HEALTH BY STEALTH

TACKLING MSKD-RELATED DISABILITY THROUGH INTEGRATED COMMUNITY ACTIVITY

As the primary cause of disability on the planet, musculoskeletal disorders (MSKDs) present an urgent and growing challenge to healthcare systems everywhere.

An umbrella term used to describe conditions that affect the joints, bones, tissues, muscles and nervous system, MSKDs include conditions like osteoarthritis, back pain, fibromyalgia and chronic pain. Deep health inequalities exist due to factors such as gender, ethnicity and income, and global MSK health services are facing a mammoth task owing to the backlog of patients post-Covid. In order to reduce the impact of MSKDs, collective communities need to focus on inclusive designs so as to be able to deliver solutions that facilitate everyone’s journey to joint health & wellbeing.

MSKDs are more than an ‘ache in your knee’ or a ‘twinge in your back’. Globally, they contribute to 17% of all Years Lived in Disability, more than any other health condition. With over $100 billion in healthcare costs each year, and up to five times that lost to sick leave and reduced productivity, the economic case for solutions is clear.

Over 20% (1.7bn) of the global population are affected by MSKDs

But the greatest toll of MSKDs is the daily impact they have on people’s lives. Patients suffer the inability to work without pain, loss of independence due to reduced mobility, early retirement, premature entry into care facilities, inability to spend time with friends and family… And critically, the emotional and mental anguish that results from these challenges, often leading to depression and significantly lower quality of life.

In addition to their direct impact, MSKDs are often a gateway to increased risk of developing other long-term health conditions (LTHCs). Back pain, the main contributor to the MSKD burden, can lead to the development of additional MSKDs and LTHCs. Non-specific back pain is just one example of an ‘upstream’ condition that can have significant ‘downstream’ health costs and life impact; resultant sedentary behaviour, increase cardiovascular risk, muscular atrophy (sarcopenia), increased falls risk, lost mobility and independence, social isolation and requiring extensive ongoing treatment and social care. This is why early intervention and accessible selfmanagement are so critical to reduce worsening downstream costs - both financial and personal.

This challenge demands well-designed, responsive health systems and interventions to deal with MSK conditions as they develop. But even more so, it demands that we create societies and communities where MSK health and wellbeing are inherently supported, preventing conditions and facilitating their self-management before their impact spirals.

This may all sound common sense enough, but prevention and community empowerment have been on the agenda for decades. Even before the pandemic, many healthcare systems found themselves ‘firefighting’ the significant challenges posed by MSKDs, with limited resources to undertake more ambitious programmes. As we adjust to the lasting impacts of Covid-19, we must look to more innovative approaches if we are to foster the proactive, community-based support we need.

‘Problem First’, co-designed solutions

Design-thinking methodology dictates we should understand the problem first and design the solution second. This approach is also known as the ‘double diamond’, with decision making points along the understanding and development pathway. Utilising this methodology in collaboration with patients, clinicians, policy makers and stakeholders can generate a deeper understanding of the problem and the solutions.

Focus on the health journey, not the destination

MSKDs are often long-term and recurring, and the reality is that many patients will never fully overcome them. By reflecting on the ‘journey’ to improved health, we can better support patients to tackle the long-term challenge of treatment and self-management. This means prioritising everyday wellbeing and valuing progress in a way that is meaningful to each patient, to shift the focus from an curative mentality to improving daily outcomes.

Desire, not demands

The paternalistic ‘finger wagging’ approach - explicitly instructing people to avoid the causes of disease – has been demonstrated to drive limited behaviour change. Much more powerful is the ‘salutogenic’ approach, which promotes healthy decisions and lifestyles by creating environments where better choices are desirable rather than demanded. By co-designing the pathways to health, we ensure people engage because they want to, not because they are told to. Leveraging this allows clinicians to become supportive coaches rather than rationalised consultants, empowering patients to lead the transformation of their own health.

Boost the power of social prescribing

By re-thinking and transitioning services from traditional hospital settings to community health and wellbeing options, social prescribing can enable true ‘upstream’ intervention. Yet when used in isolation it can’t be a silver bullet - the success of social prescribing ultimately depends on creating, sustaining and communicating a whole network of neighbourhood solutions. This is where charities and community groups can play a vital role in joining up the dots between primary health interventions and the myriad health and wellbeing options that may prevent them ever being needed.

There is no doubt of the scale of the challenge we face. Around the world, healthcare systems must grapple with compounding burdens from MSKDs, while the individuals who face them everyday often struggle to access the help they need. This requires a fundamental shift in focus, putting power in the hands of frontline clinicians, patients and communities, allowing them to shape policies, co-design solutions, and be the architects of their own wellbeing.

2.4bn are in need of rehabilitation, the majority due to an MSKD