Professor
Lindgren,
Colleagues,
I am pleased to see you all gathered in a wintry Geneva for this
important meeting. I am particularly pleased to welcome Professor
Anthony Woolf from the Royal Cornwall Hospital, Truro, UK and Dr
Kristina Akesson from Malmö University Hospital, Sweden, who have
helped to make the organization of this meeting possible.
During the past century, average life expectancy was raised by nearly
20 years. That is an unprecedented achievement, but this success was
very unevenly distributed. We failed to bring health and longevity to
all of the world’s population. WHO’s work is to a large extent a
ceaseless effort to rectify this failure: to fight diseases that kill
and disable the poor and to promote healthy living conditions and
encourage health systems that provide basic care to all.
Some of our work, however, is concerned with how best to safeguard
our success.
The increased life expectancy recorded in recent decades, together
with changes in lifestyle and diet, have lead to a rise in
noncommunicable diseases, also in the developing countries.
Noncommunicable diseases now cause nearly 40% of all deaths in
developing countries, where they affect younger people than in
industrialized countries. The epidemiological transition, with its
double burden of infectious and noncommunicable diseases, means that
many developing countries now struggle with a range and volume of
disease for which they are not prepared. As many as 64% of deaths due to
circulatory diseases, 60% of cancer deaths and 67% of chronic
respiratory diseases deaths now occur in developing countries, where the
resources to treat and care for these patients are woefully inadequate.
While the diseases which kill take much of the public attention,
musculoskeletal or rheumatic diseases are the major cause of morbidity
throughout the world. These diseases have a substantial influence on
health and quality of life, and they inflict an enormous cost on health
systems.
Rheumatic diseases include more than 150 different diseases and
syndromes, with the common denominators of pain and inflammation.
Rheumatic diseases are a serious disease burden.
- 40% of people over 70 suffer from osteoarthritis of the knee.
- 80% of patients with osteoarthritis have some degree of limitation of
movement, and 25% cannot perform their major daily activities of life.
- Rheumatoid arthritis within a decade after onset leads to work
disability defined as a total cessation of employment, in no less than
51% of patients and maybe as high as 59%.
- Low back pain has reached epidemic proportions being reported by
about 80% of people at some time in their life.
- An estimated 1.7 million hip fractures only occurred in 1990
throughout the world. This number is expected to exceed 6 million by
2050. Osteoporotic fractures account for most of the morbidity,
mortality and costs of the disease.
Surveys involving several developing countries, such as Brazil,
Chile, China, Pakistan, the Philippines, India, Indonesia, Malaysia,
Mexico and Thailand provided valuable information on the magnitude of
the problem. It showed that the burden of rheumatic diseases is
practically equal to that in the industrialized world.
At the 1976 World Health Assembly, Director-General Halfdan Mahler
said the following:
"Perhaps the most fundamental difficulty in regard to rheumatic
diseases is that the problem is insufficiently appreciated and
understood. Critical to this lack of appreciation is an information
deficit."
Since then, a community-oriented programme for the control of
rheumatic diseases was initiated jointly by WHO and the International
League of Associations for Rheumatology. This programme’s achievements
are considerable, but the challenges for the future are greater still.
One of WHO’s greatest strengths in international work is its
recognised role of honest broker in health matters. It is well supported
by its "convening power", the constitutional mandate to call
upon the best minds, knowledge and expertise from all over the world to
benefit health development in Member States.
In 1989 the WHO Scientific Group on Rheumatic Diseases made a
state-of-the-art review of a very wide spectrum of conditions, from
non-specific aches and pains in joints, to full-blown rheumatoid
arthritis. There was ample evidence that rheumatic diseases cause more
pain and disability than any other group of conditions in developed
countries. The same pattern of morbidity is now being seen in the
developing world.
Osteoporosis is another area of public health concern. In 1994, WHO
convened a study group to increase understanding of the factors
underlying the metabolic changes and to consider possible ways to
prevent and improve treatment of this disease.
Surveys undertaken in developed countries indicate that, by the age
of 70, more than one in four women have sustained at least one
osteoporotic fracture. The estimated life-time risk for wrist, hip and
vertebral fractures has been estimated to be in the order of 15% - in
other words very close to that of ischaemic heart disease.
The available data leave little doubt that osteoporosis is reaching
epidemic proportions, and that it will become increasingly important in
most countries due to a proportionate increase of the aged population,
as well as a notable change in risk factors.
Following the recommendations of this study group, the World Health
Organization has established a task force charged with the mission of
developing a WHO strategy for osteoporosis management and prevention.
This International Osteoporosis Education Project is expected to improve
the diagnosis and care of osteoporotic patients throughout the world
with special emphasis on developing countries.
WHO envisions a way to improve community health through increased
collaborative efforts with governmental and nongovernmental
organizations. Our aim is to increase the capacity to run effective
community control programmes. These programmes should include the whole
range of measures from professional training, patient and family
education, community and patients participation to enhancement of early
detection, and effective treatment and rehabilitation.
It is becoming increasingly clear that such programmes should also
become an integral part of health services including existing primary
health care systems. An association between chronic musculoskeletal
diseases, such as osteoarthritis, low back pain, osteoporosis and gout,
and such risk factors as obesity, physical inactivity, stress and
smoking, gives opportunities to prevent these diseases through changes
in lifestyle. We can prevent chronic musculoskeletal diseases by
including these diseases in a more comprehensive noncommunicable
diseases prevention and control programme. The potential in such an
approach is great. WHO is currently developing a global strategy to
achieve this.
The goal of the "Bone and Joint Decade" is to improve the
health related quality of life for people with musculoskeletal disorders
throughout the world.
I hope that this meeting will be able to build on the foundations of
combined efforts, and I wish you every success in your discussions. I am
confident that the outcome will be of great value not only to
rheumatologists, physicians and health care workers throughout the
world, but that it leads to action that will bring relief and hope to
the millions who suffer from musculoskeletal diseases.
Thank you. |
