how do we get policy makers to take musculoskeletal health...

Bone and Joint Decade 2010 - 2020 The Global Alliance for Musculoskeletal Health

Professor Anthony D Woolf Chair, Bone and Joint Decade 2010-20

Royal Cornwall Hospital, Truro & Peninsula College of Medicine and Dentistry

How do we get policy makers to

take musculoskeletal health and

conditions seriously?

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

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 ?

Musculoskeletal conditions - gaining priority

Competing

priorities

Evidence

Expert

opinion

Public

opinion

Economic

climate

Lobbying

Opportunities

Contextual

factors

HEALTH

POLICY

NGOs

Commercial

interests What is

achievable

Cost

effectiveness

Needs

Factors that influence health policy

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

IMPACT OF DISEASE

“STATE OF THE ART”

EFFECTS OF INTERVENTION

UNAVOIDABLE

BURDEN

EFFECTS IN CLINICAL

PRACTICE 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



UNAVOIDABLE

BURDEN

EFFECTS IN CLINICAL

PRACTICE AVOIDABLE

BURDEN

OF DISEASE




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

“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

“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


• 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



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

Person

Caregivers

Health care system

National economy Lower quality of life

(pain, restriction of activities) 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

Person

Caregivers

Health care system

National economy

Health care costs

Work disability

Social support

The impact

– the human and

financial consequences

The burden of MSC on primary care

UK consultation rates

Percent respondents visited health provider

in past 12 months

Source: EHIS; Wales National Health Survey; Austria National Health Survey

Percent respondents visited health provider in past 12 months

0 2 4 6 8 10 12 14

Belgium

Latvia

Cyprus

Hungary

Malta

Austria

Wales

Slovenia

Czech Repub.

Percent

Physiotherapist

Chiropodist

Occupational

therapist

1 in 4 on longterm treatment because of

“longstanding troubles with muscles, bones

and joints (arthritis, rheumatism)”



September 2007

Duration of incapacity benefit claim by condition

England, Scotland & Wales 2010

Source: Department of Work & Pensions 2010

Incapacity benefit caseload working age by duration of claim

England Scotland & Wales 2010

0

100

200

300

400

500

600

700

Injury, Poisoning and

certain other

consequences of

external causes

Diseases of the

Circulatory or

Respiratory System

Diseases of the Nervous

System

Diseases of

Musculoskeletal system

& connective tissue

Mental & Behavioutal

disorders

Condition

Caselo

ad

(1,0

00s)

6 mths to 1 yr

1- 2 yrs

2-5 yrs

5 yrs+

Disability pension by main diagnosis Finland

Source: Finnish Centre for Pensions and The Social Insurance Institution of Finland. Statistical Yearbook of Pensioners in Finland

Recipients of disability pensions- top 6 diagnoses

Finland 2009

0

20

40

60

80

100

120

140N

eo

pla

sms

Inju

rie

s &

po

iso

nin

g

Dis

ea

ses

of

circ

ula

tory

syst

em

Dis

ea

ses

of

ne

rvo

us

syst

em

Dis

ea

ses

of

mu

scu

losk

ele

tal

syst

em

Me

nta

l

dis

ord

ers

Disease category

No

. re

cip

ien

ts (

1,0

00s)

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 Disability Adjusted Life Year (DALY)

0 10 20 30

40

50

60

70

80

90

100

0 20 40 60 80 100 Age

% s

urv

ivin

g (

tho

usan

ds)

B

A

C C = Years of Life Lost

(YLLs)

B = Years of Life lived

with Disability

(YLDs)

DALY = YLL + YLD

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 High-income countries

2.1 1.53 Vision disorders, age-

related

2.0 9.34 Protein-energy

malnutrition

10

2.4 1.68 Endocrine disorders 2.1 9.81 Alcohol use disorders 9

3.2 2.25 Diabetes mellitus 2.1 10.15 Schizophrenia 8

4.0 2.86 Chronic obstructive

pulmonary disease

2.3 11.10 Cerebrovascular

disease

7

4.9 3.46 Cerebrovascular

disease

2.8 13.52 Perinatal conditions 6

5.3 3.77 Osteoarthritis 2.9 13.65 Osteoarthritis 5

5.3 3.77 Alcohol use disorders 3.2 15.36 Vision disorders, age-

related

4

7.6 5.39 Hearing loss, adult

onset

5.2 24.61 Hearing loss, adult

onset

3

8.9 6.33 Alzheimer’s and other

dementias

5.9 28.15

Cataracts 2

11.8 8.39 Unipolar depressive

disorders

9.1 43.22 Unipolar depressive

disorders

1

% of total

YLD

YLD (millions of

years)

Cause

% of total

YLD

YLD (millions of

years)

Cause

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

Source: WHO Global Burden of Disease 2004 http://www.who.int/healthinfo/global_burden_disease/YLD14_30_2004.xls

YLDs musculoskeletal diseases by European region 2004

0

500

1000

1500

2000

2500

3000

Musculoskel.

Diseases

Osteoarthritis Rheumatoid

arthritis

Other

musculoskeletal

disorders

Gout Low back pain

Cause

YL

Ds (

tho

usan

ds)

EUR A

EUR B

EUR C

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

IMPACT OF DISEASE



UNAVOIDABLE

BURDEN

EFFECTS IN CLINICAL

PRACTICE AVOIDABLE

BURDEN

OF DISEASE




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)

“Rheumatism” (Guillaume de

Baillou)

“Rheumatoid Arthritis”

(Sir Alfred Garrod)

1591

1680s 1860sa

1859a

Quinine Willow Bark

1890sa

Manufactured

Aspirin

1920s

Gold

Injections

1940s

Steroids

1980s

Methotrexate

(MTX)

1990s

Biologics

aAppelboom T. Rheumatology (Oxford). 2002;41(suppl 1):28-34.

2000s

Early

aggressive

treatment

RA can now be effectively treated

Best Study Percentage in remission

0

20

40

60

80

100

0 3 6 9 12 15 18 21 24

Time (months)

% w

ith

DA

S44

<1.

6

sequential mono step-up combination

combi with prednisone combi with infliximab

Goekoop - Ruiterman: A&R 2005

IMPACT OF DISEASE



UNAVOIDABLE

BURDEN

EFFECTS IN CLINICAL

PRACTICE AVOIDABLE

BURDEN

OF DISEASE




Identifying gaps in the provision and outcome of care

Management of musculoskeletal pain

Multinational Survey of

Osteoporotic Fracture Management Dreinhöfer et al. Osteoporos Int 2005; 16:S44-S54

Secondary prevention of fractures

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

Competing

priorities

Evidence

Expert

opinion

Public

opinion

Economic

climate

Lobbying

Opportunities

Contextual

factors

HEALTH

POLICY

NGOs

Commercial

interests What is

achievable

Cost

effectiveness

Needs

Factors that influence health policy

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

• Clear objectives

• A strong case supported by data and

examples

• Suggest solutions

• Activities to achieve objectives

• Work with all stakeholders

Influencing the decision makers – changing

public and political opinion

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

Official Support by Kofi Annan

UN Secretary General

30 November 1999

United Nations

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

Bone and Joint Decade – The Next Ten Years 2010 – 2020 “Keep people moving”

“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

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.

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.

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

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


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.


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


Gaining

recognition of the

importance of

musculoskeletal conditions

Surveillance

Standards of care

Partnership Public and patient

education Advocacy

Professional education

Research

Core programmes to gain recognition of the

importance of musculoskeletal conditions

Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


Research

Aim – To measure, monitor and raise awareness of the

suffering and cost to society associated with


Impact of Musculoskeletal Conditions

World

Health

Reports

Global Burden of

Disease

2005

In preparation

WHO

Seattle, Harvard, Queensland

Gates Foundation

in USA

Europe Global

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

http://www.eumusc.net

NAN Action Point

• National data on burden of musculoskeletal conditions

• National information on services provided

National Alliance for Promoting Musculoskeletal Health

Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


Research

Aim - Strategies for prevention and control at a

national level and their implementation

Those with

condition At

Risk

The whole

population MORBIDITY

10 30 20

Primary prevention • avoid or remove

the cause of a

health problem

before it arises

Stages of Prevention

Secondary prevention • detect a health problem

at early stage, facilitating

cure, or reducing /

preventing spread, or

reducing / preventing

long-term effects

Tertiary prevention • 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

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

Disease Control Priorities

in Developing Countries

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

IMPACT OF MUSCULOSKELETAL CONDITIONS

WHAT CAN BE ACHIEVED BY “STATE OF THE ART”

KNOWLEDGE UNAVOIDABLE

BURDEN

WHAT IS ACHIEVED BY PREVENTION

& CLINICAL PRACTICE AVOIDABLE

BURDEN

The avoidable burden of musculoskeletal

conditions

CLOSING THE GAP BETWEEN WHAT

CAN & WHAT IS BEING ACHIEVED

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


Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


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……..

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

Bone and Joint Decade The Global Alliance for Musculoskeletal Health

Over 60 National

Action Networks

a unified voice, a global reach

The Vatican

WHO

UN

USA

Germany

Worldwide endorsement

Japan

BJD Annual World Network

Conferences

1999 Zurich, Switzerland

2000 Muscat, Sultanate of Oman

2001 New York, USA (cancelled)

2002 Rio de Janeiro, Brazil

2003 Berlin, Germany

2004 Beijing, China

2005 Ottawa, Canada

2006 Durban, South Africa

2007 Gold Coast, Australia

2008 Pune, India

2009 Washington DC, USA

2010 Lund, Sweden

2011 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


Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


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 Beijing, China

2005 Ottawa, Canada

2006 Durban, South Africa

2007 Gold Coast, Australia

2008 Pune, India

2009 Washington DC, USA

Identifying issues – developing

skills to make change happen

Helping people develop their voice

• 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

Patient and Public Education

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


Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


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

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


Our current collaboration with WHO:

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

• 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

What must we do to ensure musculoskeletal conditions

and other common, high morbidity but low mortality

NCDs are recognised as a major health threat?

• 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

Hospital Care

Facility- Community-

based based

Rehabilitation

Tier 1

First responders

Bystanders

Tier 2

Formal EMS

Ambulance

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


Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


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

Establishing Standards for

Undergraduate Education

• China, Australia, Canada, Croatia ….

Medical student

Internship

Resident

Specialist - fellow

Consultant

Professor

= Every Doctor

Global core recommendations for

a musculoskeletal undergraduate

curriculum

http://ard.bmjjournals.com/current.shtml

Common conditions (low back pain, sprains, strains, OA)

Less common conditions (fractures, RA, spinal stenosis)

Unusual conditions (bone tumors, malformations )

Emergencies

The need for basic

competency

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


Gaining

recognition of the

importance of


Surveillance

Standards of care


education Advocacy


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


• 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


Challenges remain

The Bone and Joint Decade Global Alliance for Musculoskeletal Health

Together we can successfully gain priority for


Poste Vatican

“Keep people moving”

how do we get policy makers to take musculoskeletal health...

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