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1093/pubmed/fdx105
Guest Editorial
A new public health, tiered approach suppress the immune system to prevent lifelong pain and
to improving musculoskeletal health disability. These rarer conditions affect 1–2% of the popula-
through physical activity provision tion, and their public health importance emerges from the
very high impact on those affected (for example, one in
© The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 429
430 GUEST EDITORIAL
well suited to understanding the impact of living with mul- The report is a landmark in this area and presents a new,
tiple long-term conditions. Poor musculoskeletal health is a tiered, public health approach towards musculoskeletal
common contributor to multi-morbidity and its impact health and to promoting and supporting physical activity
needs to be recognized in ways that go beyond documenting for people with musculoskeletal conditions (see Fig. 1). It
incidence and prevalence. Conversely, many well-established summarizes the evidence and tackles the widespread mis-
public health interventions, such as those aimed at tackling conception that little can be done about musculoskeletal
obesity and physical inactivity, affect multiple pathological conditions, and that poor musculoskeletal health is an inev-
and degenerative processes and are among the most effect- itable—or even acceptable—consequence of ageing. It
ive ways of improving musculoskeletal health especially at recognizes that while good musculoskeletal health is a
the population level.10 strong driver for generic physical activity programmes, peo-
Fig. 1 Commissioning physical activity provision for people with musculoskeletal conditions.
GUEST EDITORIAL 431
the benefits of physical activity are so widely felt, particularly Benjamin M. Ellis1, John N. Newton2
for people living with multimorbidity. Some of these wider 1
Imperial College Healthcare NHS Trust, London, and Arthritis
benefits will be characterized in a dedicated return on invest-
Research UK, Chesterfield, UK
ment model currently being developed by Public Health 2
University of Manchester and Public Health England, London,
England. This will report not only on the financial cost-
UK
effectiveness and cost-utility, but will deal with wider societal
Address for correspondence to Benjamin Ellis, Arthritis Research
costs including productivity. Some local authorities have
UK, Copeman House, St Mary’s Court, St Mary’s Gate,
now begun to include specific aspects of musculoskeletal
Chesterfield S41 7TD, UK, E-mail: b.ellis@arthritisresearchuk.org
health in their physical activity programmes, for example in
the Rotherham ‘Active for Health’ programme which has
While there are still some important research questions to 11 Low back pain and sciatica in over 16s: assessment and manage-
ment [Internet]. National Institute for Health and Care Excellence.
be addressed, and indeed this area should be a priority for
2016. Available from: https://www.nice.org.uk/guidance/ng59 (13
research funding as well, the existing evidence and scale of June 2017, date last accessed).
the problem are clearly sufficient to justify local action. One 12 Osteoarthritis: care and management [Internet]. National Institute
of the roles in which local government-based public health for Health and Care Excellence. 2014. Available from: https://
teams can excel is in making the case for interventions that www.nice.org.uk/guidance/CG177 (13 June 2017, date last
address the wider determinants of health and where benefits accessed).
accrue across sectors. This report is both a stimulus and 13 Providing physical activity interventions for people with musculo-
strong endorsement for maintaining and strengthening exist- skeletal conditions [Internet]. Arthritis Research UK, Public Health
England, NHS England, Department of Health. Arthritis Research UK.
ing generic physical activity plans, while making a compelling
2017 Available from: http://www.arthritisresearchuk.org/policy-and-
case for reviewing these to ensure the particular needs of public-affairs/reports-and-resources/reports/physical-activity-report.
people with existing musculoskeletal conditions are met. aspx (13 June 2017, date last accessed).
432 GUEST EDITORIAL
14 Bridges S. Chronic pain. Available from: http://content.digital.nhs. a pragmatic, cluster randomized, controlled trial. Arthritis Care Res
uk/catalogue/PUB09300/HSE2011-Ch9-Chronic-Pain.pdf (13 June (Hoboken) 2012;64(2):238–47.
2017, date last accessed). 16 Frith G, Copeland RJ, Roden A et al. (2017). Evaluation of Active For
15 Hurley MV, Walsh NE, Mitchell H et al. Long-term outcomes and Health [poster presentation].The International Society of Behavioural
costs of an integrated rehabilitation program for chronic knee pain: Nutrition and Physical Activity Conference, Victoria, Canada.