From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development

Document Type : Original Article

Authors

1 Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

2 Center for Muscle and Joint Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

3 Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada

4 Sydney Musculoskeletal, Bone & Joint Health Alliance, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

5 Curtin School of Allied Health, and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia

6 School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

7 Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia

8 Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada

9 Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia

10 Curtin School of Allied Health, and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia

Abstract

Background 
Global policy to guide action on musculoskeletal (MSK) health is in a nascent phase. Lagging behind other non-communicable diseases (NCDs) there is currently little global policy to assist governments to develop national approaches to MSK health. Considering the importance of comparison and learning for global policy development, we aimed to perform a comparative analysis of national MSK policies to identify areas of innovation and draw common themes and principles that could guide MSK health policy.

Methods 
Multi-modal search strategy incorporating a systematic online search targeted at the 30 most populated nations; a call to networked experts; a specified question in a related eDelphi questionnaire; and snowballing methods. Extracted data were organised using an a priori framework adapted from the World Health Organization (WHO) Building Blocks and further inductive coding. Subsequently, texts were open coded and thematically analysed to derive specific sub-themes and principles underlying texts within each theme, serving as abstracted, transferable concepts for future global policy.

Results 
The search yielded 165 documents with 41 retained after removal of duplicates and exclusions. Only three documents were comprehensive national strategies addressing MSK health. The most common conditions addressed in the documents were pain (non-cancer), low back pain, occupational health, inflammatory conditions, and osteoarthritis. Across eight categories, we derived 47 sub-themes with transferable principles that could guide global policy for: service delivery; workforce; medicines and technologies; financing; data and information systems; leadership and governance; citizens, consumers and communities; and research and innovation.

Conclusion 
There are few examples of national strategic policy to address MSK health; however, many countries are moving towards this by documenting the burden of disease and developing policies for MSK services. This review found a breadth of principles that can add to this existing work and may be adopted to develop comprehensive system-wide MSK health approaches at national and global levels.

Keywords


  1. Briggs AM, Woolf AD, Dreinhöfer K, et al. Reducing the global burden of musculoskeletal conditions. Bull World Health Organ. 2018;96(5):366-368. doi:2471/blt.17.204891
  2. Briggs AM, Jordan JE, Sharma S, et al. Context and priorities for health systems strengthening for pain and disability in low- and middle-income countries: a secondary qualitative study and content analysis of health policies. Health Policy Plan. 2022. doi:1093/heapol/czac061
  3. Briggs AM, Persaud JG, Deverell ML, et al. Integrated prevention and management of non-communicable diseases, including musculoskeletal health: a systematic policy analysis among OECD countries. BMJ Glob Health. 2019;4(5):e001806. doi:1136/bmjgh-2019-001806
  4. Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222. doi:1016/s0140-6736(20)30925-9
  5. Blyth FM, Briggs AM, Schneider CH, Hoy DG, March LM. The global burden of musculoskeletal pain-where to from here? Am J Public Health. 2019;109(1):35-40. doi:2105/ajph.2018.304747
  6. Briggs AM, Shiffman J, Shawar YR, Åkesson K, Ali N, Woolf AD. Global health policy in the 21st century: challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions. Best Pract Res Clin Rheumatol. 2020;34(5):101549. doi:1016/j.berh.2020.101549
  7. Stone D. Making Global Policy. Cambridge: Cambridge University Press; 2019.
  8. Patterson AS, Boadu NY, Clark M, et al. Investigating global mental health: contributions from political science. Glob Public Health. 2020;15(6):805-817. doi:1080/17441692.2020.1724315
  9. Kishore SP, Majumdar UB. Learning from progress: global NCD policy implementation at national level. Lancet Glob Health. 2020;8(1):e4-e5. doi:1016/s2214-109x(19)30496-6
  10. Munkholm L, Rubin O. The global governance of antimicrobial resistance: a cross-country study of alignment between the global action plan and national action plans. Global Health. 2020;16(1):109. doi:1186/s12992-020-00639-3
  11. World Health Organization (WHO). Antimicrobial Resistance: A Manual for Developing National Action Plans. WHO; 2016.
  12. Jernigan DH, Trangenstein PJ. What's next for WHO's global strategy to reduce the harmful use of alcohol? Bull World Health Organ. 2020;98(3):222-223. doi:2471/blt.19.241737
  13. Collin J. Tobacco control, global health policy and development: towards policy coherence in global governance. Tob Control. 2012;21(2):274-280. doi:1136/tobaccocontrol-2011-050418
  14. Murray CJ, Abbafati C, Abbas KM, et al. Five insights from the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1135-1159. doi:1016/s0140-6736(20)31404-5
  15. Blyth FM, Huckel Schneider C. Global burden of pain and global pain policy-creating a purposeful body of evidence. Pain. 2018;159 Suppl 1:S43-S48. doi:1097/j.pain.0000000000001311
  16. Briggs AM, Jordan JE, Kopansky-Giles D, et al. The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants. Glob Health Res Policy. 2021;6(1):24. doi:1186/s41256-021-00201-7
  17. Briggs AM, Schneider CH, Slater H, et al. Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health. BMJ Glob Health. 2021;6(6):e006045.
  18. Briggs AM, Schneider CH, Slater H, et al. Towards a Global Strategy to Improve Musculoskeletal Health. Sydney, Australia: Global Alliance for Musculoskeletal Health; 2021.
  19. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:1080/1364557032000119616
  20. Anderson S, Allen P, Peckham S, Goodwin N. Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services. Health Res Policy Syst. 2008;6:7. doi:1186/1478-4505-6-7
  21. Australian Government Department of Health. Australian National Strategic Action Plan for Pain Management. 2019. https://www.painaustralia.org.au/static/uploads/files/national-action-plan-11-06-2019-wftmzrzushlj.pdf. Accessed March 25, 2021.
  22. Australian Government Department of Health. The National Strategic Action Plan on Arthritis. 2019. https://www.health.gov.au/sites/default/files/documents/2020/08/national-strategic-action-plan-for-arthritis_0.pdf. Accessed March 25, 2021.
  23. Australian Government Department of Health. Australian National Strategic Action Plan on Osteroporosis. 2019. Accessed 25.03.2021. https://www.health.gov.au/sites/default/files/documents/2020/01/national-strategic-action-plan-for-osteoporosis-2019_1.pdf. Accessed March 25, 2021.
  24. Belgium Federal Public Agency for Public Health and Safety. Aanpak van Chronische Pijn in Belgie: Verleden, Heden en Toekomst. Belgium Federal Public Agency for Public Health and Safety; 2011.
  25. Arthritis Alliance of Canada. Joint Action on Arthritis - A Framework to Improve Arthritis Prevention and Care in Canada. 2012. http://www.arthritisalliance.ca/images/PDF/eng/Initiatives/201209171000_framework_EN_588.pdf. Accessed March 25, 2021.
  26. Institute of Musculoskeletal Health and Arthritis. Strategic Plan 2014-2018: Enhancing Musculoskeletal, Skin and Oral Health. 2014. https://cihr-irsc.gc.ca/e/documents/imha_strategic_plan_1418-en.pdf. Accessed March 25, 2021.
  27. Health Canada. Chronic Pain in Canada: Laying a Foundation for Action. 2019. https://www.canada.ca/content/dam/hc-sc/documents/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019/canadian-pain-task-force-June-2019-report-en.pdf. Accessed March 25, 2021.
  28. Government of Chile. Estrategia Nacional De Salud Para el cumplimiento de los Objetivos Sanitarios de la Década 2011-2020. 2011. https://web.minsal.cl/portal/url/item/c4034eddbc96ca6de0400101640159b8.pdf. Accessed March 25, 2021.
  29. Ministry of Labor of Columbia. Plan Nacional de Seguridad y Salud en el Trabajo 2013-2021. Bogota, Columbia: Ministry of Labor of Columbia; 2014.
  30. National Health Board of Denmark. Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter. Copenhagen, Denmark: National Health Board of Denmark; 2017.
  31. Expert Group on Management of Chronic Pain and Cancer Pain. Kroonisen kivun ja syöpäkivun hoidon kansallinen toimintasuunnitelma vuosille 2017–2020. 2017. https://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/79292/Rap_2017_4.pdf?sequence=1&isAllowed=y. Accessed March 25, 2021.
  32. Ministry of Health and Solidarity France. Plan d’amélioration de la prise en charge de la douleur, 2006-2010. 2006.
  33. Ministry of Labor France. Plan santé au travail, 2016-2020. 2016. https://travail-emploi.gouv.fr/IMG/pdf/exe_pst_2016-2020_ok_v7_web.pdf. Accessed March 25, 2021.
  34. Government of Hungary. Egészséges Magyarország 2014-2020. 2014. https://ec.europa.eu/info/sites/info/files/2017-european-semester-national-reform-programme-hungary-en.pdf. Accessed March 25, 2021.
  35. Directorate General of Health Programming of Italy. Piano Nazionale della Cronicità. 2016. https://www.promisalute.it/upload/mattone/documentiallegati/R.Botti_NationalPlanforChronicDisease-aregionalroadmap_13660_3135.pdf. Accessed March 25, 2021.
  36. Royal College of Physicians of Ireland, Health Service Executive. The Model of Care for Rheumatology in Ireland. 2015. https://www.hse.ie/eng/about/who/cspd/ncps/rheumatology/achievements/model-of-care-for-rheumatology-in-ireland.pdf. Accessed March 25, 2021.
  37. National Health Committee of New Zealand. Low Back Pain: A Pathway to Prioritisation. 2014. https://www.health.govt.nz/system/files/documents/publications/nhc-lbp-pathway-to-prioritisation.pdf. Accessed March 25, 2021.
  38. National Health Committee of New Zealand. Low Back Pain (LBP) Tier 2 Assessment. 2015. Accessed https://www.health.govt.nz/system/files/documents/publications/low-back-pain-tier2-assessment.pdf. Accessed March 25, 2021.
  39. New Zealand Ministry of Health. The Mobility Action Program. https://www.health.govt.nz/our-work/preventative-health-wellness/mobility-action-programme#:~:text=The%20Mobility%20Action%20Programme%20(MAP,people%20have%20improved%20health%20outcomes.&text=Providing%20the%20right%20support%20at,manage%20their%20musculoskeletal%20condition%20better. Accessed March 25, 2021.
  40. European Agency for Safety and Health at Work. Norway: Together for a good working environment. 2007. https://osha.europa.eu/en/about-eu-osha/national-focal-points/norway. Accessed March 25, 2021.
  41. Norwegian Ministry of Health and Care Services. Folkehelsemeldinga 2018-2019: Gode liv i eit trygt samfunn https://www.regjeringen.no/contentassets/84138eb559e94660bb84158f2e62a77d/nn-no/pdfs/stm201820190019000dddpdfs.pdf. Accessed March 25, 2021.
  42. Directorate General Health Portugal. Plano Estrategico Nacional De Prevencao E Controlo Da Dor (PENPCDor) https://docplayer.net/7584813-National-program-for-pain-management-directorate-general-for-health-portugal-www-dgs-pt.html. Accessed March 25, 2021.
  43. Korean Ministry of Health and Welfare. The 3rd National Health Promotion Plan 2011-2020. 2011. http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=0319&CONT_SEQ=257824&page=1. Accessed March 25, 2021.
  44. City of Madrid. Estrategiade Atenciónal Dolor 20172020. Madrid, Spain: City of Madrid; 2017.
  45. Swiss Confederation Federal Office of Public Health. Massnahmenplan 2021–2024 zur Nationalen Strategie Prävention nichtübertragbarer Krankheiten (NCD-Strategie) 2017– 2024. 2020. https://www.bag.admin.ch/bag/en/home/strategie-und-politik/nationale-gesundheitsstrategien/strategie-nicht-uebertragbare-krankheiten.html. Accessed March 25, 2021.
  46. Swiss Rheumatism League. Nationale Strategie Muskuloskelettale Erkrankungen (2017-2022). 2017. https://www.researchgate.net/publication/330458435_OP0220-PARE_Development_of_the_swiss_national_strategy_'musculoskeletal_diseases'_2017-2022_by_the_swiss_league_against_rheumatism. Accessed March 25, 2021.
  47. Public Health Agency of Turkey. Türkiye Kas ve İskelet Sistemi Hastalıkları Önleme ve Kontrol Program (2015-2020). 2015. https://www.euro.who.int/__data/assets/pdf_file/0005/346694/BOH_ENG.pdf. Accessed March 25, 2021.
  48. Public Health England. Developing partnerships and a whole-system approach for the prevention of musculoskeletal conditions in England. 2018. https://apps.who.int/iris/bitstream/handle/10665/324935/php-4-3-407-414-eng.pdf?sequence=1&isAllowed=y. Accessed March 25, 2021.
  49. Department of Health and Social care working with Public Health England, Pensions DfWa. Musculoskeletal health: A 5 year strategic framework for prevention across the lifecourse. 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/810348/Musculoskeletal_Health_5_year_strategy.pdf. Accessed March 25, 2021.
  50. Public Health England, NHS England. Musculoskeletal core capabilities framework for first point of contact practitioners. 2018. https://www.csp.org.uk/system/files/musculoskeletal_framework2.pdf. Accessed March 25, 2021.
  51. The Scottish Government. Future Provision of Specialist Residential Chronic Pain Management Services in Scotland. 2014. https://www.gov.scot/publications/future-provision-specialist-residential-chronic-pain-management-services-scotland-consultation-report/pages/5/. Accessed March 25, 2021.
  52. The Scottish Government. Allied Health Professional (AHP) Musculoskeletal Pathway Framework (National Minimum Standard). 2014. https://www.gov.scot/publications/allied-health-professional-ahp-musculoskeletal-pathway-framework-national-minimum-standard/. Accessed March 25, 2021.
  53. Welsh Government. Living with Persistent Pain in Wales. 2019. https://gov.wales/sites/default/files/publications/2019-05/living-with-persistent-pain-in-wales.pdf. Accessed March 25, 2021.
  54. Institute of Medicine, Committee on Advancing Pain Research Care and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011. https://www.nap.edu/catalog/13172/relieving-pain-in-america-a-blueprint-for-transforming-prevention-care. Accessed March 25, 2021.
  55. Interagency Pain Research Coordinating Committee. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. 2011. https://www.iprcc.nih.gov/sites/default/files/documents/NationalPainStrategy_508C.pdf. Accessed March 25, 2021.
  56. National Institute for Occupational Safety and Health. Musculoskeletal Health Program. 2019. https://www.cdc.gov/niosh/docs/2019-173/pdfs/2019-173.pdf?id=10.26616/NIOSHPUB2019173. Accessed March 25, 2021.
  57. Osteoarthritis Action Alliance, Centers for Disease Control and Prevention. A National Public Health Agenda for Osteoarthritis: 2020 Update. 2020. https://www.cdc.gov/arthritis/docs/oaagenda2020.pdf. Accessed March 25, 2021.
  58. US Department of Labor. Improving Pain Management and Support for Workers with Musculoskeletal Disorders : Policies to Prevent Work Disability and Job Loss. 2017. https://www.dol.gov/sites/dolgov/files/odep/topics/pdf/pap_msk-pain%20vol%201_2017-08-29.pdf. Accessed March 25, 2021.
  59. European Commission. Occupational health and safety risks in the healthcare sector-Guide to prevention and good practice. 2010. https://op.europa.eu/en/publication-detail/-/publication/b29abb0a-f41e-4cb4-b787-4538ac5f0238. Accessed March 25, 2021.
  60. European League Against Rheumatism, European Federation of National Associations of Orthopaedics and Traumatology. European action towards better musculoskeletal health. 2017. https://ec.europa.eu/health/ph_projects/2000/promotion/fp_promotion_2000_frep_15_en.pdf. Accessed March 25, 2021.
  61. Briggs AM, Jordan JE, Jennings M, et al. A Framework to Evaluate Musculoskeletal Models of Care. 2016. https://gmusc.com/wp-content/uploads/2016/12/Framework-to-Evaluate-Musculoskeletal-MoC_updated-Dec-2016.pdf. Accessed March 25, 2021.
  62. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet. 2007;370(9595):1370-1379. doi:1016/s0140-6736(07)61579-7
  63. Heller O, Somerville C, Suggs LS, et al. The process of prioritization of non-communicable diseases in the global health policy arena. Health Policy Plan. 2019;34(5):370-383. doi:1093/heapol/czz043
  64. Ferreira GE, Buchbinder R, Zadro JR, et al. Are musculoskeletal conditions neglected in national health surveys? Rheumatology (Oxford). 2021;60(10):4874-4879. doi:1093/rheumatology/keab025
  65. Cieza 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. 2021;396(10267):2006-2017. doi:1016/s0140-6736(20)32340-0
  66. Karos K, McParland JL, Bunzli S, et al. The social threats of COVID-19 for people with chronic pain. Pain. 2020;161(10):2229-2235. doi:1097/j.pain.0000000000002004
  67. Sharma S, Blyth FM, Mishra SR, Briggs AM. Health system strengthening is needed to respond to the burden of pain in low- and middle-income countries and to support healthy ageing. J Glob Health. 2019;9(2):020317. doi:7189/jogh.09.020317
  68. Briggs AM, Jordan JE, Jennings M, et al. Supporting the evaluation and implementation of musculoskeletal models of care: a globally informed framework for judging readiness and success. Arthritis Care Res (Hoboken). 2017;69(4):567-577. doi:1002/acr.22948
  69. Tamrakar M, Kharel P, Traeger A, Maher C, O'Keeffe M, Ferreira G. Completeness and quality of low back pain prevalence data in the Global Burden of Disease Study 2017. BMJ Glob Health. 2021;6(5). doi:1136/bmjgh-2021-005847
  • Receive Date: 20 December 2021
  • Revise Date: 30 August 2022
  • Accept Date: 26 November 2022
  • First Publish Date: 27 November 2022