Keynote address: Musculoskeletal conditions as a challenge for policy making

1. Keynote address:Musculoskeletal conditions as a challenge for policy making Professor Paul EmeryPresident of EULAR Professor of Rheumatology, University of Leeds Co-President, Fit for Work Coalition

2. Musculoskeletal conditions as a challenge for policy making (Foundation: 1947) Scientific associations Patients organisations Health Professionals associations All aspects of RMDs (rheumatic and musculoskeletal diseases)

3. Musculoskeletal conditions as a challenge for policy making • EULAR mission: • to improve the treatment, prevention and rehabilitation of musculoskeletal diseases; and thereby • to reduce the burden or rheumatic diseases on the individual and society • EULAR activity areas: Education & Research Translation into daily care Representation RMD community

4. Musculoskeletal conditions as a challenge for policy making Relevance of Rheumatic and Musculoskeletal Diseases: Productivity and economic losses 120,000,000 EU citizens affected by RMDs(~1/4 of totalpopulation) Burden on Health and Social systems Individuals’ wellbeing affected

5. Musculoskeletal conditions as a challenge for policy making Morbidity: Rheumatic and musculoskeletal diseases (RMDs) are the most prevalent group of diseases in Europe • Quality of life of ~7.5% of the European population severely and permanently reduced by pain and functional impairment caused by RMDs • Up to ⅓ of European citizens of all ages suffer from RMD at one point in their lifetime • A survey on musculoskeletal pain concluded that: • 85% of people between 20 and 72 years suffered from musculoskeletal pain during the previous year • 15% of people between 20 and 72 years suffered from musculoskeletal pain every day during the previous year

6. Musculoskeletal conditions as a challenge for policy making Costs: RMDs represent one of the highest costs to European health care and socioeconomic systems • RMDs are the second most common reason for consulting a doctor (10-20% of primary care consultations) • RMDs represent an economic burden of 240 Billion euro per year • The direct costs of RMDs in EU is estimated to be of 2% of the GDP • Workdays’ lost account for 650 Million euro loss per year

7. Musculoskeletal conditions as a challenge for policy making Disability: RMDs represent the main cause of disability and premature retirement among European workers • In Sweden, up to 60% of people on early retirement or long-term sick leave claim musculoskeletal problems as the reason • In France, 6.5 million workdays were lost due to RMDs in 2005

8. Musculoskeletal conditions as a challenge for policy making The situation now: A more favourable context for people with RMDs in Europe: • Increasing involvement of EU institutions • EU legislation protecting working and environmental risks in place, but scattered • Good examples of national governments’ commitment to fight against RMDs, but no overall strategy

9. Musculoskeletal conditions as a challenge for policy making Recent EU initiatives on Rheumatic and Musculoskeletal Diseases: • 2005: European Parliament Written Declaration 41/2005 on rheumatic diseases • 2008: European Parliament Written Declaration 08/2008 on rheumatic diseases • 2009: European Parliament Interest Group on rheumatic and musculoskeletal diseases • 2010: Funding by European Commission of European musculoskeletal surveillance network project (EUMUSC.NET) • 2010: Belgian EU Presidency Ministerial Conference on Chronic Illness & Conference on RMDs • 2010: Council Conclusions on Chronic Illness • 2010: European Disability Strategy • 2011: Conference on the Burden of RMDs under the Hungarian Presidency of the EU

10. Musculoskeletal conditions as a challenge for policy making Main EU Legislation related to work-related RMDs: • 1989: Directive 89/654/EEC: minimum safety and health requirements for the workplace • 1989: Directive 89/655/EEC: minimum safety and health requirements for the use of work equipment by workers at work • 1990: Directive 90/269/EEC: minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injury to workers • 1993: Directive 93/104/EC: organisation of working time. Factors such as repetitive work, monotonous work and fatigue • 1998: Directive 98/37/EC: ergonomic principles for machinery and devices • 2002: Directive 2002/44/EC: minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibration) • 2006: Directive 2006/42/EC: health and safety requirements relating to the design and construction of machinery • 2011/2012: Integrative Directive on RMDs at workplace?

11. Musculoskeletal conditions as a challenge for policy making Examples of national policy outcomes on RMDs and work(*): • Finland: Government support for workability and functionality support for RMDs through the Minister of Labour • France: RMDs as a national public health priority thanks to its existing RMDs national plan implemented by the Ministry of Work • Germany: Agreement for improving working conditions for disabled people • Lithuania: Multi-functional working group to solve RMD related issues • Spain: Government support and announcement of a national strategy for RMDs. Catalonian regional plan on RMDs • UK: “Fit note” instead of “Sick note” (*) Based on Fit for Work

12. Musculoskeletal conditions as a challenge for policy making What is still needed? Despite the favourable context, there is still a long way to go… • The Brussels Declaration: 6 key principles and recommendations to EU and Member States to address RMDs

13. Musculoskeletal conditions as a challenge for policy making Causes DiseaseManagement Consequenceson individuals Healthcare services Reduced participation in: Prevention Treatments Biological/Genetic factors Labour market 120 Million Peoplewith RMD DisabledPeople Socio-Economic factors Education Life-style factors Social activities Recognition: “The European Union and its Member States should recognise the socioeconomic importance of rheumatic and musculoskeletal diseases of all ages and assign them appropriate priority”

14. Musculoskeletal conditions as a challenge for policy making Causes DiseaseManagement Consequenceson individuals Healthcare services Reduced participation in: Prevention Treatments Biological/Genetic factors Labour market 120 Million Peoplewith RMD DisabledPeople Socio-Economic factors Education Life-style factors Social activities Research: “There is an urgent need to prioritise basic, and clinical research regarding the causes, predictors, management and impact of these chronic diseases”

15. Musculoskeletal conditions as a challenge for policy making Causes DiseaseManagement Consequenceson individuals Healthcare services Reduced participation in: Prevention Treatments Biological/Genetic factors Labour market 120 Million Peoplewith RMD DisabledPeople Socio-Economic factors Education Life-style factors Social activities Inclusion: “The European Union and Member States should ensure that people with disabilities related to rheumatic and musculoskeletal diseases have the right to full inclusion in society; this encompasses optimisation of environmental and life-style factors, the availability of self-management tools and respect for the right to a flexible education and work environment”

16. Musculoskeletal conditions as a challenge for policy making Causes DiseaseManagement Consequenceson individuals Healthcare services Reduced participation in: Prevention Treatments Biological/Genetic factors Labour market 120 Million Peoplewith RMD DisabledPeople Socio-Economic factors Education Life-style factors Social activities Quality care: “People with rheumatic and musculoskeletal diseases should receive prompt access to high quality care, ideally in specialisedcentres, thus maximising long-term quality of life”

17. Musculoskeletal conditions as a challenge for policy making Causes DiseaseManagement Consequenceson individuals Healthcare services Reduced participation in: Prevention Treatments Biological/Genetic factors Labour market 120 Million Peoplewith RMD DisabledPeople Socio-Economic factors Education Life-style factors Social activities Evidence base: “Management of rheumatic and musculoskeletal diseases should be in accordance with evidence-based recommendations in every European Union Member State”

18. Musculoskeletal conditions as a challenge for policy making Causes DiseaseManagement Consequenceson individuals Healthcare services Reduced participation in: Prevention Treatments Biological/Genetic factors Labour market 120 Million Peoplewith RMD DisabledPeople Socio-Economic factors Education Life-style factors Social activities Patients’ involvement: “People with rheumatic and musculoskeletal diseases are experts in living with their condition and should be involved in the design, delivery and evaluation of their services”

19. Musculoskeletal conditions as a challenge for policy making Follow up EU and Member States • A European Union Strategy to fight musculoskeletal disorders, covering: public health and employment best practices, disability/anti-discrimination legislation, research • National Action Plans to allow for holistic and integrated measures, covering: Access to treatment/care, specialisedcentres, training, work place regulation, disability aspects, research support, etc. • Partnership between governments and stakeholders at EU and national level for exchange of information and best practices

20. Musculoskeletal conditions as a challenge for policy making Thank you!