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Letter to the Editor
Musculoskeletal disorders as a public health concern in India: A call for action Sir, Musculoskeletal disorders (MSDs) are one of the major causes of morbidity [1] and the second most common cause of disability worldwide, measured by years lived with disability (YLDs), with low back pain being the most frequent condition. [2] MSDs represent a burden on society in both direct costs to the healthcare system and indirect costs through loss of work and productivity. [3] The global prevalence of MSDs ranges from 14% to as high as 42%; on the other hand in India, epidemiological studies indicate the community‑based prevalence of about 20%[4] and occupation‑specific prevalence found to be as high as 90% in various studies. In addition to this, the World Health Organization (WHO) also estimates that 40% of people over the age of 60 years suffer from MSD and about 80% of the people have had low back pain at some point in their life.[5]
several vertical programs since the 1980s.[9] Although within the three‑tier health system, various national health programs under National Health Mission have been implemented, focus toward MSDs are not appreciable.
Currently, more than 12% of the Worlds elderly Population lives in India. The demographic trends suggest that between the years 2000 and 2050, the Indian population in their 60s and above will increase by 326% while those in the age group of 80+ will increase by 700% – the fastest growing group.[6] Aging populations throughout the developing nation will result in increased numbers of people suffering from musculoskeletal conditions, which further results in increased costs to the nation.[7] On the other hand, there is another trend observed in India, i.e., of working population that consists of about 40% of total population. The WHO estimated that in some segments of the workforce, ergonomic hazards account for more than 50% of all MSDs.[8] If MSD estimated for this two‑target population, the burden would be much higher and will be increasing immensely in the near future. In India, where rapid demographic change with epidemiological transitions of disease resulting in a growing share of disease burden stemming from NCDs; the importance of MSD burden has been neglected as compared to other NCDs.
With a shortage of skilled human resources in the Indian health system; engaging physiotherapists in screening and prevention of MSDs as a health promoter could be one of the potential opportunity. In one of our previous editorial, it has also been prioritized the possible ways to engage physiotherapists as public health promoters.[11] It will be a great effort if physiotherapists engaged in such a novel initiative with a focus on public health.
Based on available evidence, cancer, diabetes, hypertension, cardiovascular diseases, stroke, chronic obstructive pulmonary disease, chronic kidney disease, mental disorders, and trauma are the leading causes of morbidity, disability, and mortality in India. The Government of India has been supporting the states in prevention and control of NCDs through 46
However, during the 11th plan, there was considerable upsurge to prevent and control NCDs. The National Programme for Prevention and Control of Diabetes, cardiovascular diseases, and stroke (NPDCS) was launched in 2008 with the slogan‑“A new initiative for a healthy nation.”[10] This was a laudable effort to tackle the swiftly increasing burden of NCD in the country. Although NPDCS rightly prioritizes diseases that top the list of “causes of mortality’ in the community, it has been felt that there is no such importance has been specified to MSDs and its burden at the national level.
In conclusion, a substantial public health burden is associated with musculoskeletal diseases, which, in many cases, can be prevented or treated through distinct national health programs “National Program for prevention and control of MSDs” as like other NCDs. Incorporating musculoskeletal disorders under the umbrella of NCDs may be initiated as earliest as possible to reduce the future burden. There is still a need for epidemiological studies and public health actions for promoting a healthier lifestyle.
Financial support and sponsorship Nil.
Confl icts of interest
There are no conflicts of interest. Sandul Yasobant , Satyajit Mohanty1
Center for Development Research (ZEF), University of Bonn, Bonn, Germany,
© 2018 Physiotherapy - The Journal of Indian Association of Physiotherapists | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.pjiap.org on Tuesday, June 19, 2018, IP: 80.144.86.163] Letter to the Editor Medcare Hospital and Research Centre, Bhubaneswar, Odisha, India Address for correspondence: Dr. Sandul Yasobant, Center for Development Research (ZEF), University of Bonn, 53113 Germany. E‑mail:
[email protected] 1
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Storheim K, Zwart JA. Musculoskeletal disorders and the global burden of disease study. Ann Rheum Dis 2014;73:949‑50. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990‑2010: A systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2163‑96. Côté P, van der Velde G, Cassidy JD, Carroll LJ, Hogg‑Johnson S, Holm LW, et al. The burden and determinants of neck pain in workers: Results of the bone and joint decade 2000‑2010 task force on neck pain and its associated disorders. Spine (Phila Pa 1976) 2008;33:S60‑74. Sharma R, editor. Epidemiology of Musculoskeletal Conditions in India. New Delhi, India: Indian Council of Medical Research; 2012. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003;81:646‑56. Central Statistics Office. Situation analysis of the elderly in India: Central Statistics Office Ministry of Statistics and Programme Implementation – Governement of India G. New Delhi: Central Statistics Office; 2011. Leveille SG. Musculoskeletal aging. Curr Opin Rheumatol 2004;16:114‑8. National Research Council, Institute of Medicine. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington, DC: National Academy Press; 2001. Srivastava RK, Bachani D. Burden of NCDs, policies and programme for prevention and control of NCDs in India. Indian
J Community Med 2011;36:S7‑S12. 10. National Health Portal (NHP). National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS). NHP, Gateway to Authentic Health Information. Ministry of Health and Family Welfare, Government of India. Available from: http://www.nhp.gov.in/ national‑programme‑for‑prevention‑and‑control‑of‑c_pg. [Last accessed on 2016 Feb 16]. 11. Yasobant S, Mohanty S. Would physiotherapists be public health promoters? Concern or opportunity for Indian public health system. Austin J Palliat Care 2017;2:1012.
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DOI: 10.4103/PJIAP.PJIAP_41_17
How to cite this article: Yasobant S, Mohanty S. Musculoskeletal disorders as a public health concern in India: A call for action. Physiother - J Indian Assoc Physiother 2018;12:46-7. © 2018 Physiotherapy - The Journal of Indian Association of Physiotherapists | Published by Wolters Kluwer - Medknow
Physiotherapy ‑ The Journal of Indian Association of Physiotherapists ‑ Volume 12, Issue 1, January-June 2018
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