Integrated prevention and management of non-communicable diseases, including musculoskeletal health: a systematic policy analysis among OECD countries

Abstract

IntroductionDevelopment and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies’ aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.MethodsPolicies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0–14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.ResultsAfter removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies—all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).ConclusionRelative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.

Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions

“…All these initiatives offer direct and indirect opportunities to support MSK health care. However, the horizon for improvement in MSK health through national health policy for NCDs remains challenging [7,63]. Linked to SDG 3.4, global performance and monitoring targets for NCDs are principally aligned with mortality reduction for cancer, diabetes, respiratory conditions and cardiovascular disease, leaving less flexibility for prioritisation of MSK health, thereby offering fewer opportunities for governments to support necessary reform efforts for MSK health care [82].…”

“…The WHO Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low Resource Settings is also focussed on heart disease, stroke, cardiovascular risk, diabetes, cancer, asthma and chronic obstructive pulmonary disease [83] and policy initiatives in LMICs have historically overlooked MSK health [66]. In a recent systematic analysis of health policies focusing on integrated prevention or management of NDCs among member states of the Organisation for Economic Co-operation and Development, most countries had policies with targets for cancer (83%), cardiovascular disease (77%), diabetes (77%), respiratory disease (63%) and mental health (63%), while only 50% of countries had policies with an explicit focus on MSK health and/or pain [63]. Nonetheless, many of the proposed activities across the policies were relevant to improving MSK function, potentially offering opportunity for improvement.…”

Musculoskeletal health in the workplace

“…MSK conditions are leading causes of work disability everywhere, yet they do not feature prominently on national health policy or research agendas. A review of system policies for prevention and management of non-communicable diseases among OECD countries found that in spite of the large societal burden MSK conditions did not feature prominently [123], and a recent study from Denmark showed that in spite of back and neck pain being the most burdensome conditions in terms of years lived with disability, only 0.88% of national health research budgets were spent on identifying effective prevention and treatment strategies [124] e and that included research related to the workplace. Thus, the first call to action in a research agenda regarding MSK conditions everywhere is to call on governments, NGOs, companies, foundations and everyone else involved in research funding to prioritise funding of research related to all aspects of MSK conditions and in particular as they relate to the workplace and to work disability.…”

<p>Systemic Solutions for Addressing Non-Communicable Diseases in Low- and Middle-Income Countries</p>

“…65 A high level of data is available for a significant portion of the population in the developed nations because of integrated healthcare systems in these countries. 105 Highly committed international initiatives are required to enhance data collection in LMICs. 106 However, prospective data collection requires a lot of time, effort and investment.…”