Abstract
BackgroundMusculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response.MethodsAn in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model.ResultsThirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived.ConclusionKIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.
Highlights
Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking
While the urgency for health systems to respond to the health, social and economic burden associated with noncommunicable diseases (NCDs) is reflected in targets for the Sustainable Development Goals (SDGs) and in major international reviews and initiatives to steward system reform efforts [1, 6,7,8], Universal Health Coverage for NCDs lags well behind that for communicable, maternal, neonatal, and nutritional (CMNN) diseases, in middle-income economies [9]
Sample characteristics 31 key informants (KIs) (45%, female) from 20 countries (40% low and middle-income countries (LMICs) based on the World Bank list of economies, June 2020) with a mean (SD; range) age of 57.9 (10.8; 41–77) years and 30.4 (11.2; 6–53) years of experience in healthcare participated and 2 declined
Summary
Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. MSK health conditions are relevant across the life-course [14] They frequently feature in co- and multi-morbidity health states for NCDs [15, 16], are a risk factor for other NCDs [17, 18] and are a key determinant of intrinsic capacity associated with healthy ageing [19]. Social threats associated with COVID-19 are proposed to exacerbate the experience of persistent pain [27] This has implications for LMICs, as MSK conditions are among the leading causes that account for more than 75% of disease burden for NCDs and injuries for the poorest billion people aged 5–40 years and greater than 40 years of age [1]
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