Keynote address:
Musculoskeletal conditions as a
challenge for policy making
Professor Paul Emery
President of EULAR
Professor of Rheumatology, University of Leeds
Co-President, Fit for Work Coalition
Musculoskeletal conditions as a challenge
for policy making
(Foundation: 1947)
Scientific
associations
Health
Professionals
associations
Patients
organisations
All aspects of RMDs (rheumatic and
musculoskeletal diseases)
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
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 total
population)
Burden on Health and
Social systems
Individuals’ wellbeing
affected
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
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
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 longterm sick leave claim musculoskeletal problems as the reason
 In France, 6.5 million workdays were lost due to RMDs in 2005
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
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
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?
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
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
Musculoskeletal conditions as a challenge
for policy making
Causes
Disease
Management
Healthcare services
Prevention Treatments
Biological/Genetic
factors
Socio-Economic
factors
Life-style
factors
Consequences
on individuals
Reduced
participation in:
Labour market
120 Million
People
with RMD
Disabled
People
Education
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”
Musculoskeletal conditions as a challenge
for policy making
Causes
Disease
Management
Healthcare services
Prevention Treatments
Biological/Genetic
factors
Socio-Economic
factors
Life-style
factors
Consequences
on individuals
Reduced
participation in:
Labour market
120 Million
People
with RMD
Disabled
People
Education
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”
Musculoskeletal conditions as a challenge
for policy making
Causes
Disease
Management
Healthcare services
Prevention Treatments
Biological/Genetic
factors
Socio-Economic
factors
Life-style
factors
Consequences
on individuals
Reduced
participation in:
Labour market
120 Million
People
with RMD
Disabled
People
Education
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 selfmanagement tools and respect for the right to a flexible education and work environment”
Musculoskeletal conditions as a challenge
for policy making
Causes
Disease
Management
Healthcare services
Prevention Treatments
Biological/Genetic
factors
Socio-Economic
factors
Life-style
factors
Consequences
on individuals
Reduced
participation in:
Labour market
120 Million
People
with RMD
Disabled
People
Education
Social activities
Quality care: “People with rheumatic and musculoskeletal diseases should receive prompt
access to high quality care, ideally in specialised centres, thus maximising long-term quality of
life”
Musculoskeletal conditions as a challenge
for policy making
Causes
Disease
Management
Healthcare services
Prevention Treatments
Biological/Genetic
factors
Socio-Economic
factors
Life-style
factors
Consequences
on individuals
Reduced
participation in:
Labour market
120 Million
People
with RMD
Disabled
People
Education
Social activities
Evidence base: “Management of rheumatic and musculoskeletal diseases should be in
accordance with evidence-based recommendations in every European Union Member State”
Musculoskeletal conditions as a challenge
for policy making
Causes
Disease
Management
Healthcare services
Prevention Treatments
Biological/Genetic
factors
Socio-Economic
factors
Life-style
factors
Consequences
on individuals
Reduced
participation in:
Labour market
120 Million
People
with RMD
Disabled
People
Education
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”
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/antidiscrimination legislation, research
 National Action Plans to allow for holistic and integrated measures,
covering:
Access to treatment/care, specialised centres, 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
Musculoskeletal conditions as a challenge
for policy making
Thank you!