The World Health Organization (WHO) launched an initiative in 2017 to promote universal access to rehabilitation when it hosted “Rehabilitation 2030: A Call for Action”1 (Figure 1). Attended by more than 200 rehabilitation experts from 46 countries, this meeting highlighted the unmet need for rehabilitation services and called for coordinated action and joint commitments by all stakeholders to raise the profile of rehabilitation. WHO and its partners committed to improving rehabilitation management and investment, building a high-quality rehabilitation workforce and services, and enhancing data collection.
The World Health Organization convened a Second Global Rehabilitation 2030 Meeting in July 2019 that brought together stakeholders, including Member States, international and professional organizations, non-government organizations, rehabilitation service users, and rehabilitation experts – including journal editors. The first two days included presentations on the current state of affairs of rehabilitation services in various countries and efforts made by several Member States to integrate rehabilitation into their health care systems. Further, participants discussed strategies to make rehabilitation a political priority.
Over the next two days, WHO's staff, together with the Alliance for Health Policy and Systems Research, initiated a planning process for a health policy and research agenda related to rehabilitation. The objectives of this companion meeting were to (1) agree on a health policy and systems research framework for rehabilitation, (2) identify initial research questions, and (3) delineate enablers and barriers to building health systems and policy research capacity in rehabilitation.
Alarcos Cieza, PhD, WHO's Coordinator for Blindness and Deafness Prevention, and Disability and Rehabilitation, wrote in Rehabilitation the Health Strategy of the 21st Century, Really?2 that rehabilitation stakeholders must adopt a unified message that emphasizes the importance of functioning in order for it to become a political priority worldwide. She argues that coordinated advocacy by rehabilitation professional groups, subspecialties, and users is required to achieve this goal.
Her message highlights the critical work undertaken by the WHO to enhance access to rehabilitation, particularly in low- and middle income countries. Accessible and affordable rehabilitation services are critical for people with chronic health conditions to maintain or increase their independence, participate in their communities, improve their economic productivity, and enhance their quality of life.
The aging population not only represents a major challenge to high-income nations but to low and middle-income nations as well. The co-morbid increase in the prevalence of chronic conditions and the aging of the world's population contribute to an increasing number of people who experience declines in functioning. It is now recognized that optimizing functioning at all ages is a major global public health goal. Recent estimates of the global impact of rehabilitation on persons with health conditions is estimated to be much higher than the 1 billion people in the World Report on Disability published in 2011.3 Rehabilitation is unique in its contribution to this public health agenda because of its focuses on optimizing function. In fact, Jesus and colleagues4 reported that needs for physical medicine and rehabilitation services have been increasing significantly in per capita terms as is the percentage of total years lived with disability globally and across countries of varying income levels. These authors also highlighted that this growth was greater in lower income countries where rehabilitation is under-resourced, emphasizing the pressing needs in these countries.
It is now essential to include data on functioning in health information systems in addition to the typical morbidity and mortality outcomes. These data can help us make better-informed decisions for increased demand of rehabilitation services to enhance function as well as assist in the planning of health care systems for future expansion into these types of services.
It is evident to us that rehabilitation must be integrated fully into a nation's health system and be strengthened specifically at the primary care level in order to increase access and achieve its full potential. As the WHO highlighted, we agree that health systems must be strengthened to assure that everyone who needs rehabilitation receives it. Equity should be a fundamental goal regardless of one's social, economic, demographic or geographic situation. WHO Member States must also find solutions to the paucity of trained rehabilitation professionals and mechanisms to pay for the implementation of such services.
As editors-in-chief of rehabilitation journals, we unanimously accepted the invitation to participate in WHO's Rehabilitation 2030 meetings and we embrace the concept of function as WHO's third health indicator5 along with mortality and morbidity. We recognize the increasing importance of health policy planning in improving access to rehabilitation services. In addition, we recognize that health policy requires a foundation of evidence on which health policy planning can build cost-effective systems and services. The emphasis of our journals vary widely and it is our diversity that supports the accumulating evidence base on which health policy planners, rehabilitation providers, users of rehabilitation services, and other stakeholders depend. We encourage authors to consider the global health policy implications of their research when they prepare their research reports for publication and to make these implications explicit. Together, we can fulfill a responsibility to enhance population health including enhanced function.
Allen W. Heinemann, PhD, ABRP, FACRM
Archives of Physical Medicine and Rehabilitation
Michael Feuerstein, PhD, MPH, ABPP
Journal of Occupational Rehabilitation
Walter R. Frontera, MD, PhD, FRCP
American Journal of Physical Medicine and Rehabilitation
Steven A. Gard, PhD
Journal of Prosthetics and Orthotics
Leonard A. Kaminsky, PhD, FAACVPR, FAHA, FACSM
Journal of Cardiopulmonary Rehabilitation and Prevention
Stefano Negrini, MD
European Journal of Physical and Rehabilitation Medicine
Lorie Gage Richards, PhD, OTR/L, FAOTA, FAHA
The American Journal of Occupational Therapy
Catherine Vallée, PhD
Canadian Journal of Occupational Therapy
Maria Zalm, PhD
BMC Health Services Research
1. World Health Organization. Rehabilitation 2030. WHO. https://www.who.int/disabilities/care/rehab-2030/en/
. Published 2017. Accessed July 22, 2019.
2. Cieza A. Rehabilitation the Health Strategy of the 21st Century, Really? [published online ahead of print May 22, 2019] Arch Phys Med Rehabil. doi: 10.1016/j.apmr.2019.05.019.
3. World Health Organization. World Report on Disability. Geneva, Switzerland: World Health Organization;2011.
4. Jesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. Int J Environ Res Public Health. 2019;16(6):E980.
5. Stucki G, Bickenbach J. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Eur J Phys Rehabil Med. 2017;53(1):134–138.