Musculoskeletal disorders cost the United States approximately $850 billion per year.¹  Worldwide, musculoskeletal conditions are the most common causes of severe long-term pain and physical disability.  In addition, aging populations throughout the developed world will experience significant increases in musculoskeletal conditions, with attendant increases in costs to those countries.  Joint diseases account for half of all chronic conditions in the elderly. Forty percent of all women over the age of 50 are expected to suffer at least one osteoporotic fracture in their lifetime.  In the United States alone, musculoskeletal conditions are a leading cause of disability, accounting for more than 130 million patient visits to health care providers annually. They are the number-one reason people visit their physician, and affect nearly 50 percent of Americans over the age of 18. ¹  Musculoskeletal research is at the precipice of major breakthroughs that likely will change the way bone and joint disorders are treated and prevented throughout the world. These research efforts promise major benefits for patients who have musculoskeletal conditions.

"Public health is the approach to health care that is concerned with the health of populations, including health promotion and disease prevention services."² Given the above facts, musculoskeletal disorders certainly qualify as a public health problem.  APHA is the oldest and largest public health organization in the country. The Association currently has many different affiliated disciplines, but none of these disciplines focuses on addressing the public health crisis of musculoskeletal disorders. The time is now for the Chiropractic Health Care Section of the APHA to address these issues. 

As part of the vision for this goal we have started to put some steps in place. At the May meeting of the World Federation of Chiropractic meeting in Montreal, Rand Baird and Paul Dougherty met with Georges Benjamin, MD (executive director of APHA) and Toby King (executive Director of the U.S. Bone and Joint Decade) to discuss how the chiropractic profession may serve as a bridge between these two large multidisciplinary organizations to address the burden of musculoskeletal disease on the public's health in the United States.  The goal of this meeting was to discuss the possibility of APHA endorsing the tenets of the U.S. Bone and Joint decade. In addition they discussed the possibility of increasing awareness of musculoskeletal disease at the APHA Annual Meeting by requesting a dedicated session specifically addressing public health and musculoskeletal diseases. This dedicated session will be multidisciplinary and will facilitate discussions between different groups about musculoskeletal issues. For example, the APHA Disability Section could have a joint session with the CHC Section to discuss the role of chiropractic care in patients with disabilities and the Maternal and Child Health Section may hold a session that discusses the role of prevention in osteoporosis. 

The following are action steps generated from this meeting:

1.      Submit a resolution to APHA proposing that APHA endorse the tenants of the U.S. Bone and Joint Decade in order to:

a.      Raise awareness and educate the world on the increasing societal impact of musculoskeletal injuries and disorders.

b.      Empower patients to participate in decisions about their care and treatment.

c.      Increase global funding for prevention activities and treatment research.

d.      Continually seek and promote cost-effective prevention and treatment of musculoskeletal injuries and disorders.

2.      Submit a formal proposal to the APHA Executive Director and Member At Large committee to have a dedicated session for musculoskeletal disorders at the 2010 Annual Meeting.

While this is not a large list of action steps, this will take effort from multiple members of the CHC Section. We also want to involve the ACA in this process to encourage the ACA to make a larger emphasis on the public health burden of musculoskeletal disorders. This will be accomplished through proposing a formal presentation to the ACA Board of Directors to encourage a stronger emphasis of public health issues that chiropractors can address and then propose more formal training in these areas such as fall prevention, osteoporosis prevention and injury prevention.

“It is my hope that we will see this project be a success and that we will see the chiropractic profession rise to a greater level of participation in the public health arena,” said Paul Dougherty, incoming chair of the Chiropractic Health Care Section. “It is my vision to see the CHC become the leader in addressing the public health crisis of musculoskeletal disorders.”

References

U.S. Bone and Joint Decade

1.      United States Bone and Joint Decade: The Burden of Musculoskeletal Diseases in the United States. Rosemont, IL. American Academy of Orthopaedic Surgeons; 2008.

2.      Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, et al. Chiropractic and public health: current state and future vision. J Manipulative Physiol Ther. 2008;31:397-410.