Optimizing functioning at all ages is a major global public health goal. Rehabilitation is unique in its contribution to this public health agenda because of its focus on optimizing function. In this editorial, the editors of leading rehabilitation journals make the case for fully integrating rehabilitation into a nation’s health system and strengthening it specifically at the primary care level to increase access and achieve its full potential. Authors submitting papers to rehabilitation journals are encouraged to consider the global health policy implications of their research when they prepare their research reports for publication and to make these implications explicit.
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” (WHO, 2019; 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.
WHO convened a second global Rehabilitation 2030 meeting in July 2019 that brought together stakeholders, including member states, international and professional organizations, nongovernment organizations, rehabilitation service users, and rehabilitation experts—including journal editors. The first 2 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 2 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 (2019), WHO’s Coordinator for Blindness and Deafness Prevention, and Disability and Rehabilitation, wrote in an article titled “Rehabilitation the Health Strategy of the 21st Century, Really?” 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 argued that coordinated advocacy by rehabilitation professional groups, subspecialties, and users is required to achieve this goal.
Her message highlights the critical work undertaken by 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 represents a major challenge not only to high-income nations but to low- and middle-income nations as well. The comorbid 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. The global effect of rehabilitation on persons with health conditions is estimated to be much higher than the 1 billion people in the World Report on Disability (WHO, 2011). Rehabilitation is unique in its contribution to this public health agenda because of its focus on optimizing function. In fact, Jesus et al. (2019) reported that the need for physical medicine and rehabilitation services has 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 underresourced, 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 the 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 to increase access and achieve its full potential. As WHO highlighted, we agree that health systems must be strengthened to ensure 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 indicator (Stucki & Bickenbach, 2017) 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 varies 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.
We thank Maria Zalm for her assistance with this editorial. To encourage its wide dissemination, this editorial is freely accessible on the following journal websites: Archives of Physical Medicine and Rehabilitation, Journal of Cancer Survivorship, American Journal of Physical Medicine and Rehabilitation, Journal of Prosthetics and Orthotics, Journal of Cardiopulmonary Rehabilitation and Prevention, European Journal of Physical and Rehabilitation Medicine, American Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and BMC Health Services Research.