In this world of scarce resources and competing priorities, there will be no remedy to the problem of headache unless its scope and scale are first made known to, and understood by, those who have power and influence to make change happen.
As a starting point, the full burden attributable to headache must therefore be measured, so that its enormity is demonstrated objectively. Then the evidence of this must be thrust, in such a way that it cannot be ignored, in front of governments and those in control of health-service policy.
The three stages in which the Global Campaign is conceived are identified accordingly.
The Global Campaign in three stages
1) acquiring knowledge for action
2) using knowledge to raise awareness for action
3) exploiting awareness to generate action for beneficial change __________________________________________________
Stage 1 is to know the nature, scope and scale of the problem - that is, the burden of headache - everywhere in the world ("knowledge for action").
In 2004, when the Global Campaign was launched, very little was known of the prevalence or burden of any headache disorder for more than half the people of the world: those living in most of the Western Pacific including China, all of South East Asia including India, all of Eastern Europe including Russia, most of Eastern Mediterranean and most of Africa.
Stage 2 is to exploit this knowledge, as it is gathered, to persuade governments, health-care providers and the public that, on clear evidence, headache must have higher health-care priority ("awareness for action").
Stage 3, and the ultimate purpose of the Campaign, is to work with local policy-makers and principal stakeholders to plan and implement health-care services for headache, ensuring these are appropriate to local systems, resources and needs ("action for beneficial change").
These three stages have seven component steps [reference 1].
Step 1 is to acknowledge the problem. This means recognising, in advance of precise knowledge, that headache disorders are heavily burdensome and under-treated worldwide. This step was taken, and it gave birth to the Global Campaign.
Step 2 is to build networks and collaborations as tools for the task. This is a continuous process. Bringing about the partnership with the World Health Organization (WHO) for its global impact on public health created only the first linkage in these networks and collaborations - albeit by far the most important.
Step 3 is to gather information: all of the existing worldwide evidence of the burden attributable to headache.
This means translating prevalence and incidence data into disability quanta. It also means gathering information, by region and country, on the allocation of health-care resources to headache disorders, not only showing the gaps between need and delivery but also discovering their causes. And it means establishing what other resources, including key people, are available in each community to be built upon.
It means, further, identifying the large holes in the evidence base and, in Step 4, setting up or commissioning studies to fill them. So that proposed solutions reflect their needs - and not only those perceived by the developed world - direct support must be provided for studies to understand headache burdens and health-care gaps in developing countries.
Step 5 is to persuade agents of change of the problem and its priority. This will be achieved by arguing the strengths of the humanitarian and socioeconomic drivers of change, exploiting the data gathered from Steps 3 and 4. WHO will be given the sound evidence it needs to engage in dialogue with governments and other health-service policy-makers, convincing them that headache disorders should be high amongst their priorities for health care.
Step 6 will tackle these problems with practical local solutions, in each community building upon resources identified as present in Step 3.
The aim will be to bridge the gaps between headache-related health-care need and delivery whilst removing or at least alleviating their causes. Programmes of education, pillars of effective solutions, will use, expand and supplement those provided by other nongovernmental organizations: the International Headache Society, European Headache Federation and their member national societies for health-care providers; the World Headache Alliance for people affected by headache and the general population.
Finally, and crucially, Step 7 will prove the case. Region- or country-based demonstrational projects will be established in collaboration with WHO's Regional or Country Offices. They will convene country policy-makers and other key stakeholders to plan headache-related health-care services appropriate to local systems and local needs, justified through the arguments above and set up using action-research methodology. They will evaluate outcomes in terms of measurable reductions in population burden attributable to headache disorders, using indices to be developed as one of the Campaign objectives.
The Global Campaign entails setting priorities and finding, country by country, region by region, effective and affordable solutions to the headache problem as it occurs locally, achievable with locally-available resources and within a defined term.
The Campaign is set upon the beliefs not only that individual and societal burdens are heavy, not only that right treatment can mitigate these burdens, but also that wrong treatment - with its roots in education failure - both adds to them and wastes resources.
Thus the Campaign's central pillar is that the health-care solution for headache in most of the world is education.
The Campaign will persuade those with influence over change that, through education, better care and reduction of these burdens not only are achievable. They can also be made cost-effective through the more efficient use of currently allocated resources and by reducing consequential financial costs.
"Better care ... not only [is] achievable. [It] can also be made cost-effective through the more efficient use of currently allocated resources and by reducing consequential financial costs."
1. Steiner TJ. Lifting the burden: the global campaign against headache. Lancet Neurol 2004; 3: 204-205. [view document]