Strengthening health systems to prioritise, provide care, and prevent osteoarthritis: a roadmap for global health policy.

By 2050, almost 1 billion people are expected to live with osteoarthritis-a disabling musculoskeletal condition with currently no cure. Despite its burden and costs, osteoarthritis remains largely invisible in national and global health agendas, is poorly integrated within service models for other chronic health conditions, and is frequently perceived as inevitable with ageing and associated with limited therapeutic options. This context drives an osteoarthritis identity problem that fuels frustration among those living with the disease and health-care professionals, perpetuates stigma and inequities, undermines access to effective interventions, and crucially, deprioritises osteoarthritis in health policy. How can health systems be strengthened to mitigate the burden of disease and prioritise the prevention and control of osteoarthritis? We outline a co-created, globally relevant roadmap for health policy responses for osteoarthritis prevention and care that extend beyond the UN's Agenda 2030 targets. The intended audience for the roadmap includes health policy makers, health services managers, clinicians, and civil society organisations. The roadmap anchors to three strategic priorities underpinned by guiding principles of a life course approach, prioritising health equity, and ensuring that responses are affordable and sustainable across economies. Priority 1: recognise and respond to osteoarthritis with capacity building in national surveillance of burden, cost, and modifiable risk factors, and explicitly embedding musculoskeletal health within national and subnational health policies. Priority 2: scale up high-value, person-centred, equitable care for approximately 600 million people living with osteoarthritis. This priority requires reframing of societal narratives around osteoarthritis and reconfiguring service models to integrate osteoarthritis into primary and chronic disease care while also addressing social, environmental, and commercial determinants of musculoskeletal health. Priority 3: slow the osteoarthritis trajectory via primary and secondary prevention targeted at excess bodyweight and joint injury, enabled by cross-sectoral and cross-disease cooperation. These priorities are supported by accelerators requiring global collaboration, within and outside the osteoarthritis community.