In 1990, President George Bush signed a proclamation designating the years 1990 to 2000 as The Decade of the Brain, a time to focus attention on the plight of those who have neurological disorders such as stroke or Alzheimer disease. Many European countries adopted the proclamation. The widespread campaign yielded four cover articles in Time magazine between 1994 and 1997. Increased support for research in the neurosciences led to the publication of approximately 5000 scientific reports during this decade. In addition, many universities established well funded neuroscience departments, including some housed in newly constructed buildings.
Stimulated by the construction of a large neuroscience center on his campus, Professor Lars Lidgren, M.D., Ph.D., Chairman of the Department of Orthopaedic Surgery at Lund University in Sweden and President of the European Orthopaedic Research Society, wondered if similar support for musculoskeletal disorders could be obtained by having the years 2000 to 2010 formally designated as The Bone and Joint Decade. With the support of a planning grant from the Swedish Medical Research Council and of Lund University, he organized a consensus meeting to consider this possibility. Cosponsored by the World Health Organization, the meeting was held in Lund in April 1998 and was attended by more than seventy delegates representing fifty professional and patient organizations as well as scientific journals related to orthopaedic surgery, rheumatology, osteoporosis, traumatology, physical medicine and rehabilitation, and physical therapy. After considering the magnitude and impact of musculoskeletal problems, the delegates agreed to launch The Bone and Joint Decade, 2000-2010.
Musculoskeletal conditions are the most common causes of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. As these conditions generally are not fatal, they have received less attention from policy-makers, the media, and the public than have heart disease, cancer, and acquired immunodeficiency syndrome (AIDS). However, musculoskeletal conditions are among the most common medical conditions that result in a substantial reduction in health and quality of life for large segments of the world's population. In terms of medical treatment and lost productivity, musculoskeletal disorders consume an extensive and growing portion of resources in many countries. Biotechnical advances, while improving the care of these problems, are also increasing the expense. Additionally, the world's population is aging, causing musculoskeletal problems to increase in importance. In ten years, more poeple in Europe and North America will be older than the age of sixty than younger than the age of twenty. In 2020, the elderly will represent 25 percent of the population in nations with developed market economies. Two observations help to underscore the extent of this phenomenon: (1) joint diseases, particularly osteoarthritis, represent half of all chronic conditions in individuals who are sixty-five years of age or older, and (2) the number of fractures related to osteoporosis has almost doubled in the last decade (it is estimated that 40 percent of all women older than fifty years of age will sustain an osteoporatic fracture).
Other musculoskeletal problems are prominent in the younger population. Despite improvements in the control of poliomyelitis and other infectious diseases, globally crippling diseases and deformities continue to deprive many children of normal development. Scoliosis and other spinal deformities make it necessary for many adolescents to wear braces and to have major operations. In many industrial and agricultural economies, back pain is the second leading cause of sick leave for workers. The worldwide expansion of fitness and sports activities has led to great interest in the prevention and treatment of related injuries.
The increased use of motor vehicles in developing countries has led to a growing epidemic of traffic-related injuries. Currently, these countries incur more costs related to the medical care and lost productivity associated with road-traffic accidents than they receive in the from of foreign aid and loans. In The Global Burden of Disease1, a report published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, it is predicted that road-traffic injuries will rise from the ninth to the third leading cause of death and disability in the next twenty years. If this trend is not reversed, an additional six million people will die and sixty million will be seriously injured or crippled in the next ten years. The International Bone and Joint Decade Steering Group, the Société Française de Chirurgie Orthopédique et Traumatologique (SICOT), and the American Academy of Orthopaedic Surgeons have made an initial agreement to collaborate with the World Bank, which has initiated a project entitled The Global Road Safety Partnership.
Since the time of the consensus meeting, 310 professional and patient organizations from many countries have signed formal endorsements of The Bone and Joint Decade. The goal of the campaign is to improve the health-related quality of life for people who have musculoskeletal disorders by (1) raising awareness of the growing burden of musculoskeletal disorders on society, (2) empowering patients to participate in decisions related to their care, (3) promoting cost-effective methods of prevention and treatment, and (4) advancing an understanding of musculoskeletal disorders through research in order to improve existing methods of prevention and treatment.
Information about The Bone and Joint Decade campaign has been spread to countries on every continent. Professional and patient groups in thirty-six countries have organized national action networks to lobby their governments and to plan collaborative activities during the decade. A meeting of professional and patient leaders of the national action networks will be held in Zurich in November 1999.
The campaign is being coordinated by The International Bone and Joint Decade Steering Group, which is composed of both professional and patient representatives. The Bone and Joint Decade Foundation, a nonprofit organization, has been established, and a development officer has been hired. The governments of Hungary, Saudi Arabia, Georgia, Iran, Taiwan, Tanzania, and Holland already have endorsed the campaign. Three United States congressmen (Steny Hoyer [D-Maryland], Sherood Brown [D-Ohio], and Frank Pallone [D-New Jersey]) have sent a letter asking President Clinton to sign a proclamation formally designating the years 2000 to 2010 as The Bone and Joint Decade, and the White House is actively considering the request. The Steering Group hopes to obtain a total of ten national endorsements by September 1999. With the support of the World Health Organization, it also hopes to obtain formal recognition for The Bone and Joint Decade, 2000-2010, from the United Nations.
At the recommendation of the Steering Group, the World Health Organization has agreed to sponsor a meeting, to be held in Geneva in January 2000, that will initiate the Musculoskeletal Health Monitor Project. The identification of musculoskeletal disorders as a global burden is a central activity of The Bone and Joint Decade campaign, and one of the primary purposes of this meeting will be the initiation of a program to review and collate existing data and to reach a consensus on the use of outcome measures for the collection of data and the comparison and monitoring of outcomes. A health-needs assessment will facilitate the development of strategies to improve the health-related quality of life for people with musculoskeletal disorders in a manner that is relevant to their particular geographic and socioeconomic settings.
The Bone and Joint Decade project will promote initiatives in all parts of the world, with particular support for activities in developing countries. Humanitarian volunteer efforts and educational programs will be conducted in poorer countries by health professionals from countries with developed market economies. It is hoped that the project will stimulate a new level of collaboration among patient, professional, and scientific organizations; research bodies; scientific journals; health-care providers; governments and non-governmental organizations; and industry.
Bruce D. Browner, M.D.
Member, International Bone and Joint
Decade Steering Group