From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development

Carmen Huckel Schneider; Sarika Parambath; James J. Young; Swatee Jain; Helen Slater; Saurab Sharma; Deborah Kopansky-Giles; Lyn March; Andrew M. Briggs

doi:10.34172/ijhpm.2022.7031

Table 1

Characteristics of Policy Documents

Document Number; Country Title (Publisher) Year Published (Years Operational) Scope or Goal of the Policy
Australia 1²² Australian National Strategic Action Plan on Arthritis (Australian Department of Health) 2019 Coordinate a national response to arthritis across state and territory governments, health service providers and funders, clinicians, consumers, researchers and research funders.
Australia 2²³ Australian National Strategic Action Plan on Osteoporosis (Australian Department of Health) 2019 Address the urgent need for a national strategic response to the increasingly complex challenges and burden of osteoporosis across Australia.
Australia 3²¹ Australian National Strategic Action Plan for Pain Management (PainAustralia/Australian Department of Health) 2019 Improve the quality of life for people living with pain and the pain burden for individuals and the community is minimised.
Belgium 1²⁴ Management of chronic pain in Belgium: past, present and future (Federal Public Agency for Public Health, Safety, Food and the Environment, Belgium) 2011 Mapping the general situation of the problem of chronic pain, description of the current Belgian situation and finally recommendations for future changes.
Canada 1²⁶ Institute of Musculoskeletal Health and Arthritis Strategic Plan 2014-2018: Enhancing Musculoskeletal, Skin and Oral Health (Canadian Institute of Health Research) 2014 (2014-2018) Outline strategic investment priorities for the period 2014-2018 of the Institute of Musculoskeletal Health and Arthritis.
Canada 2²⁵ Joint Action on Arthritis - a framework to improve arthritis prevention and care in Canada (Arthritis Alliance of Canada) 2012 Galvanize action around long-term strategies to improve arthritis prevention, and quality and efficiency of care. Facilitate and focus collaboration among governments and arthritis stakeholders in awareness, models of care and research.
Canada 3²⁷ Chronic pain in Canada: laying a foundation for action (Health Canada) 2019 Improving the lives of all of Canada's people and making this country's population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public healthcare system.
Chile 1²⁸ National Health Strategy to complete the Health Objectives of the Decade (Government of Chile) 2011 (2011-2020) To reduce the impact of chronic communicable and NCD.
Columbia 1²⁹ Plan Nacional de Seguridad y Salud en el Trabajo 2013-2021 (National Plan for Safety and Health at Work 2013-2021) (Ministry of Labor) 2014 (2013-2021) Promotion of the transversality of safety and health at work in public policies; strengthening safety and health at work; strengthening the promotion of safety and health of workers and the prevention of occupational risks, and optimisation and guarantee of the recognition of worker benefits in the general labour risk system.
Denmark 1³⁰ Recommendations for multidisciplinary management of low back pain (National Health Board of Denmark) 2017 Increase the quality of assessment, treatment and prevention and rehabilitation services as well as in follow-up of the course about people with chronic low back pain.
European Union 1⁶⁰ European action towards better musculoskeletal health (EFORT/EULAR/IOF) 2017 To prevent MSK problems and conditions where possible, and to ensure that those people with MSK conditions enjoy a life of fair quality as independently as possible.
European Union 2⁵⁹ Occupational health and safety risks in the healthcare sector-Guide to prevention and good practice (European Commission) 2010 Better, healthier and more competitive workplaces and a corporate culture where managers and workers (as experts on their workplaces) discuss work processes together in a continuous improvement process including all related risks and possible measures for improvements.
Finland 1³¹ National Action Plan for the Treatment of Chronic Pain and Cancer Pain (Ministry of Social Affairs and Health, Finland) 2017 Develop a national plan for the treatment of chronic and cancer pain to build a multidisciplinary and multidisciplinary model of care from primary care to specialist care.
France 1³² Monitoring Plan for National Pain Program (Ministry of Health and Solidarity, France) 2006 (2006-2010) To continue and strengthen the policy initiated for more than 10 years to improve pain management.
France 2³³ Occupational Health Plan 2016-2020 (Ministry of Labour, France) 2016 (2016-2020) Outline objectives and actions in relations to primary prevention and culture of prevention; and quality of life at work, job retention and performance.
Hungary 1³⁴ Health Hungary 2014-2020- Health Sector Strategy (Ministry of Human Resources, State Secretariat for Health, Government of Hungary) 2015 A whole-of-system approach to improving health outcomes for Hungarian citizens and the efficiency of the system. Health awareness among citizens to act proactively; the importance of industry and government in collaboration in order to make the country healthier and live a more health-conscious life.
International 1⁶¹ A framework to evaluate musculoskeletal models of care (Global Alliance for Musculoskeletal Health of the Bone and Joint Decade) 2016 Improving consumer health outcomes and system-relevant outcomes for NCDs, particularly MSK conditions.
Italy 1³⁵ National Plan for Chronic Disease (Directorate-General of Health Programming, Italy) 2016 Contribute to the improvement of protection for people suffering from chronic diseases, reducing the burden on the individual, family and the social context. Improving the quality of life and making health services more effective and efficient in terms of prevention, support and ensuring greater uniformity and equity of access.
Ireland 1³⁶ The model of care for rheumatology in Ireland (Royal College of Physicians of Ireland) 2015 Develop a chronic disease model of care to facilitate the right person, right place, first-time approach to patients with rheumatic and MSK disorders.
New Zealand 1³⁷ National Health Committee low back pain: a pathway to prioritisation (National Health Committee) 2014 Explore the current approach to care for patients with low back pain and identify interventions where the National Health Committee could conduct a further evaluation in order to improve health outcomes and efficiency within the New Zealand health system.
New Zealand 2³⁸ Low Back Pain (LBP) Tier 2 Assessment (National Health Committee) 2015 Analyse the current delivery of chronic low back pain services, the evidence for effective interventions and proposes the development of a complete model of care for chronic low back pain.
New Zealand 3³⁹ The Mobility Action Program (New Zealand Ministry of Health) 2015 Ensure that the right care is provided in the right place at the right time by practitioners with the right resources.
Norway 1⁴⁰ Norway: Together for a good working environment (European Agency for Safety and Health at Work) 2007-2010 Report on tripartite cooperation between the government and social partners, represented by trade unions and employers’ organisations in focusing on improving the work environment, reducing sick leave and increasing the retirement age.
Norway 2⁴¹ Public Health Report 2018-2019: Good Life in a Safe Society (Norwegian Ministry of Health and Care Services, Government of Norway) 2018 (2018-2019) To reduce the incidence of premature death and ill health due to NCDs, in line with the global goals of the WHO.
Portugal 1⁴² National Strategic Plan for Pain Prevention and Control (Directorate General Health, Portugal) 2017 Reduce the prevalence of uncontrolled pain in the Portuguese population; improve the quality of life of patients with pain; and rationalize resources and control the costs necessary for pain control.
Republic of Korea 1⁴³ The 3rd National Health Promotion Plan 2011-2020 (Korean Ministry of Health and Welfare) 2011 To create a healthy community through increasing life expectancy and achieving health equity.
Spain 1⁴⁴ Pain Care Strategy 2017-2020 (City of Madrid) 2017 (2017-2020) Provide adequate assistance to all patients with pain who are cared for in the health facilities of the Madrid Health Service.
Switzerland 1⁴⁵ National strategy for the prevention of noncommunicable diseases 2017-2024 (Swiss Confederation, Federal Department of Home Affairs, Federal Office of Public Health). 2017 (2017-2024) More people stay healthy or have a high quality of life despite chronic illness. Fewer people suffer from avoidable NCDs or die prematurely. Regardless of their socioeconomic status, people are empowered in their efforts to cultivate a healthy lifestyle in a health-promoting environment.
Switzerland 2⁴⁶ National Strategy for Musculoskeletal Disorders 2017-2022 (Rheumaliga Schweiz) 2017 (2017-2022) Guarantee the strategic orientation of activities in the areas of early detection and prevention of risk factors (secondary prevention) as well as in the care and treatment of those affected (tertiary prevention).
Turkey 1⁴⁷ Turkey Musculoskeletal Disease Prevention and Control Program 2015-2020 (Ministry of Health, Turkey) 2015 (2015-2020) Plan activities for the prevention, early diagnosis and treatment of the MSK diseases within the scope of the prevention and control program; take permanent and effective steps for their early diagnosis and treatment; reduce rehabilitation services and disability and ensure that individuals benefit from the highest attainable health standard suitable for their own needs.
United Kingdom (England) 1⁴⁸ Developing partnerships and a whole-system approach for the prevention of musculoskeletal conditions in England (Public Health England) 2018 Shared narrative and journey for a public health approach to MSK health.
United Kingdom (England) 2⁵⁰ Musculoskeletal core capabilities framework for the first point of contact practitioners (Health Education England and NHS England) 2018 Ensure a person-centred approach in the first stages of managing any MSK problem with which a person may present.
United Kingdom (England) 3⁴⁹ Musculoskeletal health: A 5-year strategic framework for prevention across the life course (Department of Health and Social care, Public Health England and Department for Work and Pensions) 2019
(2019-2023) To promote MSK health and to prevent MSK conditions.
United Kingdom (Scotland) 1⁵² Allied health professional (AHP) musculoskeletal pathway framework (National Minimum Standard) (The Scottish Government) 2014 Ensure that people requiring MSK services, receive the quality of care and the support they require, at the appropriate time by the appropriate person.
United Kingdom (Scotland) 2⁵¹ Future provision of specialist residential chronic pain management services in Scotland: consultation report (Scottish Government) 2014 Respond to the findings of the consultation as set out in the independent report ‘The Provision of Residential Chronic Pain Services in Scotland: Analysis of Consultation Responses’ and sets out the Scottish Government’s proposals for taking forward the development of these services.
United Kingdom (Wales) 1⁵³ Living with persistent pain in Wales (Welsh Government) 2019 Provide advice to those experiencing persistent pain and their families, and health and social care professionals; taking a patient-centred approach.
United States of America 1⁵⁸ Improving pain management and support for workers with musculoskeletal disorders: policies to prevent work disability and job loss (US Department of Labor/IMPAQ International) 2017 Promote an effective, evidence-based, and timely approach to managing MSK pain and disability that applies a biopsychosocial treatment model to restore workplace function and prevent or minimize work disability as early as possible.
United States of America 2⁵⁶ National Institute for Occupational Safety and Health Musculoskeletal Health Program (National Institute for Occupational Safety and Health) 2019 Reduce work-related MSK disorders such as carpal tunnel syndrome and low back pain.
United States of America 3⁵⁷ A National Public Health Agenda for Osteoarthritis: 2020 Update (Osteoarthritis Action Alliance, Centre for Disease Control and Prevention, Arthritis Foundation) 2020 Adults with osteoarthritis are able to live full lives with less pain, stiffness, and disability; greater mobility; and preserved function and independence.
United States of America 4⁵⁵ National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain (Department of Health and Human Services/Interagency Pain Research Coordinating Committee) 2011 Decrease the prevalence of pain across its continuum from acute to high-impact chronic pain and its associated morbidity and disability across the lifespan. Reduce the burden of pain for individuals, their families, and society as a whole.
United States of America 5⁵⁴ Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research (Institute of Medicine) 2011 Transform the way pain is understood, assessed, treated, and prevented. Improve the care of people who experience pain, the training of clinicians who treat them, and the collection of data on pain in the United States.

Abbreviations:
MSK, musculoskeletal;
WHO, World Health Organization;
NCD, non-communicable disease;
EULAR, European League Against Rheumatism;
EFORT, The European Federation of National Associations of Orthopaedics and Traumatology;
NHS, National Health Service;
IOF, International Osteoporosis Foundation.

Document Number; Country	Title (Publisher)	Year Published (Years Operational)	Scope or Goal of the Policy
Australia 1²²	Australian National Strategic Action Plan on Arthritis (Australian Department of Health)	2019	Coordinate a national response to arthritis across state and territory governments, health service providers and funders, clinicians, consumers, researchers and research funders.
Australia 2²³	Australian National Strategic Action Plan on Osteoporosis (Australian Department of Health)	2019	Address the urgent need for a national strategic response to the increasingly complex challenges and burden of osteoporosis across Australia.
Australia 3²¹	Australian National Strategic Action Plan for Pain Management (PainAustralia/Australian Department of Health)	2019	Improve the quality of life for people living with pain and the pain burden for individuals and the community is minimised.
Belgium 1²⁴	Management of chronic pain in Belgium: past, present and future (Federal Public Agency for Public Health, Safety, Food and the Environment, Belgium)	2011	Mapping the general situation of the problem of chronic pain, description of the current Belgian situation and finally recommendations for future changes.
Canada 1²⁶	Institute of Musculoskeletal Health and Arthritis Strategic Plan 2014-2018: Enhancing Musculoskeletal, Skin and Oral Health (Canadian Institute of Health Research)	2014 (2014-2018)	Outline strategic investment priorities for the period 2014-2018 of the Institute of Musculoskeletal Health and Arthritis.
Canada 2²⁵	Joint Action on Arthritis - a framework to improve arthritis prevention and care in Canada (Arthritis Alliance of Canada)	2012	Galvanize action around long-term strategies to improve arthritis prevention, and quality and efficiency of care. Facilitate and focus collaboration among governments and arthritis stakeholders in awareness, models of care and research.
Canada 3²⁷	Chronic pain in Canada: laying a foundation for action (Health Canada)	2019	Improving the lives of all of Canada's people and making this country's population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public healthcare system.
Chile 1²⁸	National Health Strategy to complete the Health Objectives of the Decade (Government of Chile)	2011 (2011-2020)	To reduce the impact of chronic communicable and NCD.
Columbia 1²⁹	Plan Nacional de Seguridad y Salud en el Trabajo 2013-2021 (National Plan for Safety and Health at Work 2013-2021) (Ministry of Labor)	2014 (2013-2021)	Promotion of the transversality of safety and health at work in public policies; strengthening safety and health at work; strengthening the promotion of safety and health of workers and the prevention of occupational risks, and optimisation and guarantee of the recognition of worker benefits in the general labour risk system.
Denmark 1³⁰	Recommendations for multidisciplinary management of low back pain (National Health Board of Denmark)	2017	Increase the quality of assessment, treatment and prevention and rehabilitation services as well as in follow-up of the course about people with chronic low back pain.
European Union 1⁶⁰	European action towards better musculoskeletal health (EFORT/EULAR/IOF)	2017	To prevent MSK problems and conditions where possible, and to ensure that those people with MSK conditions enjoy a life of fair quality as independently as possible.
European Union 2⁵⁹	Occupational health and safety risks in the healthcare sector-Guide to prevention and good practice (European Commission)	2010	Better, healthier and more competitive workplaces and a corporate culture where managers and workers (as experts on their workplaces) discuss work processes together in a continuous improvement process including all related risks and possible measures for improvements.
Finland 1³¹	National Action Plan for the Treatment of Chronic Pain and Cancer Pain (Ministry of Social Affairs and Health, Finland)	2017	Develop a national plan for the treatment of chronic and cancer pain to build a multidisciplinary and multidisciplinary model of care from primary care to specialist care.
France 1³²	Monitoring Plan for National Pain Program (Ministry of Health and Solidarity, France)	2006 (2006-2010)	To continue and strengthen the policy initiated for more than 10 years to improve pain management.
France 2³³	Occupational Health Plan 2016-2020 (Ministry of Labour, France)	2016 (2016-2020)	Outline objectives and actions in relations to primary prevention and culture of prevention; and quality of life at work, job retention and performance.
Hungary 1³⁴	Health Hungary 2014-2020- Health Sector Strategy (Ministry of Human Resources, State Secretariat for Health, Government of Hungary)	2015	A whole-of-system approach to improving health outcomes for Hungarian citizens and the efficiency of the system. Health awareness among citizens to act proactively; the importance of industry and government in collaboration in order to make the country healthier and live a more health-conscious life.
International 1⁶¹	A framework to evaluate musculoskeletal models of care (Global Alliance for Musculoskeletal Health of the Bone and Joint Decade)	2016	Improving consumer health outcomes and system-relevant outcomes for NCDs, particularly MSK conditions.
Italy 1³⁵	National Plan for Chronic Disease (Directorate-General of Health Programming, Italy)	2016	Contribute to the improvement of protection for people suffering from chronic diseases, reducing the burden on the individual, family and the social context. Improving the quality of life and making health services more effective and efficient in terms of prevention, support and ensuring greater uniformity and equity of access.
Ireland 1³⁶	The model of care for rheumatology in Ireland (Royal College of Physicians of Ireland)	2015	Develop a chronic disease model of care to facilitate the right person, right place, first-time approach to patients with rheumatic and MSK disorders.
New Zealand 1³⁷	National Health Committee low back pain: a pathway to prioritisation (National Health Committee)	2014	Explore the current approach to care for patients with low back pain and identify interventions where the National Health Committee could conduct a further evaluation in order to improve health outcomes and efficiency within the New Zealand health system.
New Zealand 2³⁸	Low Back Pain (LBP) Tier 2 Assessment (National Health Committee)	2015	Analyse the current delivery of chronic low back pain services, the evidence for effective interventions and proposes the development of a complete model of care for chronic low back pain.
New Zealand 3³⁹	The Mobility Action Program (New Zealand Ministry of Health)	2015	Ensure that the right care is provided in the right place at the right time by practitioners with the right resources.
Norway 1⁴⁰	Norway: Together for a good working environment (European Agency for Safety and Health at Work)	2007-2010	Report on tripartite cooperation between the government and social partners, represented by trade unions and employers’ organisations in focusing on improving the work environment, reducing sick leave and increasing the retirement age.
Norway 2⁴¹	Public Health Report 2018-2019: Good Life in a Safe Society (Norwegian Ministry of Health and Care Services, Government of Norway)	2018 (2018-2019)	To reduce the incidence of premature death and ill health due to NCDs, in line with the global goals of the WHO.
Portugal 1⁴²	National Strategic Plan for Pain Prevention and Control (Directorate General Health, Portugal)	2017	Reduce the prevalence of uncontrolled pain in the Portuguese population; improve the quality of life of patients with pain; and rationalize resources and control the costs necessary for pain control.
Republic of Korea 1⁴³	The 3rd National Health Promotion Plan 2011-2020 (Korean Ministry of Health and Welfare)	2011	To create a healthy community through increasing life expectancy and achieving health equity.
Spain 1⁴⁴	Pain Care Strategy 2017-2020 (City of Madrid)	2017 (2017-2020)	Provide adequate assistance to all patients with pain who are cared for in the health facilities of the Madrid Health Service.
Switzerland 1⁴⁵	National strategy for the prevention of noncommunicable diseases 2017-2024 (Swiss Confederation, Federal Department of Home Affairs, Federal Office of Public Health).	2017 (2017-2024)	More people stay healthy or have a high quality of life despite chronic illness. Fewer people suffer from avoidable NCDs or die prematurely. Regardless of their socioeconomic status, people are empowered in their efforts to cultivate a healthy lifestyle in a health-promoting environment.
Switzerland 2⁴⁶	National Strategy for Musculoskeletal Disorders 2017-2022 (Rheumaliga Schweiz)	2017 (2017-2022)	Guarantee the strategic orientation of activities in the areas of early detection and prevention of risk factors (secondary prevention) as well as in the care and treatment of those affected (tertiary prevention).
Turkey 1⁴⁷	Turkey Musculoskeletal Disease Prevention and Control Program 2015-2020 (Ministry of Health, Turkey)	2015 (2015-2020)	Plan activities for the prevention, early diagnosis and treatment of the MSK diseases within the scope of the prevention and control program; take permanent and effective steps for their early diagnosis and treatment; reduce rehabilitation services and disability and ensure that individuals benefit from the highest attainable health standard suitable for their own needs.
United Kingdom (England) 1⁴⁸	Developing partnerships and a whole-system approach for the prevention of musculoskeletal conditions in England (Public Health England)	2018	Shared narrative and journey for a public health approach to MSK health.
United Kingdom (England) 2⁵⁰	Musculoskeletal core capabilities framework for the first point of contact practitioners (Health Education England and NHS England)	2018	Ensure a person-centred approach in the first stages of managing any MSK problem with which a person may present.
United Kingdom (England) 3⁴⁹	Musculoskeletal health: A 5-year strategic framework for prevention across the life course (Department of Health and Social care, Public Health England and Department for Work and Pensions)	2019 (2019-2023)	To promote MSK health and to prevent MSK conditions.
United Kingdom (Scotland) 1⁵²	Allied health professional (AHP) musculoskeletal pathway framework (National Minimum Standard) (The Scottish Government)	2014	Ensure that people requiring MSK services, receive the quality of care and the support they require, at the appropriate time by the appropriate person.
United Kingdom (Scotland) 2⁵¹	Future provision of specialist residential chronic pain management services in Scotland: consultation report (Scottish Government)	2014	Respond to the findings of the consultation as set out in the independent report ‘The Provision of Residential Chronic Pain Services in Scotland: Analysis of Consultation Responses’ and sets out the Scottish Government’s proposals for taking forward the development of these services.
United Kingdom (Wales) 1⁵³	Living with persistent pain in Wales (Welsh Government)	2019	Provide advice to those experiencing persistent pain and their families, and health and social care professionals; taking a patient-centred approach.
United States of America 1⁵⁸	Improving pain management and support for workers with musculoskeletal disorders: policies to prevent work disability and job loss (US Department of Labor/IMPAQ International)	2017	Promote an effective, evidence-based, and timely approach to managing MSK pain and disability that applies a biopsychosocial treatment model to restore workplace function and prevent or minimize work disability as early as possible.
United States of America 2⁵⁶	National Institute for Occupational Safety and Health Musculoskeletal Health Program (National Institute for Occupational Safety and Health)	2019	Reduce work-related MSK disorders such as carpal tunnel syndrome and low back pain.
United States of America 3⁵⁷	A National Public Health Agenda for Osteoarthritis: 2020 Update (Osteoarthritis Action Alliance, Centre for Disease Control and Prevention, Arthritis Foundation)	2020	Adults with osteoarthritis are able to live full lives with less pain, stiffness, and disability; greater mobility; and preserved function and independence.
United States of America 4⁵⁵	National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain (Department of Health and Human Services/Interagency Pain Research Coordinating Committee)	2011	Decrease the prevalence of pain across its continuum from acute to high-impact chronic pain and its associated morbidity and disability across the lifespan. Reduce the burden of pain for individuals, their families, and society as a whole.
United States of America 5⁵⁴	Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research (Institute of Medicine)	2011	Transform the way pain is understood, assessed, treated, and prevented. Improve the care of people who experience pain, the training of clinicians who treat them, and the collection of data on pain in the United States.