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WHO AGENDA POST-2015

The release of the World Health Organisations (WHO) post-2015 development agenda, raises important questions for those interested in highlighting the political salience of musculoskeletal conditions:  ‘Where will musculoskeletal conditions fit, if at all, into the next generation of global health goals?’

Musculoskeletal conditions (MSCs) such as low back pain, arthritis and other diseases of the joints affect millions of people around the world and are one the leading causes of disability (GBD 2012, Lancet). With such a vast impact, why are these conditions being ignored as a public health priority?

Positioning health in the post-2015 draft development agenda explores the potential for a Universal Health Coverage (UHC) to maintain a concern for health equity, the right to health and its financial protection. This overarching single health-goal aims to accommodate the ‘agenda for global health’, accelerating and maintaining the visibility of its agreed health goals rather than promote competition between them. 

Traditionally, MSC’s have lost out to disease-interests which have high mortality rates, which gain them priority in the global health agenda.  Consequently, diseases of the musculoskeletal system, which can be effectively prevented and controlled, are neither managed with equity nor given appropriate levels of priority.  As a result there is enormous unmet need and avoidable disability.

MSCs are the second greatest cause of disability worldwide (measured by years lived with disability YLDs) and although they do not lead directly to mortality, their impact on the ability to live independently and continue productive working life is severely debilitating to both individuals and society.  As a group musculoskeletal disorders cause 21.3% of all years lived with disability, this is second only to mental and behavioural disorders which account for 22.7% of YLDs (GBD 2012, Lancet).  

The importance of health to the global economy is detailed in the recent WHO discussion paper: “In addition to the fact that healthy people have stronger cognitive and physical capabilities and, in consequence, make more productive contributions to society, health policy contributes to poverty reduction through the financial protection inherent in universal health coverage.” 

In 2009 alone one third of all sick-leave in Europe alone (9.3 million work days lost) was attributable to MSC’s. It is also estimated that MSCs in the workforce cost the EU over €240 billion a year (FfWEurope, 2012). Clearly these conditions have an enormous impact on current economic status and its future progress.

Whilst the changing agenda for global health recognises that the political recognition of the societal and economic impact of non-communicable diseases (NCDs) is important, continuing to have a primary focus on NCD Mortality and life expectancy, means that the true impact of MSC’s is not, and cannot, be fully recognised.

It is with this in mind, that the importance of including musculoskeletal health in the WHO’s agreed health goals and UHC is realised; goals shape political agenda and influence resource transfers. Moreover, the UHC also recognises the importance of using healthy life expectancy as a better measure of progress, something which is vital to making sure the impact of MSC’s are revealed recognised when measuring global health progress.

Clearly MSCs should not replace other priorities, but with such a vast economic impact alone, they should join other NCDs at the forefront of global health concerns. People with MSCs should have access to all the services they need and that action extends to the social, economic and environmental determinants of health and not just the biomedical causes of illness.

With the agenda for global health changing in ways that influence how priorities for development will be defined in the future the time to act for MSCs has never been more vital.