1. Keynote address: Musculoskeletal conditions as a challenge for policy making Professor Paul Emery President of EULAR Professor of Rheumatology, University of Leeds Co-President, Fit for Work Coalition

2. Patients organisations Scientific associations Health Professionals associations (Foundation: 1947) Musculoskeletal conditions as a challenge for policy making All aspects of RMDs (rheumatic and musculoskeletal diseases)

3. EULAR mission:  to improve the treatment, prevention and rehabilitation of musculoskeletal diseases; and thereby  to reduce the burden or rheumatic diseases on the individual and society EULAR activity areas : Representation RMD community Translation into daily care Education & Research Musculoskeletal conditions as a challenge for policy making

4. Relevance of Rheumatic and Musculoskeletal Diseases : 120,000,000 EU citizens affected by RMDs (~1/4 of total population) 120,000,000 EU citizens affected by RMDs (~1/4 of total population) Individuals’ wellbeing affected Productivity and economic losses Burden on Health and Social systems Musculoskeletal conditions as a challenge for policy making

5. Morbidity: Rheumatic and musculoskeletal diseases (RMDs) are the most prevalent group of diseases in Europe  Quality of life of ~7.5% of the European population severely and permanently reduced by pain and functional impairment caused by RMDs  Up to ⅓ of European citizens of all ages suffer from RMD at one point in their lifetime  A survey on musculoskeletal pain concluded that: 85% of people between 20 and 72 years suffered from musculoskeletal pain during the previous year 15% of people between 20 and 72 years suffered from musculoskeletal pain every day during the previous year Musculoskeletal conditions as a challenge for policy making

6. Costs: RMDs represent one of the highest costs to European health care and socioeconomic systems  RMDs are the second most common reason for consulting a doctor (10-20% of primary care consultations)  RMDs represent an economic burden of 240 Billion euro per year  The direct costs of RMDs in EU is estimated to be of 2% of the GDP  Workdays’ lost account for 650 Million euro loss per year Musculoskeletal conditions as a challenge for policy making

7. Disability: RMDs represent the main cause of disability and premature retirement among European workers  In Sweden, up to 60% of people on early retirement or long- term sick leave claim musculoskeletal problems as the reason  In France, 6.5 million workdays were lost due to RMDs in 2005 Musculoskeletal conditions as a challenge for policy making

8. The situation now: A more favourable context for people with RMDs in Europe:  Increasing involvement of EU institutions  EU legislation protecting working and environmental risks in place, but scattered  Good examples of national governments’ commitment to fight against RMDs, but no overall strategy Musculoskeletal conditions as a challenge for policy making

9. Recent EU initiatives on Rheumatic and Musculoskeletal Diseases :  2005: European Parliament Written Declaration 41/2005 on rheumatic diseases  2008: European Parliament Written Declaration 08/2008 on rheumatic diseases  2009: European Parliament Interest Group on rheumatic and musculoskeletal diseases  2010: Funding by European Commission of European musculoskeletal surveillance network project (EUMUSC.NET)  2010: Belgian EU Presidency Ministerial Conference on Chronic Illness & Conference on RMDs  2010: Council Conclusions on Chronic Illness  2010: European Disability Strategy  2011: Conference on the Burden of RMDs under the Hungarian Presidency of the EU Musculoskeletal conditions as a challenge for policy making

10. Main EU Legislation related to work-related RMDs :  1989: Directive 89/654/EEC: minimum safety and health requirements for the workplace  1989: Directive 89/655/EEC: minimum safety and health requirements for the use of work equipment by workers at work  1990: Directive 90/269/EEC: minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injury to workers  1993: Directive 93/104/EC: organisation of working time. Factors such as repetitive work, monotonous work and fatigue  1998: Directive 98/37/EC: ergonomic principles for machinery and devices  2002: Directive 2002/44/EC: minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (vibration)  2006: Directive 2006/42/EC: health and safety requirements relating to the design and construction of machinery  2011/2012: Integrative Directive on RMDs at workplace? Musculoskeletal conditions as a challenge for policy making

11. Examples of national policy outcomes on RMDs and work (*) :  Finland: Government support for workability and functionality support for RMDs through the Minister of Labour  France: RMDs as a national public health priority thanks to its existing RMDs national plan implemented by the Ministry of Work  Germany: Agreement for improving working conditions for disabled people  Lithuania: Multi-functional working group to solve RMD related issues  Spain: Government support and announcement of a national strategy for RMDs. Catalonian regional plan on RMDs  UK: “Fit note” instead of “Sick note” (*) Based on Fit for Work Musculoskeletal conditions as a challenge for policy making

12. What is still needed? Despite the favourable context, there is still a long way to go…  The Brussels Declaration: 6 key principles and recommendations to EU and Member States to address RMDs Musculoskeletal conditions as a challenge for policy making

13. 120 Million People with RMD 120 Million People with RMD Disabled People CausesDisease Management Consequences on individuals Biological/Genetic factors Socio-Economic factors Life-style factors Healthcare services Treatments Labour market Social activities Education Reduced participation in: Recognition: “The European Union and its Member States should recognise the socioeconomic importance of rheumatic and musculoskeletal diseases of all ages and assign them appropriate priority” Prevention Musculoskeletal conditions as a challenge for policy making

14. 120 Million People with RMD 120 Million People with RMD Disabled People CausesDisease Management Consequences on individuals Biological/Genetic factors Socio-Economic factors Life-style factors Healthcare services Treatments Labour market Social activities Education Reduced participation in: Prevention Research: “There is an urgent need to prioritise basic, and clinical research regarding the causes, predictors, management and impact of these chronic diseases” Musculoskeletal conditions as a challenge for policy making

15. 120 Million People with RMD 120 Million People with RMD Disabled People CausesDisease Management Consequences on individuals Biological/Genetic factors Socio-Economic factors Life-style factors Healthcare services Treatments Labour market Social activities Education Reduced participation in: Prevention Inclusion: “The European Union and Member States should ensure that people with disabilities related to rheumatic and musculoskeletal diseases have the right to full inclusion in society; this encompasses optimisation of environmental and life-style factors, the availability of self- management tools and respect for the right to a flexible education and work environment” Musculoskeletal conditions as a challenge for policy making

16. 120 Million People with RMD 120 Million People with RMD Disabled People CausesDisease Management Consequences on individuals Biological/Genetic factors Socio-Economic factors Life-style factors Healthcare services Treatments Labour market Social activities Education Reduced participation in: Prevention Quality care: “People with rheumatic and musculoskeletal diseases should receive prompt access to high quality care, ideally in specialised centres, thus maximising long-term quality of life” Musculoskeletal conditions as a challenge for policy making

17. 120 Million People with RMD 120 Million People with RMD Disabled People CausesDisease Management Consequences on individuals Biological/Genetic factors Socio-Economic factors Life-style factors Healthcare services Treatments Labour market Social activities Education Reduced participation in: Prevention Evidence base: “Management of rheumatic and musculoskeletal diseases should be in accordance with evidence-based recommendations in every European Union Member State” Musculoskeletal conditions as a challenge for policy making

18. 120 Million People with RMD 120 Million People with RMD Disabled People CausesDisease Management Consequences on individuals Biological/Genetic factors Socio-Economic factors Life-style factors Healthcare services Treatments Labour market Social activities Education Reduced participation in: Prevention Patients’ involvement: “People with rheumatic and musculoskeletal diseases are experts in living with their condition and should be involved in the design, delivery and evaluation of their services” Musculoskeletal conditions as a challenge for policy making

19. Follow up EU and Member States  A European Union Strategy to fight musculoskeletal disorders, covering: public health and employment best practices, disability/anti- discrimination legislation, research  National Action Plans to allow for holistic and integrated measures, covering: Access to treatment/care, specialised centres, training, work place regulation, disability aspects, research support, etc.  Partnership between governments and stakeholders at EU and national level for exchange of information and best practices Musculoskeletal conditions as a challenge for policy making

20. Thank you! Musculoskeletal conditions as a challenge for policy making