Address diseases that cause disability, says major global study

A series of papers published in the medical journal The Lancet has indicated the huge global burden of musculoskeletal and other non-communicable disease. The Global Burden of Disease 2010 Study, published in December, shows that four of the top six causes of years lost to disability in 2010 were in physical therapists’ key areas of expertise – low back pain,  neck pain, chronic obstructive pulmonary disease and other musculoskeletal conditions.  

While communicable diseases such as diarrhoeal disease and tetanus are decreasing as a proportion of the total global burden, deaths from non-communicable diseases (NCDs) are rising. Deaths from heart disease and diabetes rose by just under eight million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide in 2010.

The study, led by Professor Christopher Murray of the Institute for Health Metrics and Evaluation, Seattle, the WHO and other researchers, has revised the estimates of burden of all health conditions and risk factors in all regions of the world. The authors say that “the rising burden from mental, musculoskeletal conditions and diabetes will impose new challenges on health systems” and that “health systems will need to address the needs of the rising numbers of individuals with a range of conditions that largely cause disability, not mortality”.

Heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010, and ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS the leading causes of premature mortality. Physical inactivity ranked number ten in health risk factors, with a strong link to NCDs. 

Marilyn Moffat, WCPT’s President, said that the research provided further evidence of the enormous global burden of diseases related to inactivity and unhealthy lifestyles. Physical therapists not only prevent those conditions, but improve the health and independence of people affected by them. “It is becoming increasingly evident to all that, as the experts in human movement and activity, we have a major part to play.”

Catherine Sykes, WCPT’s Professional Policy Consultant, said it is noteworthy how NCDs and their risk factors predominate in the rankings of leading causes of death and disability. An online tool is available summarising the data at www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-change-leading-causes-and-risks-between-1990-and-2010

“It is useful for PTs to look at top causes of death and disability and their risk factors according to region, age band, and sex,” she says. “Together with evidence of efficacy of physical therapy interventions, the information is useful because it supports the need for physical therapy resources.”

The International Coordinating Council of the Bone and Joint Decade points out that the biggest single cause of disability in most regions is back pain. 

Professor Anthony Woolf, Chair of the council, said: “Across the world, health policy has ignored diseases which affect quality of life and independence and focused on those with high mortality such as infectious diseases, and more recently on cancer, heart disease and diabetes. Now it is time for priority to be placed on dealing with this enormous burden from arthritis, back pain and other musculoskeletal conditions to prevent unnecessary pain and disability.”  

The call is echoed by the authors of the study who say that “health systems will need to address the needs of the rising numbers of individuals with a range of conditions that largely cause disability, not mortality”.

WCPT produces a policy statement on physical therapists as exercise experts across the lifespan [www.wcpt.org/policy/ps-exercise%20experts] and an associated guideline [www.wcpt.org/guidelines/exercise-programmes]