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Bone and Joint Decade 2010 - 2020
The Global Alliance for Musculoskeletal Health
How do we get policy makers to
take musculoskeletal health and
conditions seriously?
Professor Anthony D Woolf
Chair, Bone and Joint Decade 2010-20
Royal Cornwall Hospital, Truro & Peninsula
College of Medicine and Dentistry
Musculoskeletal conditions - the unmet need
• Musculoskeletal disorders are common in all countries and cultures
• include joint diseases, spinal disorders, back and regional pain problems,
osteoporosis and fragility fractures, and consequences of injuries and trauma
• hundreds of millions of people are affected around the world
• They are a major burden on health and social care
• worst impact on quality of life of many chronic diseases
• most common cause of severe long-term pain and physical disability
• They are one of the greatest threats to healthy active aging
• There are effective ways of preventing and controlling musculoskeletal conditions
but these are not being implemented with equity
• There is a lack of policies and priorities for musculoskeletal conditions
• There is enormous unmet need and avoidable disability
Musculoskeletal conditions - some reasons for lack of
priorities and policies
• Lack of awareness by policy makers, non-expert health
workers and public about
• the impact of musculoskeletal conditions (epidemiology,
costs etc.)
• what can be achieved by prevention and treatment
Musculoskeletal conditions - gaining priority
How do we ensure that musculoskeletal
conditions are among the leading major health
concerns in the minds and actions of opinion
formers and policy makers throughout the world ?
Factors that influence health policy
Contextual
factors
Competing
priorities
Opportunities
NGOs
Needs
Evidence
HEALTH
POLICY
Lobbying
Commercial
interests
What is
achievable
Cost
effectiveness
Expert
opinion
Economic
climate
Public
opinion
Evidence to support advocacy
• Identifying and communicating the evidence that policy makers
need and understand “making the case”
– How many people are affected (voters!)
– What is the cost to us
– What can you do about it
– What savings can be made with what investment (tax
payers!)
• Guiding principles
– Demonstrate value for money
– Appeal to the public
Bone and Joint Monitor Project
Health Needs Assessment of
Musculoskeletal Conditions
IMPACT OF DISEASE
“STATE OF THE ART”
EFFECTS OF INTERVENTION
EFFECTS IN CLINICAL
PRACTICE
UNAVOIDABLE
BURDEN
AVOIDABLE
BURDEN
OF DISEASE
Co-ordinators: Anthony Woolf, Kristina Åkesson, Mieke Hazes
Bone and Joint Monitor Project
Health Needs Assessment of
Musculoskeletal Conditions
IMPACT OF DISEASE
“STATE OF THE ART”
EFFECTS OF INTERVENTION
EFFECTS IN CLINICAL
PRACTICE
UNAVOIDABLE
BURDEN
AVOIDABLE
BURDEN
OF DISEASE
Co-ordinators: Anthony Woolf, Kristina Åkesson, Mieke Hazes
The Burden of Musculoskeletal Conditions
“Musculoskeletal diseases are the major cause of morbidity
throughout the world. These diseases have a substantial
influence on health and quality of life and they inflict an
enormous cost on health systems”
Dr Gro Harlem Brundtland
Past Director General, WHO, January 2000
Scientific Group Meeting
organised by WHO and
Bone and Joint Decade,
Geneva
The Burden of Musculoskeletal Conditions
“Musculoskeletal diseases are the major cause of morbidity
throughout the world. These diseases have a substantial
influence on health and quality of life and they inflict an
enormous cost on health systems”
Dr Gro Harlem Brundtland
Past Director General, WHO, January 2000
”…. With the increasing number of
older people and changes in lifestyle
occuring throughout the world, this
trend will increase dramatically over
the next decade and beyond. …we
must act on them now ”
Kofi Annan, 1999
Secretary General, UN
“The Burden of Musculoskeletal Conditions at the
Start of the New Millennium”
Geneva, January 2000
• Scientific Group Meeting organised by
WHO and Bone and Joint Decade and
opened by Dr Gro Harlem Brundtland,
(then Director General WHO)
• Experts from all continents and in all
conditions
• What is the global burden?
• How should we monitor the burden?
• WHO Technical Report October 2003
Musculoskeletal Conditions
• Joint diseases
– Osteoarthritis
– Rheumatoid arthritis
– Gout
– Infections
• Systemic connective tissue
disorders
• Back pain
• Musculoskeletal pain
• Osteoporosis and low
trauma fractures
• Bone infections
• Trauma
• Injuries
and more………
22% of the population in Europe currently had, or had
experienced “long-term muscle, bone and joint problems
such as rheumatism and arthritis”
Health in the European Union
Eurobarometer Special Report 272,
September 2007
1 in 3 experience musculoskeletal pain
restricting activities of daily living
32% experienced
activity-limiting
musculoskeletal
pain in the
preceding week
Health in the European Union
Eurobarometer Special Report 272,
September 2007
Worker Health Chartbook 2004, USA
Injuries and illnesses in private industry, 2001
The majority of occupational health
problems are acute musculoskeletal
injuries or associated with repetitive
musculoskeletal trauma
Distribution of occupational injury and illness cases with
days away from work in private industry, USA 2001
Worker Health Chartbook 2004, USA
What effect do musculoskeletal conditions
have?
• Pain
• Deformity
• Physical disability
• Quality of life
• Mortality
The impact
– the human and
financial consequences
Lower quality of life
(pain, restriction of activities)
National economy
Health care system
Caregivers
Person
Caregiver time
Health conditions associated with disability
• Limited data but national surveys in some countries
• Australia: arthritis, backpain, hearing disorders, hypertension,
heart disease, asthma and vision disorders were most common
disability-related health conditions in1998 population survey
• Canada: arthritis, backpain and hearing disorders were most
common in adults over 15 years in 2006 study
• USA: rheumatism leading cause among adults >65 years,
accounting for 30% who reported limitations in their “activities of
daily living”
• Road traffic injuries: between 1.2 and 1.4 million deaths pa
but further 20 – 50 million injured; post-crash disability 2 – 87%
in systematic review
Impact on quality of life of chronic disease
Musculoskeletal conditions are associated with the poorest quality of life
Sprangers et al J Clin Epidemiol 2000; 53(9):895-907
The impact
– the human and
financial consequences
National economy
Health care system
Caregivers
Person
Health care costs
Social support
Work disability
The burden of MSC on primary care
UK consultation rates
Percent respondents visited health provider
in past 12 months
Percent respondents visited health provider in past 12 months
Czech Repub.
Slovenia
Wales
Physiotherapist
Austria
Chiropodist
Malta
Occupational
therapist
Hungary
Cyprus
Latvia
Belgium
0
2
4
6
8
Percent
Source: EHIS; Wales National Health Survey; Austria National Health Survey
10
12
14
1 in 4 on longterm treatment because of
“longstanding troubles with muscles, bones
and joints (arthritis, rheumatism)”
Health in the European Union
Eurobarometer Special Report 272,
September 2007
Duration of incapacity benefit claim by condition
England, Scotland & Wales 2010
Incapacity benefit caseload working age by duration of claim
England Scotland & Wales 2010
700
600
Caseload (1,000s)
500
6 mths to 1 yr
400
1- 2 yrs
2-5 yrs
300
5 yrs+
200
100
0
Injury, Poisoning and
certain other
consequences of
external causes
Diseases of the
Circulatory or
Respiratory System
Diseases of the Nervous
Diseases of
System
Musculoskeletal system
& connective tissue
Condition
Source: Department of Work & Pensions 2010
Mental & Behavioutal
disorders
Disability pension by main diagnosis Finland
Recipients of disability pensions- top 6 diagnoses
Finland 2009
No. recipients (1,000s)
140
120
100
80
60
40
20
Disease category
Source: Finnish Centre for Pensions and The Social Insurance Institution of Finland. Statistical Yearbook of Pensioners in Finland
Mental
disorders
Diseases of
musculoskeletal
system
Diseases of
nervous system
Diseases of
circulatory
system
Injuries &
poisoning
Neoplasms
0
From the individual to health of the
population
Measuring population health
Summary measures of population health combine information
on mortality and non-fatal health outcomes to represent the
health of a particular population as a single number
% surviving (thousands)
Disability Adjusted Life Year (DALY)
100
90
80
70
60
50
40
C = Years of Life Lost
(YLLs)
C
B
B = Years of Life lived
with Disability
(YLDs)
A
30
20
10
0
DALY = YLL + YLD
0
20
40
60
Age
80
100
DALY is one lost year of
healthy life
The 20 Leading Causes of Global Burden of
Disease (DALYs), 2001
Global Burden of Disease and Risk Factors
Lopez et al
DCPP World Bank 2006
Global Burden of Disease: the 10 Leading
Causes of YLD, 2001
Low- and middle-income countries
YLD
Cause
(millions of
years)
% of total
YLD
High-income countries
YLD
Cause
(millions of
years)
% of total
YLD
1
Unipolar depressive
disorders
43.22
9.1
Unipolar depressive
disorders
8.39
11.8
2
Cataracts
28.15
5.9
Alzheimer’s and other
dementias
6.33
8.9
3
Hearing loss, adult
onset
24.61
5.2
Hearing loss, adult
onset
5.39
7.6
4
Vision disorders, agerelated
15.36
3.2
Alcohol use disorders
3.77
5.3
5
Osteoarthritis
13.65
2.9
Osteoarthritis
3.77
5.3
6
Perinatal conditions
13.52
2.8
Cerebrovascular
disease
3.46
4.9
7
Cerebrovascular
disease
11.10
2.3
Chronic obstructive
pulmonary disease
2.86
4.0
8
Schizophrenia
10.15
2.1
Diabetes mellitus
2.25
3.2
9
Alcohol use disorders
9.81
2.1
Endocrine disorders
1.68
2.4
10
Protein-energy
malnutrition
9.34
2.0
Vision disorders, agerelated
1.53
2.1
Global Burden of Disease and Risk Factors Lopez et al DCPP World Bank 2006
YLDs due to musculoskeletal
conditions vary by European region
WHO 2004
YLDs musculoskeletal diseases by European region 2004
3000
YLDs (thousands)
2500
2000
EUR A
1500
EUR B
EUR C
1000
500
0
Musculoskel.Osteoarthritis Rheumatoid
Other
Diseases
arthritis musculoskeletal
disorders
Gout
Low back pain
Cause
Source: WHO Global Burden of Disease 2004 http://www.who.int/healthinfo/global_burden_disease/YLD14_30_2004.xls
The problem
• Musculoskeletal conditions are
– the single biggest cause of physical disability in developed
countries and rapidly increasing in developing countries
– major cause of healthcare and social support costs
– a major cause of lost productivity
• The burden will increase unless actions are taken
The future
The burden of musculoskeletal
conditions is increasing
Why?
• Growing and ageing
population
• Changes in lifestyle
Bone and Joint Monitor Project
Health Needs Assessment of
Musculoskeletal Conditions
IMPACT OF DISEASE
“STATE OF THE ART”
EFFECTS OF INTERVENTION
EFFECTS IN CLINICAL
PRACTICE
UNAVOIDABLE
BURDEN
AVOIDABLE
BURDEN
OF DISEASE
Co-ordinators: Anthony Woolf, Kristina Åkesson, Mieke Hazes
Interventions for musculoskeletal conditions
are effective
• Osteoarthritis
• exercise. pain control and self management
• joint prostheses
• Rheumatoid arthritis
• effective disease modifying therapy eg methotrexate,
biologics
• Osteoporosis and Fractures
• fracture prevention strategies using anti-resorptive
agents for those at highest risk
• Back Pain
• early rehabilitation
The Evolving Management of Rheumatoid Arthritis (RA)
Early
aggressive
treatment
Biologics
Methotrexate
(MTX)
Gold Steroids
Injections
Quinine
Manufactured
Aspirin
Willow Bark
1680s
1860sa
1591
1859a
“Rheumatism”
(Guillaume de
Baillou)
“Rheumatoid
Arthritis”
(Sir Alfred
Garrod)
aAppelboom
1890sa
T. Rheumatology (Oxford). 2002;41(suppl 1):28-34.
1920s
1940s
1980s
1990s
2000s
RA can now be effectively treated
Best Study
Percentage in remission
100
% with DAS44 <1.6
80
60
40
20
0
0
3
6
9
12
15
18
Time (months)
sequential mono
combi with prednisone
Goekoop - Ruiterman: A&R 2005
step-up combination
combi with infliximab
21
24
Bone and Joint Monitor Project
Health Needs Assessment of
Musculoskeletal Conditions
IMPACT OF DISEASE
“STATE OF THE ART”
EFFECTS OF INTERVENTION
EFFECTS IN CLINICAL
PRACTICE
UNAVOIDABLE
BURDEN
AVOIDABLE
BURDEN
OF DISEASE
Co-ordinators: Anthony Woolf, Kristina Åkesson, Mieke Hazes
Identifying gaps in the provision and
outcome of care
Secondary prevention of fractures
Multinational Survey of
Osteoporotic Fracture Management
Dreinhöfer et al. Osteoporos Int 2005; 16:S44-S54
Management of musculoskeletal pain
Major inequities in care: use of resources
unequally distributed to people with equal needs
Differences in RA across countries
In spite of this enormous and increasing
burden and the major advances in what can
be achieved by prevention and treatment, this
is not reflected in:
•
•
•
•
•
Public awareness
Political priorities
Health care provision
Medical education for undergraduates and primary care
Research expenditure
Factors that influence health policy
Contextual
factors
Competing
priorities
Opportunities
NGOs
Needs
Evidence
HEALTH
POLICY
Lobbying
Commercial
interests
What is
achievable
Cost
effectiveness
Expert
opinion
Economic
climate
Public
opinion
Recognition of the need for concerted
action in late 1990’s
• In Europe a recognition of need to gain priority for
prevention and management of arthritis and other
musculoskeletal conditions in mid 1990s – modelled
on St Vincent’s Declaration for diabetes
• In Sweden a recognition of the need to gain priority
and resources for research into musculoskeletal
disorders – modelled on Decade of the Brain
Influencing the decision makers – changing
public and political opinion
• Clear objectives
• A strong case supported by data and
examples
• Suggest solutions
• Activities to achieve objectives
• Work with all stakeholders
What do we want?
• To reduce the burden and cost of musculoskeletal
conditions to individuals, carers and society in all
countries
– Promotion of a lifestyle that will optimise musculoskeletal
health at all ages
– Identify and treat those who are at highest risk
– Accessible, timely, safe, appropriate treatment to control
symptoms and prevent unnecessary disability due to
musculoskeletal conditions and injuries
– Accessible and appropriate rehabilitation to reduce any
disability due musculoskeletal conditions and injuries
– Advance knowledge and care through research
Physicians, health
professionals, patients
organisations
Scientists
Orthopaedics
Recognition of the need for concerted
action
• Professional, scientific and patient organisations
brought together in 1998 in Lund and agreed to
launch the Bone and Joint Decade 2000 - 2010
• Remandated in 2010
United Nations
Official Support by Kofi Annan
UN Secretary General
30 November 1999
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
The Bone and Joint Decade is a global alliance of
professional, scientific and patient organisations
working together to make musculoskeletal health a
public health priority
• Promoting musculoskeletal health and
musculoskeletal science worldwide
• To reduce the burden and cost of musculoskeletal
conditions to individuals, carers and society
“Keep people moving”
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
• Endorsed by the UN, the WHO, the World Bank, the Vatican and health
ministries in over 60 countries
• Steered by an International Co-ordinating Council and delivered by
National Action Networks in over 60 countries
Bone and Joint Decade – The Last and Next Ten Years
“Keep people moving”
Significant achievement over the last Ten Years:
• Bringing the musculoskeletal community together to improve
musculoskeletal health and science
Situation at end of the first Ten Years:
• Musculoskeletal conditions are still not a priority in most health
systems and there is enormous unmet need and avoidable disability.
Goal for the next Ten Years:
• To ensure that musculoskeletal conditions are among the leading
major health concerns in the minds and actions of opinion formers
and policy makers throughout the world. Their priority should
reflect the enormous impact on individuals and cost to society.
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
What makes us unique
• We are the only organisation that brings together all stakeholders
across the globe, considering all musculoskeletal conditions and
providing access to high-level policy makers
• We are an umbrella, linking networks of national organisations across
the globe, which include those for health care professionals and
patients, providing a unified voice and a global reach
• We focus on health policy and evidence with a mandate to
develop strategies and set the agenda, aimed at improving
quality of life by implementing effective prevention and treatment
Values of the Bone and Joint Decade
•
•
•
•
•
•
•
Credibility
Partnership
Inclusivity
Unity
Global
Strategic
Evidence-based
“A unified voice – a world of difference”
A global alliance for musculoskeletal health
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
The challenges to gaining greater priority
• Non-communicable diseases recognised as a major health
problem but focus is on high mortality not high morbidity
conditions
• Urgency of improving lifestyle recognised but benefits to
musculoskeletal health not appreciated
• Need for lifelong economic independence recognised but
threat from common disabling musculoskeletal conditions not
seen
• Aging of population globally recognised but focus on
minds not mobility
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
Our Strategy
• We are focusing resources on gaining recognition of the
importance of musculoskeletal conditions globally,
regionally and nationally through core programmes
• These programmes are being steered by the International
Coordinating Council, and delivered in partnership by National
Action Networks, supporting organisations and individuals
working together, with the support of the Bone and Joint
Decade.
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
Our Key audiences:
• Our target audiences
•
•
•
•
•
WHO
UN
Regional policy makers, such as EU
National policy makers
Non-specialist health care professionals
• Our mobilising audiences
• Professional, scientific and patient organisations relevant to
musculoskeletal health advocating for change
• Our enabling audiences
• Sponsors
• Partners
• Our supporting audience
• Public
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Core programmes to gain recognition of the
importance of musculoskeletal conditions
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Aim – To measure, monitor and raise awareness of the
suffering and cost to society associated with
musculoskeletal conditions
Impact of Musculoskeletal Conditions
World
Health
Reports
in USA
Global Burden of
Disease
2005
In preparation
WHO
Seattle, Harvard, Queensland
Gates Foundation
Global
Europe
EUMUSC.NET is raising and harmonising
quality and equity of care across Europe
by creating a health surveillance and
information system that provides
• Improved data and data sources for agreed indicators to enable good quality
and comparable information, surveillance and identification of inequalities of outcome.
• A sustainable health monitoring system
• Standards of care with specific user-focused targets
• Health care quality indicators to enable systems of care to be evaluated, best
practice identified and improve equity of care across Europe
• Identification and dissemination of knowledge and best practice to enable
the implementation of these standards and the achievement of the indicators
A partnership of 22 centres across Europe supported by
the EU and EULAR
• Musculoskeletal Health
in Europe Report
• Recommended core
indicators of the
impact musculoskeletal
conditions
• Country Fact Sheets
• www.eumusc.net
NAN Action Point
• National data on burden of musculoskeletal conditions
• National information on services provided
National Alliance for Promoting Musculoskeletal Health
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Aim - Strategies for prevention and control at a
national level and their implementation
Research
Stages of Prevention
10
The whole
population
30
20
At
Risk
Those with
condition
MORBIDITY
Primary prevention Secondary prevention
Tertiary prevention
•
•
avoid or remove
the cause of a
health problem
before it arises
•
detect a health problem
at early stage, facilitating
cure, or reducing /
preventing spread, or
reducing / preventing
long-term effects
reduce the impact
of an already
established
disease
Setting standards of care and providing the
evidence base for health policy
In Europe
• A common policy to prevent and
control musculoskeletal conditions
in Europe (funded by EU)
• Patient-related standards of care
and healthcare quality indicators
for providers being developed by
EUMUSC.NET (funded by EU and
EULAR)
In developing countries
• Cost-effective health interventions
for musculoskeletal conditions in
the Disease Control Priorities in
Developing Countries Report
(initiative of World Bank, WHO and
NIH).
Disease Control Priorities
in Developing Countries
Disease Control Priorities
in Developing Countries
Preventive Strategies: deal with known risk factors
–
–
–
–
–
–
Ideal body weight
Balanced diet including calcium & vitamin D
Physical activity
Avoid smoking & excess alcohol
Injury prevention (work, home, leisure)
A safe environment
There are effective interventions for the
management of musculoskeletal conditions
• Osteoarthritis
• pain control and self management
• exercise
• joint prostheses
• Rheumatoid arthritis
• education and self management
• symptom control & rehabilitation
• effective disease modifying therapy eg methotrexate
• Back Pain
• early rehabilitation
• Osteoporosis and Fractures
• fracture prevention strategies for those at highest
risk eg previous fragility fracture treat with
bisphosphonates
The avoidable burden of musculoskeletal
conditions
IMPACT OF MUSCULOSKELETAL CONDITIONS
WHAT CAN BE ACHIEVED BY “STATE OF THE ART”
KNOWLEDGE
WHAT IS ACHIEVED BY PREVENTION
& CLINICAL PRACTICE
CLOSING THE GAP BETWEEN WHAT
CAN & WHAT IS BEING ACHIEVED
AVOIDABLE
BURDEN
UNAVOIDABLE
BURDEN
What is needed to close the gap ?
• Health promotion
– inclusion of musculoskeletal health as a benefit for healthy lifestyles
• Case-finding strategies
– early onset polyarthritis
– previous fragility fracture
• Access to appropriate management at the right time
– disease modifying drugs with monitoring eg methotrexate
– surgery eg fracture management, arthroplasty, trauma
– rehabilitation to restore function
• Resources
– trained health professionals / health workers
– availability of interventions – drugs, prostheses…….
• Surveillance
– measurable quality indicators
EUMUSC.NET is raising and harmonising
quality and equity of care across Europe
by creating a health surveillance and
information system that provides
• Improved data and data sources for agreed indicators to enable good quality
and comparable information, surveillance and identification of inequalities of outcome.
• A sustainable health monitoring system
• Standards of care with specific user-focused targets
• Health care quality indicators to enable systems of care to be evaluated, best
practice identified and improve equity of care across Europe
• Identification and dissemination of knowledge and best practice to enable
the implementation of these standards and the achievement of the indicators
A partnership of 22 centres across Europe supported by
the EU and EULAR
NAN Action Point
• National standards of care for major musculoskeletal problems and
conditions – OA, RA, back pain, osteoporosis, trauma care,
occupational disorders (adopt and adapt existing
recommendations)
• National health care quality indicators
• National audits of provision of care according to expected
standards
• Ability to compare within and between countries
National Alliance for Promoting Musculoskeletal Health
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Aim – To develop sustainable networks at global, regional
and national levels who can advocate for priority
Physicians, health
professionals, patients
organisations
Scientists
Orthopaedics
and others……..
Bone and Joint Decade
The Global Alliance for Musculoskeletal Health
Partnership is our strength
• We are the only organisation that brings together all stakeholders across
the globe, considering all musculoskeletal conditions and providing access
to high-level policy makers
• We are an alliance, linking networks of national organisations across the
globe, which include those for health care professionals and patients
Over 60 National
Action Networks
a unified voice,
a global reach
Worldwide endorsement
UN
WHO
The Vatican
USA
Germany
Japan
BJD Annual World Network
Conferences
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Zurich, Switzerland
Muscat, Sultanate of Oman
New York, USA (cancelled)
Rio de Janeiro, Brazil
Berlin, Germany
Beijing, China
Ottawa, Canada
Durban, South Africa
Gold Coast, Australia
Pune, India
Washington DC, USA
Lund, Sweden
Beirut, Lebanon
NAN Action Point
• National action networks working as alliances of all
stakeholders interested in promoting musculoskeletal health
• Strategic action plans
• Advocacy training
• Share ideas and experiences with other countries
National Alliance for Promoting Musculoskeletal Health
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Aim – To empower people to gain priority for their own
care by raising public awareness and developing patient
advocacy organisations
The Bone & Joint Decade Patient Advocacy
Seminars
2004
2005
2006
2007
2008
2009
Beijing, China
Ottawa, Canada
Durban, South Africa
Gold Coast, Australia
Pune, India
Washington DC, USA
Identifying issues – developing
skills to make change happen
Helping people develop their voice
Patient and Public Education
• A free public seminar for people
with arthritis and people who care
about them
• Updates on OA, RA, JA by world
renowned experts
• Q&A panels
• Multiple partners
• Held parallel to major professional
patients so faculty available
Musculoskeletal health in the workplace
• How to keep people physically healthy
• How to prevent MSD’s
• How to enable people with MSD’s and MSC’s to keep in the
workplace
• A new BJD initiative
NAN Action Point
• Public and patient education programmes
– Meetings
– Leaflets
– Media activities
• Work with other initiatives and stakeholders where promoting
musculoskeletal health has a relevance
– Physical fitness
– Nutrition
– Large employers
National Alliance for Promoting Musculoskeletal Health
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Aim - raise awareness of public and policy makers
Advocacy
raising awareness of public and policy makers
• Target
• Policy makers (WHO, national Ministries of Health)
• Other relevant stakeholders e.g. employers
• Public
• Message
• Growing burden of MSC
• Effectiveness of modern day prevention and treatment
• Need for equitable access to prevention, treatment and
rehabilitation
Working with the World Health
Organisation
Identifying opportunities for collaboration
World Health Organisation
•
•
•
WHO is responsible for health within the United Nations system. It provides
leadership on global health matters, shaping the health research agenda,
setting norms and standards, articulating evidence-based policy options,
providing technical support to countries and monitoring and assessing health
trends.
The World Health Assembly is the supreme decision-making body for WHO.
It is attended by all 194 Member States. It determines the policies of the
Organization.
The Executive Board (34 members) agrees the agenda for the Health
Assembly and adopts resolutions for forwarding to the Health Assembly. The
main functions of the Board are to give effect to the decisions and policies of
the Health Assembly, to advise it and generally to facilitate its work.
Member States set the agenda for WHO
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
Our current collaboration with WHO:
Noncommunicable diseases
• WHO Strategy for Noncommunicable Diseases
Musculoskeletal trauma
• WHO Decade of Action for Road Safety
• WHO Global Alliance for the Care of the Injured
Disability
• WHO World Report on Disability
Other areas of collaboration
• Global Burden of disease
• Revision of WHO ICD10
2008-2013 Action Plan for the Global Strategy
for the Prevention and Control of
Noncommunicable Diseases
“Working in partnership to prevent
and control the four noncommunicable
diseases — cardiovascular diseases,
diabetes, cancers and chronic
respiratory diseases and the four
shared risk factors - tobacco use,
physical inactivity, unhealthy diets and
the harmful use of alcohol”
Global Status Report on NCDs 2010
The Global Status Report on
Noncommunicable Diseases 2010 is the
first report on the worldwide epidemic of
cardiovascular diseases, cancer,
diabetes and chronic respiratory
diseases, along with their risk factors
and determinants.
WHO – NCD Plan
• 4 Diseases prioritized:
–
–
–
–
Cancer
Cardiovascular diseases
Chronic obstructive pulmonary disease
Diabetes
• 4 Risk Factors targetted:
–
–
–
–
Tobacco use
Unhealthy diet
Harmful use of alcohol
Physical inactivity / obesity
What must we do to ensure musculoskeletal conditions
and other common, high morbidity but low mortality
NCDs are recognised as a major health threat?
• Opportunities
– The risk factors are common to musculoskeletal health
“Healthy lives for healthy hearts, lungs, bones and joints”
• Actions
– Raise awareness of impact of MSC and common risk factors
– Look for opportunities for working together on implementation
eg patient empowerment / self management
– Get engaged at the national and local level in activities related
to reducing the burden of NCD and get MSC included
– Work with other NCD groups
• World Report on Disability launched 9 June 2011 at United Nations
• provides global guidance on implementing the United Nations
Convention on the Rights of persons with Disabilities
• gives a picture of the situation of people with disabilities, their needs
and unmet needs, and the barriers they face to participating fully in
their societies
• highlights good practice examples
• makes recommendations for the way forward
UN Launch, New York and
Partners Meeting WHO, Geneva
June 2011
• BJD invited to launch and to be a partner
• Opportunity to work with WHO and other NGOs and
stakeholders to develop the recommendations and
help with their implementation
• Opportunities to work at national level as the World
Report on Disability is rolled out with national launches
Comment
• Many of the barriers people with disabilities face are avoidable and
the disadvantage associated with disability can be overcome.
BUT
• Not enough recognition of the importance of mobility and dexterity
and the role of musculoskeletal conditions in limiting these
activities and that much can be done to prevent or effectively
manage these conditions
• Not enough focus on specific causes of disability and how to
prevent disability
Road Trauma
• Musculoskeletal injuries and
longterm physical disability are
the common outcome of road
traffic accidents
• Road traffic accidents are
increasing worldwide, especially
in developing countries
• Preventing musculoskeletal
problems and disability from
whatever cause is goal of the
Bone and Joint Decade
BJD one of 4 core partners
The trauma line
from injury to reintegration into society
Spectrum of Trauma Care
Pre-Hospital Care
Tier 1
First responders
Bystanders
Tier 2
Formal EMS
Ambulance
Hospital Care
Rehabilitation
Facilitybased
Communitybased
BJD Advocacy Toolkit
• A programme to develop advocacy for
musculoskeletal health bringing together all
stakeholders
NAN Action Point
• Gain endorsement of the importance of musculoskeletal
conditions
• Identify their priorities and look for synergies
– Healthy active aging is a priority in Europe
• Get involved in national implementation of WHO activities
• Work with policy makers
• Influence national and international opinions
– Remember that all countries have a vote in UN / WHO
• Advocacy training
• Mentorship programmes for future leaders
National Alliance for Promoting Musculoskeletal Health
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Aim – develop an appropriately skilled workforce
Density of health workers
Raising standards of care through
medical education and training –
Bone and Joint Decade Education
Task Force
Professor
Consultant
Specialist - fellow
Establishing Standards for
Undergraduate Education
• China, Australia, Canada, Croatia ….
Resident
Internship
Medical student
= Every Doctor
Global core recommendations for
a musculoskeletal undergraduate
curriculum
The need for basic
competency
Emergencies
Unusual conditions (bone tumors, malformations )
Less common conditions (fractures, RA, spinal stenosis)
Common conditions (low back pain, sprains, strains, OA)
Woolf, Åkesson & Walsh Annals Rheumatic Diseases May 2004
A sustainable training programme
NAN Action Point
• Implementation of core musculoskeletal undergraduate
curriculum in all medical schools
• Review balance of the workforce and their competencies in
identifying and managing musculoskeletal conditions
National Alliance for Promoting Musculoskeletal Health
Partnership
Public and patient
education
Standards of
care
Surveillance
Advocacy
Professional
education
Gaining
recognition of the
importance of
musculoskeletal
conditions
Research
Aim – advance the understanding of musculoskeletal
conditions and improve prevention and treatment
through research
Research - Investing for the Future
Promoting musculoskeletal science
• musculoskeletal research should be
national research priority
• research funding should reflect
burden of disease or clinical needs
Young Investigators Initiative
A grant mentoring and career development program
Aim
To increase pipeline of MSK clinician
and basic scientists
• A mentoring program – it does not
provide funding
• 200 participants
• Multi-disciplinary
• Participants have achieved 97 / $65
million funded grants in five years
• Rheumatologists: 43
NAN Action Point
• Increase priority and funding for research in musculoskeletal
science
• Encourage development of groups working together in
musculoskeletal science
• Courses in musculoskeletal science – basic and clinical
• Young investigator programmes
National Alliance for Promoting Musculoskeletal Health
Bone and Joint Decade – The Next Ten Years 2010 – 2020
“Keep people moving”
Challenges remain
• How to gain priority for longterm disabling conditions with high personal,
family and societal costs when current priorities focus on conditions with
high mortality
• Gaining recognition that musculoskeletal conditions are the leading
cause of disability, much of which can now be prevented
• Changing the paradigm from
quantity of life
to
quantity of quality life
The Bone and Joint Decade
Global Alliance for Musculoskeletal Health
Poste Vatican
Together we can successfully gain priority for
musculoskeletal conditions
“Keep people moving”