Bone and Joint Decade 2010 - 2020 The Global Alliance for - - PowerPoint PPT Presentation

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,
• steoporosis 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

• pinion

Public

• pinion

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 “STATE OF THE ART” EFFECTS OF INTERVENTION UNAVOIDABLE BURDEN EFFECTS IN CLINICAL PRACTICE AVOIDABLE BURDEN OF DISEASE

Bone and Joint Monitor Project

Health Needs Assessment of Musculoskeletal Conditions

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

• rganised 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

• lder people and changes in lifestyle
• ccuring 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

• pened 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

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

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)”

Health in the European Union Eurobarometer Special Report 272, 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

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 Caseload (1,000s) 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

20 40 60 80 100 120 140

Neoplasms Injuries & poisoning Diseases of circulatory system Diseases of nervous system Diseases of musculoskeletal system Mental disorders

Disease category

• No. recipients (1,000s)

From the individual to health of the population

Measuring population health

Summary measures of population health combine information

• n mortality and non-fatal health outcomes to represent the

health of a particular population as a single number

Disability Adjusted Life Year (DALY) 10 20 30 40 50 60 70 80 90 100 20 40 60 80 100 Age % surviving (thousands)

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

• nset

5.2 24.61 Hearing loss, adult

• nset

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

500 1000 1500 2000 2500 3000

Musculoskel. Diseases Osteoarthritis Rheumatoid arthritis Other musculoskeletal disorders Gout Low back pain

Cause YLDs (thousands) 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 “STATE OF THE ART” EFFECTS OF INTERVENTION UNAVOIDABLE BURDEN EFFECTS IN CLINICAL PRACTICE AVOIDABLE BURDEN OF DISEASE

Bone and Joint Monitor Project

Health Needs Assessment of Musculoskeletal Conditions

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)

“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

20 40 60 80 100 3 6 9 12 15 18 21 24 Time (months) % with DAS44 <1.6 sequential mono step-up combination combi with prednisone combi with infliximab Goekoop - Ruiterman: A&R 2005

IMPACT OF DISEASE “STATE OF THE ART” EFFECTS OF INTERVENTION UNAVOIDABLE BURDEN EFFECTS IN CLINICAL PRACTICE AVOIDABLE BURDEN OF DISEASE

Bone and Joint Monitor Project

Health Needs Assessment of Musculoskeletal Conditions

Co-ordinators: Anthony Woolf, Kristina Åkesson, Mieke Hazes

Identifying gaps in the provision and

• utcome 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

• pinion

Public

• pinion

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

• n 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

• rganisations

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 Next Ten Years 2010 – 2020

“Keep people moving”

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 Bone and Joint Decade – The Next Ten Years 2010 – 2020

“Keep people moving”

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

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

Bone and Joint Decade – The Next Ten Years 2010 – 2020

“Keep people moving”

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 musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education 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

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

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 musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education 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
• f 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,

• ccupational 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

Gaining recognition of the importance of musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education Research Aim – To develop sustainable networks at global, regional and national levels who can advocate for priority

Physicians, health

professionals, patients

• rganisations

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

National Alliance for Promoting Musculoskeletal Health

Gaining recognition of the importance of musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education 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 National Alliance for Promoting Musculoskeletal Health

Gaining recognition of the importance of musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education 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

Bone and Joint Decade – The Next Ten Years 2010 – 2020

“Keep people moving”

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

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

National Alliance for Promoting Musculoskeletal Health

Gaining recognition of the importance of musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education 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

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 National Alliance for Promoting Musculoskeletal Health

Gaining recognition of the importance of musculoskeletal conditions

Surveillance Standards of care Partnership Public and patient education Advocacy Professional education 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

• 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

Bone and Joint Decade – The Next Ten Years 2010 – 2020

“Keep people moving”

Challenges remain

The Bone and Joint Decade

Global Alliance for Musculoskeletal Health

Together we can successfully gain priority for musculoskeletal conditions

Poste Vatican

“Keep people moving”