution by gender. According to several studies, women and girls often use facilities less frequently than men and boys, and under conditions that limit physiological benefits. The infrastructure is identical for everyone. Usage is not.
The phenomenon stems from well-documented mechanisms. In many neighborhoods of Latin America, public sports spaces are perceived, and often actually experienced, as male spaces. A woman who goes there alone exposes herself to remarks, sometimes to harassment. A teenager must negotiate with her family the legitimacy of leaving to “do sports.” A mother must first solve childcare, shopping, and dinner.
The soccer field is open. Time is not.
One girl in five: the gender gap from childhood
Global WHO data on young people’s physical activity accentuate the gap. Among 6-17-year-olds, one-third of girls and about one boy in two meet recommendations; among 11-14-year-olds, it’s about one girl in five and one boy in three. The study notes a 17.4-point gap between boys and girls, without causally establishing the precise social mechanisms that explain it.
Latin America concentrates some of the world’s largest gaps on this point, but the phenomenon is not regional. It affects Southern Europe, Southeast Asia, disadvantaged communities in wealthy countries. What the sports field concretely offers are opportunities to be active. Usage also depends on social, family, and cultural factors that go beyond physical accessibility alone.
The health consequences of this gap accumulate over time. A girl who is inactive at age 10 is more likely to be a sedentary woman at age 30. Overweight, hypertension, type 2 diabetes—diseases that consume an increasing share of public health budgets in Latin America—strike earlier and harder populations that never developed the habit of movement. Facilities alone do not modify the social factors that structure actual access; health improvement remains unequally distributed without support measures.
Social class digs a second gap
The gap between children of manual workers and children of managers shows that proximity can contribute to behaviors, but it is not sufficient on its own. Usage requires cognitive and temporal availability that the living conditions of modest households structurally reduce. When parents work staggered or fragmented hours, the supervision necessary for a child to reach a sports facility alone disappears. When the child carries domestic responsibilities after school, free time available for physical activity is already consumed. These constraints stem from living conditions, not individual preferences.
They result from work organization and housing conditions that weigh differently depending on social position. The sports facility, therefore, remains available without being accessible in the real sense of the term. Reducing this gap would require intervening in the living conditions that determine availability, not solely in the distance to the infrastructure. Construction of facilities alone does not constitute the full set of social levers necessary.
Gender structures the first level of inequality. Class constitutes a second, which is partially overlaid with but distinct from the first. Children from working-class families are four times more affected by obesity than children of senior managers. According to several studies, this practice gap persists even in neighborhoods where infrastructure was built to reduce it.
The cost of actual access exceeds monetary cost alone. A poor family can live within 500 meters of a sports facility while remaining practically unable to use it: parents with staggered hours, child mobilized by domestic tasks after school, even symbolic membership fee to pay, sports clothes considered non-priority. It is the total burden weighing on the time and budget of modest households.
Ultra-processed food, accessible and cheap in these same neighborhoods, replaces the energy expenditure that the sports field was supposed to encourage. Both phenomena, diet and sedentariness, reinforce each other in poor environments. The sports infrastructure acts on only one lever, and the least constraining one. This does not make it useless. It makes it insufficient.
There is an analogy here with other forms of access inequality. Wealth inequalities operate according to the same logic: the same resources formally accessible to all produce radically different results depending on starting conditions. The neutrality of supply does not guarantee the neutrality of effects.
Thirty years of facilities in France, the same finding
France offers a textbook case for testing the hypothesis over a long period. Since the late 1990s, urban policies have financed numerous renovation and support initiatives in priority neighborhoods, including sports facilities. Gymnasiums, multisports courts, swimming pools: French working-class neighborhoods are now relatively well-equipped with infrastructure.
Inequalities in physical practice, meanwhile, remain profound. The French National Sports-Health Strategy 2025-2030, adopted by the French government, explicitly acknowledges this. It identifies the same targets as the Lancet in Latin America: women, children from modest families, isolated elderly people. And it explicitly recognizes the need to combine infrastructure with public support measures.
Concretely, this means sports educators present in facilities to welcome publics who don’t go spontaneously, “sports by prescription” programs where a general practitioner prescribes an activity with follow-up, targeted initiatives for young girls in schools. The strategy recognizes and aims to reduce inequalities in access to physical activity, without explicit numerical targets for reducing practice gaps in the document reviewed. This is a paradigm shift that appears modest but significant in its budgetary implications.
What works: intervening on social determinants
A few Latin American programs have begun to document what a different approach changes. In Brazil, the “Academia da Cidade” program, literally “the gym of the city,” does not merely open equipped spaces. Physical education teachers are present, the program incorporates schedules designed for women with young children, and occasional activities lower the entry threshold for non-practitioners. Preliminary results suggest better inclusion of women and older populations than in unaccompanied facilities.
In Mexico, initiatives combining sports spaces and safety campaigns in public parks, working on perceptions of insecurity—lower among women surveyed and likely to discourage their attendance—suggest that interventions on the perceived environment could influence attendance without infrastructure modification, according to preliminary results. These results remain preliminary and local. Yet they point toward a coherent direction: social determinants of usage are modifiable, but this requires articulating interventions with facility construction.
The window for action is narrow. Physical activity habits form mainly in childhood and adolescence. Inequalities that widen early are the hardest to correct later. For Latin America, which combines a growing obesity epidemic with strained public health systems, acting on physical practice among girls and poor children between 2025 and 2035 probably represents one of the most cost-effective preventive investments available.
Measuring usage, not just access
The difficulty in measuring actual usage also stems from the nature of the data used. Self-reported surveys on physical practice introduce systematic biases: respondents tend to overestimate their activity level, and this bias is more pronounced in populations for whom sedentariness is socially perceived as an admission of failure. The populations most distant from practice are also those whose self-reports are least reliable. Objective data, from measurement devices worn by individuals, partially correct this bias, but remain unevenly available across social groups and territories. This methodological limitation implies that the real scale of practice inequalities is probably underestimated in national surveys.
Monitoring indicators built on self-reported data thus risk signaling progress that partly reflects an evolution in declared norms rather than an evolution in actual behaviors. Choosing the right measurement tools determines the capacity to honestly evaluate intervention effectiveness and reorient policies accordingly.
The measurement problem is itself political. Governments count facilities built, square meters of sports surface per capita, number of municipalities covered. These indicators are simple to produce and communicate. Construction-only indicators do not directly inform individual usage, but the strategy also provides for monitoring impacts on behaviors and health.
A few countries are beginning to collect data disaggregated by gender, age, and income on actual physical practice. The WHO has published national data since 2022 allowing these comparisons. The strategy provides for monitoring physical practice disaggregated by social groups, a commitment whose value will depend on the quality of data collected at the local level.
The methodological issue is as follows: if the success indicator remains “number of facilities built,” public policies will continue to optimize that indicator. If the indicator becomes “reduction in the practice gap between girls and boys aged 6 to 17” or “increase in practice among households below the poverty threshold,” the action levers change. Human support staff, adapted schedules, campaigns in schools, interventions on perceived safety of public spaces: none of these tools appear in a construction tender. These measures can help reduce health inequalities beyond facility construction alone.
The question opening for Latin American and French policymakers is one of reallocation. In constrained budgets, increasing the share dedicated to human support means arbitrating against bricks and mortar. This arbitrage is politically difficult: a gymnasium can be photographed, ribbons can be cut, it can be counted in a report. A sports educator who convinces thirty teenage girls to come running Wednesday morning produces real effects and invisible data.
Sources
- French National Sports-Health Strategy 2025-2030
- Lancet Regional Health Americas, 2023, sports infrastructure intervention in disadvantaged areas of Latin America (Lancet Regional Health – Americas, vol. 2023)
- World Health Organization, Global Physical Activity Data and physical activity recommendations 6-17 years (who.int/news-room/fact-sheets/detail/physical-activity)
