Global need: including rehabilitation in health system strengthening

Abstract

We read with great enthusiasm Alarcos Cieza and colleagues’1Cieza A Causey K Kamenov K Hanson SW Chatterji S Vos T Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 2006-2017Summary Full Text Full Text PDF Scopus (57) Google Scholar analysis of data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate that 2·41 billion people (95% uncertainty interval 2·34–2·50 billion) worldwide would benefit from rehabilitation services. This comprehensive work quantifies an increasing burden of non-fatal health losses potentially addressed by rehabilitation services. Cieza and colleagues’ work complements findings from our series of secondary analyses of GBD 2017,2Jesus TS Landry MD Hoenig H et al.Physical rehabilitation needs in the BRICS nations from 1990 to 2017: cross-national analyses using data from the Global Burden of Disease Study.Int J Environ Res Public Health. 2020; 174139Crossref Scopus (5) Google Scholar, 3Jesus TS Landry MD Hoenig H Global need for physical rehabilitation: systematic analysis from the Global Burden of Disease Study 2017.Int J Environ Res Public Health. 2019; 16: 980Crossref PubMed Scopus (30) Google Scholar, 4Jesus TS Landry MD Brooks D Hoenig H Physical rehabilitation needs per condition type: results from the Global Burden of Disease Study 2017.Arch Phys Med Rehabil. 2020; 101: 960-968Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar in which we focused on an extensive set of health conditions that could benefit from physical rehabilitation (excluding mental health and sensory impairments). In years of life lived with disability (YLDs), we found a 66% global increase from 1990 to 2017 specifically in physical rehabilitation needs,3Jesus TS Landry MD Hoenig H Global need for physical rehabilitation: systematic analysis from the Global Burden of Disease Study 2017.Int J Environ Res Public Health. 2019; 16: 980Crossref PubMed Scopus (30) Google Scholar whereas Cieza and colleagues1Cieza A Causey K Kamenov K Hanson SW Chatterji S Vos T Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 2006-2017Summary Full Text Full Text PDF Scopus (57) Google Scholar found a 69% global increase from 1990 to 2019 for key rehabilitation-sensitive conditions. Similar to Cieza and colleagues’ results, we found that musculoskeletal conditions largely contributed (ie, by 53%) to physical rehabilitation needs worldwide.4Jesus TS Landry MD Brooks D Hoenig H Physical rehabilitation needs per condition type: results from the Global Burden of Disease Study 2017.Arch Phys Med Rehabil. 2020; 101: 960-968Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar These results underscore the high and increasing global need for rehabilitation services, and the substantial contribution of musculoskeletal conditions to these needs. Cieza and colleagues1Cieza A Causey K Kamenov K Hanson SW Chatterji S Vos T Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 2006-2017Summary Full Text Full Text PDF Scopus (57) Google Scholar also found that global YLDs from rehabilitation-sensitive neurological, cardiovascular, and neoplasm conditions more than doubled between 1990 and 2019 (104%, 106%, and 129% increases, respectively). In turn, we observed substantial increases from 1990 to 2017 for neurological, cardiovascular, and neoplasm conditions in YLD rates (ie, YLDs per 100 000 people; 31%, 23%, and 62% increases, respectively).4Jesus TS Landry MD Brooks D Hoenig H Physical rehabilitation needs per condition type: results from the Global Burden of Disease Study 2017.Arch Phys Med Rehabil. 2020; 101: 960-968Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar Among the five largest emergent economies, rehabilitation needs from neurological conditions grew especially in China (ie, by 113% per capita).2Jesus TS Landry MD Hoenig H et al.Physical rehabilitation needs in the BRICS nations from 1990 to 2017: cross-national analyses using data from the Global Burden of Disease Study.Int J Environ Res Public Health. 2020; 174139Crossref Scopus (5) Google Scholar Physical rehabilitation needs per capita grew by 17% worldwide.3Jesus TS Landry MD Hoenig H Global need for physical rehabilitation: systematic analysis from the Global Burden of Disease Study 2017.Int J Environ Res Public Health. 2019; 16: 980Crossref PubMed Scopus (30) Google Scholar Analogous with the Article by Cieza and colleagues,1Cieza A Causey K Kamenov K Hanson SW Chatterji S Vos T Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 2006-2017Summary Full Text Full Text PDF Scopus (57) Google Scholar we found that age-standardised values either did not change or modestly changed with time,2Jesus TS Landry MD Hoenig H et al.Physical rehabilitation needs in the BRICS nations from 1990 to 2017: cross-national analyses using data from the Global Burden of Disease Study.Int J Environ Res Public Health. 2020; 174139Crossref Scopus (5) Google Scholar, 3Jesus TS Landry MD Hoenig H Global need for physical rehabilitation: systematic analysis from the Global Burden of Disease Study 2017.Int J Environ Res Public Health. 2019; 16: 980Crossref PubMed Scopus (30) Google Scholar, 4Jesus TS Landry MD Brooks D Hoenig H Physical rehabilitation needs per condition type: results from the Global Burden of Disease Study 2017.Arch Phys Med Rehabil. 2020; 101: 960-968Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar meaning that population growth and ageing are key determinants of rising rehabilitation needs. As the global population ages, this trend will probably endure, adding further rehabilitation needs. Furthermore, in an ecological study across 35 high-income countries, using data on the physical and occupational therapy workforce supply and needs-based data from GBD 2017, we found no relationship among supply and need variables when adjusted for sociodemographic covariates.5Jesus TS Landry MD Hoenig H Dussault G Koh GC Fronteira I Is physical rehabilitation need associated with the rehabilitation workforce supply? An ecological study across 35 high-income countries.Int J Health Policy Manag. 2020; (published online August 17.)https://doi.org/10.34172/ijhpm.2020.150Crossref Google Scholar Indeed, important supply–need disparities were found even within high-income countries,5Jesus TS Landry MD Hoenig H Dussault G Koh GC Fronteira I Is physical rehabilitation need associated with the rehabilitation workforce supply? An ecological study across 35 high-income countries.Int J Health Policy Manag. 2020; (published online August 17.)https://doi.org/10.34172/ijhpm.2020.150Crossref Google Scholar and across low-income and middle-income countries where rehabilitation resources are scarce. Overall, Cieza and colleagues1Cieza A Causey K Kamenov K Hanson SW Chatterji S Vos T Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 2006-2017Summary Full Text Full Text PDF Scopus (57) Google Scholar provide an up-to-date and detailed estimation of global rehabilitation needs; we hope that the growing body of data and knowledge on unmet rehabilitation needs can mainstream rehabilitation as a key element of health system strengthening worldwide. We declare no competing interests. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need. Full-Text PDF Open Access