Only 5% or less of national research councils’ spending is allocated to musculoskeletal conditions in established market economies, yet musculoskeletal impairments ranked number one in chronic impairments reported in the USA.

Musculoskeletal conditions have an enormous and growing impact worldwide. HEALTH 21: the health for all policy framework for the WHO European Region, identifies musculoskeletal conditions as a target; but national health care priorities in the UK and most European countries do not address this. Only 5% or less of national research councils’ spending is allocated to musculoskeletal conditions in established market economies, yet musculoskeletal impairments ranked number one in chronic impairments reported in the USA. And chronic musculoskeletal pain is reported in surveys by 1 in 4 people in both less and more developed countries.

Musculoskeletal conditions are the most expensive disease category in the Swedish cost of illness study, representing 22.6% of the total cost of illness, and the greatest costs are, not surprisingly, the indirect costs related to morbidity and disability (4). This burden is increasing throughout the world with population growth and the change in risk factors such as increased longevity, urbanisation and motorisation, particularly in less developed countries.

Why is the importance of musculoskeletal conditions under appreciated?

Is it because musculoskeletal conditions are in general rarely fatal, are considered irreversible and the prevalence of many increase with age, which leads to a view of inevitability and low expectation by both the public and health professionals of what can be achieved?

This view may be perpetuated by lack of awareness of the impact of musculoskeletal conditions on the individual and on society, and by the present lack of training in their management. Preventive measures and effective treatments are now available that can significantly improve the outcome of musculoskeletal conditions.

A primary objective of the Bone and Joint Decade is to provide, in collaboration with the WHO Global Burden of Disease 2000 Project, comprehensive and objective information on the burden related to these conditions to inform the debate on priorities and strategies. In addition, defining methods to monitor change will enable health trends to be anticipated and allow planning of research and development, training and investment in health care services. This was the purpose of the WHO Scientific Group Meeting, opened by Dr Gro Harlem Brundtland, held last year, which focused on the present knowledge of the incidence, prevalence and impact of musculoskeletal conditions. In addition there was discussion of indicators that can be used to assess burden and to monitor change related to demographics or new treatments. At present, few indicators relevant to musculoskeletal conditions are routinely collected by either national health organizations or the WHO in any statistical databases. There is an urgent need to identify such indicators that can be widely applied.

It is clear from data collated that the impact from musculoskeletal conditions and trauma varies between different parts of the world and is influenced by social structure, expectation and economics, and that it is most difficult to measure impact in less developed nations where the predicted increase is greatest.

Recognition of the burden of musculoskeletal conditions will result in greater awareness of the pervasive effect they have on the individual and of their cost to society. Measuring the burden will facilitate appropriate priorities and relevant strategies to be developed for its reduction. The application of agreed indicators will allow the burden to be monitored and to evaluate the effectiveness of any interventions. Understanding the burden will, in these ways, ultimately improve outcome for the individual. The impact of musculoskeletal conditions will be re- evaluated over the Decade to demonstrate whether strategies are proving effective at maximising health gain and reducing this burden for society and for the individual.

Prof. Anthony D Woolf

Article taken from an editorial published in the British Medical Journal, May 5, 2001.

Australia endorsed the Bone and Joint Decade in Oct