Global Burden of Disease: the 10 Leading Causes of YLD, 2001 High-income countries Low- and middle-income countries YLD % of total YLD % of total (millions of YLD (millions of YLD Cause Cause years) years) 1 Unipolar depressive 43.22 9.1 Unipolar depressive 8.39 11.8 disorders disorders 2 Cataracts 28.15 5.9 6.33 8.9 Alzheimer ’ s and other dementias 3 Hearing loss, adult 24.61 5.2 Hearing loss, adult 5.39 7.6 onset onset 4 Vision disorders, age- 15.36 3.2 Alcohol use disorders 3.77 5.3 related 5 Osteoarthritis 13.65 2.9 Osteoarthritis 3.77 5.3 6 Perinatal conditions 13.52 2.8 Cerebrovascular 3.46 4.9 disease 7 Cerebrovascular 11.10 2.3 Chronic obstructive 2.86 4.0 disease pulmonary disease 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 9.34 2.0 Vision disorders, age- 1.53 2.1 malnutrition related 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 2500 YLDs (thousands) 2000 EUR A 1500 EUR B EUR C 1000 500 0 Musculoskel. Osteoarthritis Rheumatoid Other Gout Low back pain Diseases arthritis musculoskeletal disorders 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 Proj ect Health Needs Assessment of Musculoskeletal Conditions IMPACT OF DISEASE “ STATE OF THE ART ” UNAVOIDABLE BURDEN EFFECTS OF INTERVENTION EFFECTS IN CLINICAL AVOIDABLE PRACTICE 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) Steroids Gold Injections Manufactured Aspirin Quinine Willow Bark 1680s 1860s a 1890s a 1920s 1940s 1980s 1990s 2000s 1591 1859 a “ Rheumatism ” “ Rheumatoid (Guillaume de Arthritis ” Baillou) (Sir Alfred Garrod) a Appelboom T. Rheumatology (Oxford). 2002;41(suppl 1):28-34.
RA can now be effectively treated Best Study Percentage in remission 100 80 % with DAS44 <1.6 60 40 20 0 0 3 6 9 12 15 18 21 24 Time (months) sequential mono step-up combination combi with prednisone combi with infliximab Goekoop - Ruiterman: A&R 2005
Bone and Joint Monitor Proj ect Health Needs Assessment of Musculoskeletal Conditions IMPACT OF DISEASE “ STATE OF THE ART ” UNAVOIDABLE BURDEN EFFECTS OF INTERVENTION EFFECTS IN CLINICAL AVOIDABLE PRACTICE 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 Opportunities priorities NGOs Needs HEALTH Evidence Lobbying POLICY Commercial What is interests achievable Expert Economic Cost opinion climate effectiveness 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 Orthopaedics Scientists
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
Public and patient Advocacy Partnership education Standards of Professional care education Gaining recognition of the importance of Surveillance Research musculoskeletal conditions Core programmes to gain recognition of the importance of musculoskeletal conditions
Public and patient Advocacy Partnership education Standards of Professional care education Gaining recognition of the importance of Surveillance Research musculoskeletal conditions 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
Public and patient Advocacy Partnership education Standards of Professional care education Gaining recognition of the importance of Surveillance Research musculoskeletal conditions Aim - Strategies for prevention and control at a national level and their implementation
Stages of Prevention 3 0 1 0 2 0 The whole Those with At MORBIDITY population condition Risk Primary prevention Secondary prevention Tertiary prevention • avoid or remove • detect a health problem • reduce the impact the cause of a at early stage, facilitating of an already health problem cure, or reducing / established before it arises preventing spread, or disease reducing / preventing long-term effects
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 Disease Control Priorities for musculoskeletal conditions in in Developing Countries 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
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 ” UNAVOIDABLE KNOWLEDGE BURDEN WHAT IS ACHIEVED BY PREVENTION AVOIDABLE & CLINICAL PRACTICE BURDEN 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 National Alliance for Promoting Musculoskeletal Health
Public and patient Advocacy Partnership education Standards of Professional care education Gaining recognition of the importance of Surveillance Research musculoskeletal conditions 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 The Vatican Germany Japan WHO USA
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
Public and patient Advocacy Partnership education Standards of Professional care education Gaining recognition of the importance of Surveillance Research musculoskeletal conditions 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
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
Public and patient Advocacy Partnership education Standards of Professional care education Gaining recognition of the importance of Surveillance Research musculoskeletal conditions 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 Pre-Hospital Care Hospital Care Tier 1 Tier 2 First responders Formal EMS Bystanders Ambulance Rehabilitation Facility- Community- based based
BJD Advocacy Toolkit • A programme to develop advocacy for musculoskeletal health bringing together all stakeholders
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