Bentley and colleagues’ article (published in this issue of the Journal) on injuries to New Zealanders participating in adventure tourism and adventure sports is timely—it occurs against a background of significant media interest in accidents and mortality associated with risk-taking sports.1

The current attention and debate has once again been precipitated by tragic events and controversy at Mount Everest (called “Sagamartha” by the Nepalese) where New Zealander Mark Inglis made the “first double leg amputee ascent” of the mountain and incurred significant injuries during the climb as a result. Furthermore, Inglis was part of a large contingent of climbers (including several mountain guides) who walked past a dying fellow mountaineer, David Sharp, without offering help. Indeed, the controversy surrounding this event has led to significant criticism of adventure sport attitudes and current commercial adventure practices.

Recent reports in the literature involving accidents to New Zealanders and foreign visitors have also highlighted the human and health costs associated with adventure sports and they have focused attention on the legal and ethical obligations of commercial adventure companies.2–4

Moreover, the rapid growth and the economic importance of the adventure tourism industry—and the increasing number of independent participants involved in adventure sports such as mountain biking, rock climbing, and white water rafting—makes this a topic of national importance, especially to emergency medical services, search and rescue workers, and (increasingly) the tourism industry.

To date, little reliable quantitative information has been published on the risks involved in adventure sports in New Zealand. Bentley and his colleagues point out that as there is no single national body or organisation responsible for safety across this broad sector, opportunity for data collection is limited.1 Thus the extent of the problem is difficult to determine which limits the scope for interventions and education in minimising risk of injury and improving current risk management practices.

In their survey Bentley and colleagues examined the involvement of adventure tourism and adventure sports activity in injury claims made to the Accident Compensation Corporation (ACC). They aimed to estimate the extent of the problem by extracting information from the ACC database for compensation claims occurring at a place for sport or recreation, between July 2004 to June 2005. They identified a total financial burden of over NZ$12 million for the year, and found that (not surprisingly) male claimants in the 21–50 age range incurred the largest proportions of claims.

Significantly, 27 fatalities were identified—most frequently the results of fishing, mountaineering, and diving/snorkelling. Four adventure tourism activities (horse riding, tramping/hiking, mountain biking, and surfing) accounted for 60% of the claims—and as these activities had distinct injury patterns, the authors recommend that preventive measures target those specific risk factors.

The author’s claim that the findings provide a useful baseline picture of adventure tourism and adventure sports injury, and they suggest that there is a significant problem in New Zealand. They further contend that improved risk management practices are required for commercial adventure tourism and adventure sports operators. However, the significant limitations of the data preclude these conclusions from being reached.

Firstly, as the study only looks at New Zealand residents and does not differentiate between commercial and individual activity, it is unable to provide accurate information on the commercial sector’s performance and the risk of injury. The call for improved risk management practices and the introduction of codes of practice for commercial operators therefore cannot be justified.

Secondly, this is not an “epidemiological analysis” but rather a descriptive analysis of poor quality data. As freely acknowledged by the authors themselves, the use of ACC data is problematic:

Therefore the use of ACC data in estimating injury rates (numerator data) is unreliable. The use of SPARC’s (Sport and Recreation New Zealand) participation rates (denominator data)—which is also unreliable, dated and only available in a limited number of activities—to determine claims incidence rates is similarly problematic and misleading. Any useful comparison between activities and the identification of high-risk areas on the basis of this information is therefore unreliable.

Thirdly, the authors have determined that certain activities are “high injury risk areas” and base this on the cost and number of compensation claims, without differentiating or commenting on the severity of the injury.

The breadth of the study is too large as it compares broadly different activities such as fishing and mountaineering. Some of the data reporting is trivial and not surprising—for example, the fact that most injuries occurred in the 20 to 50 year age range.

Fourthly, without information on participation or base rates it is difficult to determine the seriousness of the fatality data.

Fifthly, cost and injury—in comparison to other non-adventurous sporting activities, work-related injuries, or tourism misadventure—have not been provided, and therefore it is not possible to determine the significance of the findings and to conclude that it is a “significant problem”.

The negative public perception that adventure tourism and adventure sports activities are dangerous is problematic. Bentley et al point out that perceptions of risk in the host country can have a profound effect on the choice of holiday destination by potential visitors.2 An inaccurate estimation of the extent of the problem may therefore deter visits from potential holiday-makers and have economic implications for New Zealand. Given the current level of media interest and the possible repercussions to the data presented, it is imperative that the researchers’ interpret their findings cautiously.

It is also important to bear in mind that New Zealand is currently experiencing significant public health problems related to the rapid rise in obesity, diabetes, and other metabolic problems. This appears in part to be related to changing lifestyles and decreasing participation in exercise activities. But by highlighting the risks associated with sporting activities without an adequate cost-benefit analysis, and introducing codes of practice and regulatory interventions without good evidence of benefit, may deter exercise participation, and paradoxically compound the problem.

In summary, the interpretations of the findings in this study have been taken too far, they run the risk of being unnecessarily alarmist, and their lack of specificity preclude premature advice from being given with respect to interventions.

Further research is required to more clearly understand the risks of morbidity and mortality associated with adventure sports activities. Collaboration between the adventure tourism industry and medical researchers would be helpful.

Future researchers would benefit from an approach that focuses more on a narrower range of activities, measures exposure and injury rates more accurately, and which clarifies confounding factors more clearly.

Author information: Erik Monasterio, Consultant in Forensic Psychiatry, Medlicott Academic Unit, Hillmorton Hospital, Christchurch.

Acknowledgment: I am grateful to Dr Ceri Evans for his helpful comments in the preparation of this editorial.

Correspondence: Dr Erik Monasterio, Medlicott Academic Unit, Hillmorton Hospital, PO Box 4733 Christchurch. Fax (03) 3391148; email: erik.monasterio@cdhb.govt.nz