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• The COVID-19 pandemic as a watershed moment: the importance of improved monitoring of population health needs
  Grant MA Wyper, Diane L Stockton, Brecht Devleesschauwer and Robby De Pauw
  Published on: 14 June 2021

• Published on: 14 June 2021

  The COVID-19 pandemic as a watershed moment: the importance of improved monitoring of population health needs

  • Grant MA Wyper, Public Health Intelligence Adviser Public Health Scotland, Glasgow, UK
  • Other Contributors:
    • Diane L Stockton, Consultant in Public Health
    • Brecht Devleesschauwer, Epidemiologist
    • Robby De Pauw, Epidemiologist

  Tamrakar and colleagues have undertaken a welcome, and coherent, evaluation of the completeness and representativeness of prevalence inputs for low back pain used in the Global Burden of Disease (GBD) 2017 study [1]. These types of assessments are particularly important so that users are aware of the uncertainties at each stage of the process for estimating disability-adjusted life years – and even more so for low back pain, which is consistently found to be one of the leading causes of health losses worldwide. They can assist users in appraising modelled estimates in a way that can more readily be triangulated with country-level evidence.

  Issues of uncertainty and generalizability of modelled estimates mainly arise due to a paucity of data. From the perspective of burden of disease assessment this is common across many health conditions which are data sparse, and thus have to rely on modelled estimates on the occurrence and distribution of severity of cases [2]. In the case of low back pain this mainly arises because a large proportion of people do not routinely access care services to manage their symptoms, which is also common for other musculoskeletal disorders and headaches. In both the GBD and national burden of disease assessments, the reliance of secondary use of administrative data (e.g. hospital, prescriptions or GP consultation records) is not an ideal proxy.

  The public health monitoring of individual health conditions has reached a watershed mome...

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  Tamrakar and colleagues have undertaken a welcome, and coherent, evaluation of the completeness and representativeness of prevalence inputs for low back pain used in the Global Burden of Disease (GBD) 2017 study [1]. These types of assessments are particularly important so that users are aware of the uncertainties at each stage of the process for estimating disability-adjusted life years – and even more so for low back pain, which is consistently found to be one of the leading causes of health losses worldwide. They can assist users in appraising modelled estimates in a way that can more readily be triangulated with country-level evidence.

  Issues of uncertainty and generalizability of modelled estimates mainly arise due to a paucity of data. From the perspective of burden of disease assessment this is common across many health conditions which are data sparse, and thus have to rely on modelled estimates on the occurrence and distribution of severity of cases [2]. In the case of low back pain this mainly arises because a large proportion of people do not routinely access care services to manage their symptoms, which is also common for other musculoskeletal disorders and headaches. In both the GBD and national burden of disease assessments, the reliance of secondary use of administrative data (e.g. hospital, prescriptions or GP consultation records) is not an ideal proxy.

  The public health monitoring of individual health conditions has reached a watershed moment with the COVID-19 pandemic. The wider harms of the pandemic have meant there have been delays, cancellations and restrictions to accessing health, and other care, services. It is expected, and has been since reported, that this will lead to increases in both the severity and occurrence of disease [3,4]. From the perspective of low back pain and other musculoskeletal disorders, there is a potential for increased, and exacerbated, short- and long-term harm in relation to occurrence and severity. The main influencing factors are related to the mass move to individuals working from home in environments that may not allow them to work ergonomically, and changes to level of physical activity, both of which are likely to have differential exposure depending on socioeconomic status.

  A harmonized and generalizable approach for monitoring both the prevalence and severity of low back pain and other common, and debilitating, health conditions that are not suitably captured by routine administrative records are required to ensure we can monitor, and respond to, changing population health needs.

  References:
  [1] Tamrakar M, Kharel P, Traeger A, et al. Completeness and quality of low back pain prevalence data in the Global Burden of Disease Study 2017. BMJ Global Health. 2021;6:e005847.

  [2] Wyper GMA, Assuncao R, Fletcher E, et al. The increasing significance of disease severity in in a burden of disease framework. Scandinavian Journal of Public Health 2021;in press.

  [3] Douglas M, Katikireddi SV, Taulbut M, et al. Mitigating the wider health effects of covid-19 pandemic response. BMJ 2020;369:m1557.

  [4] Niedzwiedz CL, Green MJ, Benzeval M, et al. Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study. Journal of Epidemiology and Community Health 2021;75:224-231.

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  Conflict of Interest:
  None declared.

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