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Musculoskeletal problems are thought to be the leading reason for visits to primary care physicians, and are one of the top 10 reasons for family physician visits across Canada and globally. 

Despite being the world’s leading cause of pain, disability and health care expenditure, musculoskeletal issues - including low back pain, fractures, arthritis and osteoporosis - are globally under-prioritised according to an international research team including Dr. Deborah Kopansky-Giles, Assistant Professor at DFCM and Professor at the Canadian Memorial Chiropractic College.

The research, and resulting report, was commissioned by the Global Alliance for Musculoskeletal Health and led by Professor Andrew Briggs at Curtin School of Allied Health in Australia. Representing 72 countries and 116 organizations, the research suggests that the prevalence, burden and cost of musculoskeletal health impairments will continue to rise globally, especially in low and middle‐income countries, owing to population growth, population ageing, an increasing prevalence of risk factors. 

“One of the limiting factors to reform efforts is that no global-level strategic response to the burden of disability has been developed – until now. This novel data-driven initiative will be critical to guiding global-level work in health reform, such as that undertaken by the World Health Organization (WHO),” says Professor Briggs. 

The report proposes eight key pillars for health systems to strengthen musculoskeletal health, from leadership and financing to engagement and surveillance.

“Musculoskeletal issues significantly affect quality of life for people and their families, and place an enormous burden on family doctors and other primary care providers as well as health economies. Yet, they are generally poorly managed,” says Dr. Kopansky-Giles, who is a DFCM researcher and recently completed her term as Health Professional Educator co-lead.

“Recent efforts to improve training and education are showing some improvements, such as an updated musculoskeletal curriculum for family medicine residents at U of T, but much more needs to be done. This blueprint, which includes perspectives from patients, health advocates, clinicians, teachers, policy makers and researchers, in countries with various levels of economic health, provides an excellent baseline from which Canada, the WHO and other countries can build their musculoskeletal health policies.”  

The international team of researchers is from: University of Sydney; University of Toronto; Canadian Memorial Chiropractic College, Kathmandu University and the University of Southern Denmark. The full report and an executive summary are now available.

As temperatures soar across western Canada, wildfires continue to burn, and heat warnings continue in Toronto, family doctors are concerned about the immediate and long term effects of climate change on patients and the planet. 

Dr. Samantha Green, Assistant Professor and Faculty Lead in Climate Change and Health in the Department of Family and Community of Medicine (DFCM) is concerned for those most at risk of heat-related illness.

“For young children, the elderly, pregnant women, and people with chronic conditions like asthma and diabetes, extreme heat is a real concern. People experiencing homelessness, living alone, working outdoors, or taking certain medications like antidepressants, diuretics and beta blockers are also more at risk,” says Dr. Green, who is also a family physician at St. Michael’s Hospital, Unity Health Toronto.

“Extreme heat is associated with asthma exacerbations, fluid and electrolyte disturbances, infections, violence, and even suicide. Given the current temperatures, it’s worth checking in on vulnerable patients to offer tips on how to stay safe and point them in the direction of local resources such as Emergency Cooling Centres.”

While this heat wave will pass, extreme weather events are becoming more frequent because of climate change.

In fact, a World Weather Attribution collaboration report estimates that the current heatwave was made 150 times more likely as a result of climate change brought about by greenhouse gas emissions. 

“I’m worried that if the burden on people, families and communities can already be this bad with one degree of average global temperature rise, things could get much worse if we don’t take fast, effective and equitable action on climate change,” Dr. Edward Xie, an Assistant Professor at DFCM and family and emergency medicine doctor at University Health Network told Global News.

As Canada emerges from the COVID-19 pandemic, we must remember that we are at the convergence of two health emergencies, says Dr. Green.

Climate change might not feel like a priority for family doctors, but it is increasingly harming health and the determinants of health – from heat-related deaths and displacement due to wildfires, to flooding, allergies and zoonotic diseases.

“As family physicians, we are obliged to both mitigate and adapt to the climate crisis,” says Dr. Green. “It’s not just an issue of social accountability – working to mitigate climate change also provides opportunities for patient health, such as active transportation, plant rich diets, access to nature and reduced air pollution.”

The DFCM Climate Change & Health Community of Practice is working on guidance and resources to help family physicians and other health professionals support patient and planetary health. In the meantime, Dr. Green stresses the importance of providing heat-related guidance to patients and recognizing the signs of heat exhaustion and heat stroke.

“To stay cool in extreme heat, it is best to restrict physical activity to the coolest period of the day, seek out air-conditioned spaces, drink fluids before you feel thirsty and wear light coloured, breathable clothing,” says Dr. Green. “Be alert for heat exhaustion and classic heat stroke - patients with a core temperature above 40°C with warm, dry skin and an altered mental status. Heat stroke can progress to multi-organ failure and death without emergency resuscitation – as our extreme weather continues, we need to be alert to these risks.”

Resources and practical strategies for the prevention and treatment of heat-related illness are available in this technical guide prepared by Health Canada (2011) and this CFP article co-authored by DFCM faculty member Dr. Alan Abelsohn (2014).

DFCM faculty who are concerned about the climate crisis and its unprecedented health impacts are invited to join the DFCM Climate Change & Health Community of Practice by emailing dfcm.climatechange@utoronto.ca.