In a speech to the ACA House of Delegates last year, I made the comment that as first-contact physician-level providers, we possess the training, skills and competencies to have an impact on population health. In fact, population health is one aspect of Triple Aim outlined in the Patient Protection and Affordable Care Act. Population health serves the overall agenda of public health. Think of public health as policy and partnerships to engage in as health actions and population health as applying those actions.
While my expertise is not in the field of public health, I am proud to be a member of the Chiropractic Health Section of the American Public Health Association (APHA). Note that many in chiropractic have earned a master’s in public health (MPH). At the recent APHA annual meeting in New Orleans, the Chiropractic Health Section honored John Hyland, DC, MPH, with its Distinguished Service Award and Dana Madigan, DC, MPH, with the Rising Star Award. Congratulations to both, and thank you for your volunteer service.
So what is the connection between public health and the practice of chiropractic? I think we all can agree that the typical chiropractic physician assesses and manages a variety of musculoskeletal conditions. I think we can also agree with the statistical evidence that musculoskeletal disease presents a burden to our society. “Musculoskeletal conditions are reported by U.S. citizens more than any other health condition. It is estimated that these conditions occur in nearly one in two persons over the age of 18, or about 48 percent of the U.S. population. These conditions are also the most common cause of severe long-term pain and physical disability around the world affecting hundreds of millions of people” (Burden of Major Musculoskeletal Conditions, Woolf & Pfleger, WHO Bulletin 2003; 81: 646-56).
According to the United States Bone and Joint Initiative (USBJI), “Musculoskeletal conditions include back pain, arthritis, traumatic injuries, osteoporosis and childhood conditions. Osteoarthritis is ranked fourth across the globe as a cause for years lived with disability. The prevalence of musculoskeletal conditions are predicted to increase greatly across the globe due to increasing life expectancies, changes in risk factors and availability of appropriate preventive measures unless actions are taken now. Musculoskeletal conditions can lead to significant disability, resulting in lost productivity and a substantial impact on quality of life. In 2006, the estimated total cost of treatment and lost wages associated with musculoskeletal diseases in the United States alone was $950 billion, equal to 7.4 percent of the gross domestic product (GDP).”
The USBJI is the national action network of the Global Bone and Joint Decade, a multi-disciplinary initiative targeting the care of people with musculoskeletal conditions — bone and joint disorders. Its focus is on improving quality of life as well as advancing the understanding and treatment of those conditions through research, prevention and education. John Ventura, DC, FACO, represents the American Chiropractic Association as a board member. ACA has been involved in the Bone and Joint Decade since its inception.
The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost (BMUS) was produced through the USBJI by experts from rheumatology, orthopedic surgery, physical medicine, rehabilitation, chiropractic and other musculoskeletal health care specialties to provide a better understanding of the extent and burden of current and future musculoskeletal diseases as the proportion of the U.S. population over the age of 65 increases. Preventive measures and new treatments are urgently needed to alleviate the pain and disability caused by musculoskeletal diseases. BMUS is now available online through the USBJI at www.boneandjointburden.org/report/i0/bigpicture
. The online version allows open access to tables and graphs that may be disseminated. Through this publication, the USBJI better accomplishes its role as a facilitator of both public and population health.
The question is not whether our profession plays a role in public/population health related to musculoskeletal diseases, but how we can generate a greater impact. How can we become more relevant and be participants in the process? Solutions call for more research on the role of conservative management of musculoskeletal diseases. Other potential solutions include defining our role in the management of chronic pain and developing preventive strategies related to spine conditions. We have much to offer society with respect to better health. Let’s become more visible in our efforts.