Dr. Yetsa Tuakli-Wosornu, MD, MPH, has dedicated her professional career to making international sports more affirming, welcoming, and equitable for all athletes.
A former Ghanaian track star who founded the Sports Equity Lab at the Yale School of Public Health, Tuakli-Wosornu leads an interdisciplinary group of students, faculty, and scholars whose research has addressed some of the most important challenges facing athletes today.
Her team’s most recent report, Policy and Legal Frameworks for Preventing Interpersonal Violence in Elite Sport, suggests that a commitment to athlete-centered sports governance among major sports organizations is essential to protecting athletes from the harmful interactions that can uniquely arise in sports settings. The report was produced in collaboration with the Global Health Justice Partnership, an initiative of the Yale Law School and Yale School of Public Health, and the Schell Center for International Human Rights at Yale.
“We need to flip the script,” Tuakli-Wosornu said. “We must start from the perspectives and experiences of athletes, because at the end of the day, they're the experts and most valuable people on any sports field. Nothing happens if we don't lace up. Nothing happens if we don't show up for practice or competition.”
The report encourages international sports bodies to draw from fields such as public health in creating organizational structures that affirm the humanity of athletes and adhere to international human rights standards. The inherent power imbalance between many athletes and the authority figures in their sports can lead to a variety of abuses ranging from physical, financial, and sexual to psychological and emotional, the report states. It can also foster unfair working conditions that breach international standards. The existing structures of sports organizations make it difficult for athletes to bring negative experiences forward, exacerbating their feelings of disempowerment, the report states.
The International Olympic Committee and other bodies need to be reformed, Tuakli-Wosornu said, because they remain largely institution-centered, untouchable by public law regimes, and often use internal arbitration methods to settle disputes. By using well-documented public health practices such as implementation science, trauma- and violence-informed practice, and community engagement, sports organizations can better translate research findings into real-life applications, humanely engage athletes, and prioritize qualitative data to better understand athletes’ real concerns. By doing this, Tuakli-Wosornu and her team believe the current hierarchy of sport organizations can be improved so that athletes’ needs and experiences are prioritized.
The recommendations in the report are based on feedback the team obtained during a five-hour virtual roundtable with leading athletes, medical professionals, legal experts, sport organization officers, activists, and other elite sport stakeholders in December 2020. The report, written the next year, was published June 20, 2024, in time for the Summer Olympics and Paralympics in Paris, which begin July 26.
Tuakli-Wosornu said the lab’s research always starts with athletes. "Starting with a deep listening exercise amongst athletes at various levels of competition puts the reference point – and the power – back where it belongs. We suspect this strategy will ultimately steady the ship and set sport on the right course,” she said.
To illustrate her point, Tuakli-Wosornu mentioned U.S. gymnast Simone Biles’s decision to withdraw from the Tokyo Olympics in 2021, which brought attention to athletes’ struggles with trauma and its various health outcomes. Biles and other U.S. gymnasts also criticized the F.B.I.’s handling of its investigation into team doctor Larry Nasser’s serial sexual abuse during testimony in Congress. Tuakli-Wosornu also cited international tennis star Naomi Osaka pulling out of the French Open in May 2021 due to her struggles with mental health. These examples show athletes asserting their humanity and value over and above the needs of their sports organizations, she said. In a recent study by researchers in Australia, elite athletes expressed frustration over the lack of support for pregnant athletes who wish to continue training and competiting.
“Elite athletes are already doing the work this report calls for,” Tuakli-Wosornu says. “We just need to listen to them.”
Still, athletes’ individual actions cannot make up for needed structural change in sports governing bodies, the report indicates.
ORIGINS OF THE SPORTS EQUITY LAB
Tuakli-Wosornu’s path to the Yale School of Public Health began on the Ghanaian National Track & Field Team, where she competed professionally as a long jumper until 2016. Along the way, she became a board-certified physical medicine and rehabilitation physician-scientist, helping athletes of all abilities across the world prevent injuries, recover from them, and optimize performance.
Her time working as a member of the International Paralympic Committee’s medical committee, and the International Olympic Committee’s working group to prevent harassment and abuse in sport, further opened her eyes to the institutional shortcomings of elite sports organizations.
“There, I saw the gaping errors many of these big sports bodies are committing, probably due to force of habit,” she said. As the inaugural welfare officer at the 2016 Paralympic Games in Rio de Janeiro, Brazil, she helped craft the Paralympic Movement’s updated policy to prevent and remedy physical, psychological, sexual and neglect-related abuse. But even that effort met some of the same obstacles referenced in the report, she said.
After joining Yale, Tuakli-Wosornu recruited a number of master’s students and scholars to create the Sports Equity Lab, an interdisciplinary research group focused on improving equity and accountability in global sports. She credits the students at the Yale Medical School and Yale School of Public Health with providing much of the early inspiration, intellectual diversity, and tenacity behind the lab’s dozens of research reports, which range from designing bamboo wheelchairs for persons with disabilities in low-resource and tropical settings to finding ways to promote mental health among Black women in sport.
“The MPH students are very visionary and courageous in a way that a lot of us faculty may not always be. Their energy, their confidence, their boldness… I'm not going to lie to you. It is the majority of the reason I was initially inspired to start a lab and consider myself a principal investigator in the first instance,” she said.
PUBLIC HEALTH APPROACHES CAN HELP
The interpersonal violence report is one example of how athlete-centered sports governance could address important and complex issues in sport, Tuakli-Wosornu explained.
The report is focused on reducing the prevalence and severity of interpersonal violence at all levels of sport, but especially in elite sport. The authors and the roundtable participants point to both formal and informal power structures which facilitate this kind of abuse and prevent perpetrators from being held accountable — especially when it involves athlete-coach interactions.
Since elite athletes can be conditioned at a young age to place deep trust in their coaches and trainers, the report indicates, conditions become ripe for abuse and misuse of power. Elite athletes are also often trained to ignore or suffer through pain in order to meet performance goals, which can exacerbate existing inequities. The report identified several examples, like playing through injuries or keeping quiet in the face of excessively harsh coaching.
Roundtable members stated that the role of a coach often becomes so all-encompassing — massage therapist, psychologist, nutritionist, life coach, parental figure — that “boundary-crossing” becomes common enough as to not be recognized as abuse.
To address this dynamic, Tuakli-Wosornu and her team recommend international, athlete-informed professional bodies that are responsible for creating professional standards of behavior and ethics among coaches, administrators, and other personnel.
It’s an answer that stems from public health research related to health policy, she said, much like the other findings across the report.
“If we were to have professional coach-training pathways, and administrator-training pathways that are standardized, global, sport-specific, and meet the standards of other well-regulated industries, I think we would slowly start to see increased accountability across all roles in sport. That would probably start to change behavior positively,” she said.
Public health approaches are valuable for improving sport, Tuakli-Wosornu said, because expertise in conducting qualitative studies can help to document abuse and understand the difficulties with holding people accountable. Also, by using an epidemiological lens, researchers and sport officials can more easily identify violence, determine its causes, and take appropriate action. And studies into the socioeconomic determinants of health and child development can help to inform regulations and best practices surrounding how budding Olympians and Paralympians interact with coaches, medical professionals, and other authority figures.
Alice M. Miller, Co-Director of the Global Health Justice Partnership, who co-authored the report and helped to organize the roundtable discussion, said these kinds of joint projects between public health and legal experts are incredibly important for preventing harms and promoting equity all over the world.
“This intersection of gender and race and place are so critical to understanding how the harm happens, how the silence happens, how the change is going to happen,” she said.
Tuakli-Wosornu agreed.
“Sport is inherently competitive and embodies self-determinism. So, we tend to look inward for solutions,” she said. “Whereas, if we were to look outward, we could learn from clinical and public health science, law, economics, and more.”
“We must look outside the field of sport for wisdom we can adapt, blend, and apply in a way that makes sense to athletes and all other sport participants. But for us, athletes are the logical starting point.”