The burden of musculoskeletal conditions has always exceeded society’s efforts to redress their impacts. Beginning with the seminal cost-of-illness studies Dorothy Rice and colleagues have conducted since the mid-1960s , we have known that musculoskeletal conditions are among the most prevalent and have among the greatest economic impact. In fact, in the most recent estimates, persons with musculoskeletal conditions incur medical care costs and wage losses equivalent to 7% of the gross domestic product (GDP) in the US; the amount in excess of what would be expected among persons of the same age is still several hundred billion dollars a year . The paradox of high impact and low attention was highlighted in the work of Lois Verbrugge who showed that fatal conditions have a greater pull on policymakers than non-fatal ones, and men have higher rates of fatal conditions such as heart disease and many forms of cancer while women have higher rates of non-fatal ones including most musculoskeletal conditions as well as neurological impairment .

This special issue of Best Practices is devoted to documenting the prevalence and economic and social impacts of musculoskeletal conditions and in showing who bears a disproportionate burden of them. Several papers also contribute to the literature on what impedes access to the services that may reduce the burden of these conditions, how best to conduct studies of the effectiveness of such services and which of these services produce the best value to individuals and society.

The authorship of the papers in this issue spans the globe, with contributions from Europe, North America and Asia–Oceania. Indeed, several papers include authors from more than one country. The geographic diversity of the authors notwithstanding, it is clear that in all developed nations the ageing of the population combined with reduced mortality have increased the number of persons in the age range with a high and perhaps growing prevalence of musculoskeletal conditions.

Beyond the universal nature of the high impact of musculoskeletal conditions, it is also clear that the disproportionate burdens experienced by the disadvantaged occur in countries devoted to an equal distribution of opportunity and outcomes as well as those in which the individual is left to his or her own devices to a greater degree; inequity in burden is surprisingly universal given the amounts devoted in some countries to reducing disparities by socioeconomic status, race/ethnicity and gender.

Treatments of all kinds – behavioural, pharmacologic and surgical – have improved the probability that persons with musculoskeletal conditions can have a decent quality of life. Nagging inequity in access to those services, some documented in this issue for the first time, suggest that while even more effective treatments are on the horizon, the main issue before us is to give to all the chance to experience the benefits of what works.