Scientific progress and achievements in musculoskeletal health care during the period 2000–2010 have been summarised extensively in the Bone and Joint Decade (BJD) 10-Year Report and in the present publication.

The BJD has been remandated for a further 10 years as its goals have not been fully achieved but it has brought together a strong alliance and achieved a lot within the first decade. It might therefore be of some interest to recapture how the BJD actually started for the sake of documenting the history of the initiative and in an attempt to examine how such undertakings can bring about real change.

In the 1990s, it had become painfully obvious to many of us working in the field that something had to be done. The ageing population (or ‘age-quake’ as we came to call it), the unrecognised high social cost of sick leave and early retirement, the epidemic increase in traffic injuries and lack of adequate trauma care, the inequality in access to modern treatment and not least the lack of research funding are now facts well known to most – but at the time the compound effect of these volatile elements was largely overlooked.

Thus, through a long interactive process starting in 1996 involving personal meetings with various organisational leaders in European Federation of National Associations of Orthopaedics and Traumatology (EFORT), American Academy of Orthopaedic Surgeons (AAOS), Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), Australian Community Research (ACR) and in consultation with a group of leading Swedish professors in orthopaedics, rheumatology and basic science, it was decided to set up a small workshop. The aim was to investigate the possibility of establishing a worldwide global musculoskeletal initiative. It was named Archimedes and had a subtitle The BJD, with a further subtitle “Give me a lever long enough and a place to stand and I will move the earth” . We were well aware that developing a worldwide 10-year-long campaign was of course a huge undertaking, and during the workshop some of the main challenges were identified. However, as large as these obstacles were, in the face of the growing urgency to address the global musculoskeletal health burden, it was decided to proceed.

We convened a global meeting in April 1998 in Lund, Sweden and developed a draft for a 10-year campaign, with its launch set for the year 2000. An interactive programme was planned involving the medical profession, patient organisations, academic institutions, health, policy makers and the general public. An invitation was then sent to leading researchers within the musculoskeletal area and to journals urging them to engage in the scientific programme and the policy discussion agenda. The selected areas were joint diseases, osteoporosis, back pain, spine conditions, childhood muscular conditions, trauma and road traffic injuries.

At the meeting, where all came on their own expense, an impressive 77 musculoskeletal organisations and 31 journals were represented. In addition to the scientific updates and future research perspectives, an action group was set up to coordinate the initiative forward. This action group was the embryo of the first Steering Committee.

All members present signed a declaration of intent and developed in consensus an action statement, leading us to the birth of the BJD. In January 2000, with almost 200 participants present, the BJD was officially launched in Geneva at the World Health Organization (WHO) by the Director General Gro Harlem Brundtland. The event included a WHO lecture programme and a subsequent WHO publication. Already in 1999, BJD had been approved in a personal meeting by the UN General Secretary Kofi Annan and a UN Declaration was signed. From the start, the need to organise country-specific networks was recognised to drive local action, and for them to convene at a global meeting each year in different parts of the world to exchange information and to share ideas about activity.

Looking back, there were a few key elements during the decade which have been instrumental to the successes – most importantly the creation of these national action networks bringing the doctors, academics, patients and policy makers, together for the very first time, to act on priorities in musculoskeletal health. Another potent element which helped to raise social awareness was to publish national and global data on the enormous burden of musculoskeletal diseases. The establishment and branding of musculoskeletal science including epidemiology, basic research, inflammatory conditions, matrix and bone biology and genetics into the research programmes also gave the initiative influence. This will continue to be necessary in the future to be competitive and make significant research progress. Another focus from the start was to engage a broad range of major global organisations to focus their attention on the epidemic of injury and disability caused by road traffic accidents. This particular seed planted by the BJD has led to the prevention of traffic injuries being declared by UN as a priority for the next decade. Recently, in 2011, a global programme for improving trauma care was initiated by the WHO, also based on a BJD initiative.

In the years 2008 and 2009, coming towards the end of the first decade, it was thoroughly investigated at the global annual meetings whether the participating networks would like to carry on with a BJD initiative past 2010 and into 2020. A vast majority was in favour; the time and hard work that had been invested, the local initiatives which were by then up and running and the successes that had been logged were not ready to be put down. Thus, preparing for the continuation, a new International Coordinating Council was established from 2010 and at the same time, new by-laws were adopted for a continuous renewal.

So, what have I learnt over this 10-year campaign period and what could be taken forward?

Information about the enormous consequences of musculoskeletal conditions, the impact of prevention programmes and how to improve standard of care is essential.

It turned out that it was possible to reach out to and personally meet the heads of major governmental organisations, both on a global level such as at the UN and the WHO, as well as on the national level, with individual heads of states and health ministers. Access to those in power, as we might have expected, was not our biggest challenge, but rather, what to do when faced with that opportunity. The point being that you need to be well prepared in such a meeting. Even if what you would like to promote and why it is obvious for you, it may not be to the receiver of the information, so it is absolutely crucial to know exactly what you are asking for and to have the necessary supporting data available beforehand. In a very short written statement, ask precisely for something that is understandable and achievable. Just to have an audience with some of the political or governmental leaders explaining that musculoskeletal conditions are important does not get us anywhere. We need to ask for the change we want to see, and give a plan of how to do it.

The next European Framework Programme to support Research and Innovation, called Horizon 2020, will allocate 90 billion euros to research for the period 2014–2019. Musculoskeletal, inflammatory conditions and physical disability are in the main programme for the first time.

This has only been possible by the 10-year continuous drumbeat of the Decade. Meanwhile, in the face of a long-term recession, European politicians are starting to realise that they absolutely need a healthy ageing population to meet the demands of a heavily burdened social security system and to survive financially.

The areas and goals originally selected for the Bone and Joint Decade have not changed over the 10-year period and will continue to be important. But basic messages need to be repeated. Facts need to be revisited and explained repeatedly. Musculoskeletal science in cooperation must be brought forward in a real sense by working in concrete innovative projects involving different scientific groups and patient advocates.

An important observation I have noted during this 10-year period is that medical professions to a great extent are uncomfortable explaining to decision makers in government what they are doing and what they would like to achieve. At the start of the Decade it was quite clear that almost all of the highly professional and well-educated network participants had never paid a visit to their health department to explain or inform about research progress, unmet needs or even to ask for anything. The decision makers cannot help us if we do not inform them of why our area is important, and we must do this with a united voice. The ways in which all the stakeholder groups are interacting and communicating have to be an integrated part of how the Decade moves forward.

I am honoured and grateful to have been able to join you on the lever arm.

We have together been rocking the earth during the BJD journey.

At the following link: www.rcsyd.se/boneandjointdecade/ further information could be found:

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  The Bone and Joint Decade 2000–2010 for prevention and treatment of musculoskeletal disorders. Lund, Sweden, April 17–18, 1998

  
  
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  Publications during the 10-year period

  
  
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  The Bone and Joint Decade Milestones

  
  
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  The 10-Year BJD Report

  
  
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  Photo documentation of the 10-year period with important highlights and individual contributions