The new National Health Plan (PNS) will be published shortly, with action until 2030. Luís Cunha Miranda, from the Portuguese Institute of Rheumatology, criticizes the document he revised, pointing to the chapter on arthritis and musculoskeletal disorders. Read the opinion piece.
There is a new National Health Plan (PNS) that will be published shortly and has a time horizon until 2030, which is about 300 pages, where a guide to improving Portuguese health would reportedly be shaped and with clear strategies and goals, who took into account the impact of various diseases, both in terms of mortality but also in terms of disability and quality of life.
It is said that life expectancy in Portugal has been increasing but that our elderly in the last years of life are among those living in these years with poorer quality of life. Rheumatic and musculoskeletal diseases (RMD) are among the diseases affecting the elderly, those that contribute most to this loss of quality of life. And it was with this assumption that I reviewed PNS 2021-2030 and tried to imagine what strategies go beyond reducing mortality from some diseases, which is the strategic vision for aging and disability.
The first almost 200 pages are about indicators and a framework ranging from demographics to access to drinking water for COVID-19 (whose relevance for 2030 escapes me).
But throughout the document, we learned that DGS and its experts manage to invent concepts and terms that are not used by others in the medical world. MRD, which could just be rheumatic diseases, started to be called in Portugal and only here musculoskeletal diseases, something deeply wrong both in terms of concept and nomenclature. But we also learned as interesting data that these diseases are the ones with the most disabilities and that they increased very markedly from 2009 to 2019.
So DRM in terms of Disability Adjusted Life Years (DALYs)were the ones that increased the most from 2009 to 2019. Together with low back pain, which is also an MRD, they increased by 16.5% and corresponds to 7% of the total DALYs of all diseases, making them the diseases with the greatest disabilities .
If we link this to the analysis of the disease burden and disability Years lived with disabilities (YLDs) where DRM has increased by 33.1% from 2009 to 2019, where the different DRMs stand out in this disease burden indicator (1st place back pain, 6th osteoarthritis, 7th other diseases musculoskeletal disorders, 10th neck pain), as in their totality corresponds to 21.7% of all YLDs, where the disease after depression has an effect of 6.8% or 1/3 of the effect of DRMs.
We can say that MRDs are the diseases that have the highest growth impact on DALYs and YLDs, and that despite this they have been neglected and reduced in a national health strategy whose priorities are not in line with the effects neither on sustainability nor on the strategic vision for a health plan until 2030.
PNS has some situations that, being caricatured, do not fail to reflect that lobbies exists. Thus, in the document, we have an exaggerated emphasis on two important pathologies, but whose real impact is becoming less and less.
In the document there is this passage “Tuberculosis and HIV infection must also be taken into account because even though their incidence is declining, they are still of a relevant size.” DGS makes a political rather than a technical assumption, as the mortality rate from HIV or tuberculosis is clearly much lower and with less impact than other infectious diseases and even rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis, fractured osteoporosis or lupus. systemic erythematosus (SLE). Therefore, its scope stems from the existence of specific national programs in DGS and media visibility and not a real economic, social, mortality or other impact. In fact, there has been a reported increase in sexually transmitted diseases other than HIV, and these are not taken into account in specific strategies for their reduction. It is also not considered to eradicate hepatitis C, although it is possible.
It is clear that the reduction of mortality in several neoplasms as well as in cardiovascular events or diabetes should and are national priorities in PNS, but by disregarding several rheumatic and non-rheumatic pathologies we repeat the formulas and presses of the last century on. a population that will soon be one of the five oldest in the world, for a painful aging and without quality of life.
The DGS experts come from the coordination of sectoral programs, and these programs have an effective value of visibility, but also of access to project funding, without quotas for programs, which means that millions made available for several years have been dominated of a few. diseases ..
When evaluating PNS, it is unadjusted to the potential negative disability and the disease burden of MRDs and other diseases (eg neurological or mental health), which is not linked to mortality, has a huge impact on all strategies from resources human resources in health, accessibility, direct and indirect costs and the future sustainability of the system. Of diseases with low associated mortality, two diseases with minimal disease burden compared to Alzheimer’s, e.g. depression, SLE or rheumatoid arthritis, “selected”.
Finally, it remains to ask DGS, taking into account that there are 12 priority programs and 11 non-priority programs, which is why the adoption of the National Program for Rheumatic Diseases (PNCDR) started in 2004 as a priority, ended in 2014 and has never been resumed .. Perhaps it has been found in this decision that DRM are the diseases that have the largest increase in impact, as determined by PNS in its text.
We live in times of great technical and scientific demand, but also with issues such as the sustainability of SNS and social security, and PNS must be a document with intellectual characteristics, with a vision of the future and above all technically and scientifically sound. This one, which will be published with few or no changes, is just a health policy document with the pressure groups at work, smart instead of expertsto value certain specialties and health professionals to the detriment of others who may be more qualified.
In the case of rheumatology, it is the PNS of musculoskeletal diseases and therefore without joints that indicates their deep ankylosis and aversion to movement and stopped changes waiting for an aging without quality but full of incapacity.