WHO Collaboration Presents Public Health Opportunities for Chiropractic

The World Health Organization (WHO) held its 71st Assembly May 21-26, 2018, at the United Nations headquarters in Geneva. WHO is the directing and coordinating authority on international health, and uses the annual Assembly to set norms and standards for ethical and evidence-based health care policy. I had the honor of attending the Assembly this year as part of the World Federation of Chiropractic (WFC) delegation. The WFC is the only chiropractic organization with status as a non-governmental organization in official relations with WHO.1 It has been a privilege to serve as the ACA representative to the WFC Council (Northwestern Health Sciences University generously sponsored my travel).

Over four days of plenary sessions, committee meetings, and technical briefings, I observed an impressive breadth and depth of operations at WHO—and a chiropractic profession that is primed for more meaningful engagement with the broader public health community. Despite the global range of interests, resources and infrastructure represented among nation members, WHO consistently modeled behavior consistent with the central themes of our ACA brand: patient-centered, evidence-informed, collaborative health care. These shared values create opportunities for chiropractic to engage WHO in key areas of concern. Among these include global strategies on healthy ageing, diet and physical activity, and integrated, people-centered health services. However, perhaps the most obvious opportunity for chiropractic to demonstrate public health leadership is in the management of musculoskeletal disease.

WHO has sharpened its focus in recent years on noncommunicable diseases (NCDs), which are responsible for 70 percent of deaths worldwide. This includes cardiovascular disease, cancer, diabetes, and chronic lung disease.2 A key message championed by the WFC delegation and others at the Assembly was recognition of musculoskeletal conditions generally, and back pain specifically, as NCDs of significant consequence. Back pain is responsible for the most years lived with disability worldwide.3 Musculoskeletal conditions are associated with obesity, poor mental health, increased risk of developing other chronic conditions, and all-cause mortality.4 A recent brief, coauthored by two chiropractors and published in the Bulletin of the World Health Organization, clearly makes the case for working cooperatively to address the impact of musculoskeletal disorders on society.5 Strategies range from policy that include musculoskeletal health as integral components of essential care packages, to improved coordination of care for multi-morbid patients in private practice. Patient-centered, evidence-based practice is central to facilitating trust among a multidisciplinary group of providers, in addition to improving outcomes of care.

Given unyielding trends in the burden of these conditions, and recent international attention garnered by the recent series on back pain in The Lancet,6 chiropractic is poised for unprecedented opportunity. Capitalizing on this opportunity will require a coordinated effort among the profession, with unyielding focus on patient-centered, evidence-informed, collaborative solutions. The ACA brand is leading us in the right direction. It is through this lens that chiropractic will meaningfully contribute to resolving back pain as a public health concern, and realize its value proposition within the healthcare system.

Dr. Maiers is a member of the American Chiropractic Association (ACA) Board of Governors. She serves as ACA’s representative to the World Federation of Chiropractic Council. At Northwestern Health Sciences University, she is associate dean of research and knowledge transfer as well as a principal in the Center for Healthcare Innovation and Policy.


  1. World Federation of Chiropractic. World Health Organization. https://www.wfc.org/website/index.php?option=com_content&view=article&id=110&Itemid=107&lang=en (accessed June 2018).
  2. World Health Organization. NCD mortality and morbidity. http://www.who.int/gho/ncd/mortality_morbidity/en/ (accessed June 2018).
  3. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al.; GBD 2016 DALYs and HALE Collaborators. Global, regional and national disability-adjusted life years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390:1260-344. doi: http://dx.doi.org/10.1016/S0140-6736(17)32130-X.
  4. Briggs AM, Cross MJ, Hoy DG, Sanchez-Riera L, Blyth FM, Woolf AD, et al. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. Gerontologist. 2016 Apr; 56Suppl 2:S243-55. doi: http://dx.doi.org/10.1093/gertont/gnw002.
  5. Briggs AM, Woolf AD, Dreinhofer K, Homb N, Hoy DG, Kopansky-Giles, D, Akesson K, March L. Reducing the Global Burden of Musculoskeletal Conditions. Bull World Health Organ 2018;96:366-368. doi: http://dx.doi.org/10.2471/BLT.17.204891.
  6. Low Back Pain series from the Lancet journals. Published March 22, 2018. https://www.thelancet.com/series/low-back-pain (accessed June 2018).