Guest blog by Dr Arash Angadji, Chief Executive, Orthopaedic Research UK
The nation has a musculoskeletal (MSK) problem. As a society we have tended to focus on MSK issues relating to the ageing population, but the latest figures on the number of people not working in the UK due to long-term sickness (including poor MSK health) highlight how we need to start thinking of poor MSK health as a multi-generational challenge. According to the Office for National Statistics (ONS), more than two and a half million people are currently unemployed due to health-related issues, including back and neck pain. The government has responded with a Call for Evidence, designed to capture a wide range of perspectives on the prevention, early diagnosis, treatment, and management of a range of serious health conditions including MSK disorders. Getting people back to work is central to its plans for economic growth.
Changing working patterns during and following the pandemic appear to have exacerbated the situation with an increase in people reporting MSK problems, often due to ergonomically unfit workstations in their homes and/or physical inactivity. This has alarmed many employers who have realised that their duty of care to employees extends beyond the traditional work environment.
A further challenge for government is presented by its desire to increase the retirement age to 67. Keeping people fit enough to thrive in the workplace until their late 60s, especially those involved in physical tasks, will demand a serious focus on their MSK health whilst addressing the other chronic health conditions and social factors that impact life expectancy, especially in social disadvantaged areas. We can no longer accept the weakening or deterioration in our physical capabilities as an inevitable consequence of ageing. Equally, we cannot expect people involved in physically demanding roles, to continue working without addressing their evolving MSK needs.
There are some good examples of organisations responding to these challenges. The Royal United Hospitals Bath NHS Foundation Trust is running drop-in wellbeing sessions for domestic services staff and porters and can refer individuals for physiotherapy if needed. The Royal National Orthopaedic Hospital NHS Trust advises staff about good ergonomics if working from home. Business in the Community in association with Public Health England has produced a toolkit for employers to advise on MSK in the workplace. Anglian Water run a ‘Fit for the Future’ programme for their staff which has led to a reduction in days lost to ill health and improved productivity. However, these isolated examples of good practice are insufficient if we truly want to meet the nation’s MSK challenges. We also cannot rely on an already over-stretched NHS.
One positive outcome of the focus on poor workforce health has been a shift in the narrative surrounding MSK health from ‘cost’ – often characterised as dealing with the ‘burden’ of poor MSK health posed by an ageing population – to ‘productivity’. There is a clear return on investment for government, employers and society, in terms of national productivity and prosperity, from improving the overall MSK health of the nation. This will hopefully strengthen the case for increased government investment in MSK prevention, diagnosis and treatment which has been historically underfunded. We saw signs of this in the most recent Budget when the Chancellor announced a £400m package of government support for those forced to leave work because of MSK issues, which including funding for digital resources and the creation of community MSK hubs. This is a good start, but tackling a problem of this scale, especially given the focus on prevention, will require imaginative thinking and investment from employers, engineers, data scientists, designers, the fitness industry and others – a collective response to a shared challenge.
We need to create a healthcare system focused on preventing illness as much as treating it. We need designers to create ergonomically sound workplaces for factories, offices and the home. We need technologists to design smart tools and digital solutions to promote good MSK health. We need employers to see the value in investing in MSK health programmes for employees, and the fitness industry to create easily accessible MSK strengthening and rehabilitation programmes for an adult audience that according to Sport England figures is 20% less active than in the 1960s.[1] The same study shows that 27% of all adults (rising to 48% of the least affluent adults) are classified as ‘inactive’. The seriousness of this situation is underlined by WHO data showing that physical inactivity accounts for 10,000 unnecessary deaths in the UK every year, more than for harmful alcohol consumption.[2]
With MSK health no longer seen simply as an ‘old person’s’ problem but as a multi-generational issue, the focus on getting people back into the workplace, or staying longer in the workplace, represents an important opportunity for all of us involved in MSK health. One of the taglines we use in our charity is ‘Pain free movement for all’ – it is an aspiration that has never felt more relevant.
[1] Sport England Active Lives Survey (20-21)
[2] Global mortality from modifiable health behaviors (WHO, 2021)