by Sue Brown, CEO ARMA
My own local ICS, like many others, has the following ambition in its current strategic plan: “To eradicate the gap in healthy life expectancy between NECN ICS and the rest of the country”. The strategy contains one mention of improving access to MSK services and two local examples of work to achieve this. It’s not enough, and here’s why.
On 1 June, the Office for Health Improvement and Disparities (OHID) published a report on understanding the drivers of healthy life expectancy. This shows just how important MSK is to that ambition to improve healthy life expectancy. I’m asking you all to help us drive home that message to every ICB.
The contribution of a condition to healthy life expectancy is a combination of the strength of association between the health condition and self-reported poor health, and the prevalence of the condition. MSK has the third-largest influence on self-reported health (behind nervous system and tumours), but when combined with prevalence, it has significantly the biggest contribution. The weighted contribution of MSK is 0.54 compared with the second biggest (heart and circulation system) which has a weighted impact of 0.26.
In this context, failure to prioritise MSK by any organisation seeking to address healthy life expectancy is insupportable.
What you can do
Sadly, we know that the priority ICBs give to MSK is variable. In the light of the OHID report, all should be reconsidering if they are giving MSK enough focus. You can help us encourage this.
All ICBs enable local people to ask questions of their Board meetings. You can ask: in the light of the OHID report showing the contribution of MSK to healthy life expectancy, what priority is the ICB giving to MSK? Better still, join our local services project online resource and share the answer you get with others in your area.
We are also organising regional meetings, open to anyone with an interest in collaborating with others to drive MSK up the agenda. We held the first of these in London, and dates for others will appear on our website soon.
Implications for public health
The OHID report concludes that preventing the onset of chronic conditions and effective clinical management for those with chronic conditions would have a notable impact on healthy life expectancy. For behavioural factors contributing to ill health, being physically inactive had the largest impact. However, when trying to improve healthy life expectancy it was important to note the complex relationship between wider determinants of health, psychosocial risk factors, health-related behaviours and physiological risk factors.
The conclusion I draw from this is that it will not be enough to improve MSK services as they are now. We also need to find ways to address those multiple determinants of health. Our MSK services need to respond to this complexity.
This year’s ARMA annual lecture generated lots of discussion and interest. It was a challenge to completely rethink how we support population health. If you’ve not seen it, I think the recording is worth a look.
I know that everyone reading this newsletter has the ability to influence MSK health in different ways. I urge you all, whether patients, clinicians, policy makers or researchers to get involved in raising these debates with your own ICB.