Bill needs to keep working but arthritis flare-ups are making it harder for him to keep up with his peers, never mind keeping up with his young family.

Genevieve has had to endure years of increasing pain and restricted mobility, until finally an invasive hip replacement becomes her only option.

Canada is at a crossroads. How we deal with the needs of people living with arthritis and other musculoskeletal diseases needs to change.

For arthritis alone, we’re talking about over 4.6 million Canadians living in pain. By 2035, that number is expected to double to nearly 10 million people.

Put aside the grievous impacts on the individual coping with chronic, sometimes crippling pain, fatigue and restricted mobility, and the impact on their family and community. In purely economic terms, the toll is also enormous.

Arthritis is the leading cause of long-term disability. It takes people off the job and out of the workforce, draining $33 billion out of the Canadian economy each year — two-thirds of which comes in lost productivity. By 2035, we’ll be looking at an annual economic loss of $66 billion.

How do we tackle a problem that big?

First, we need to make a commitment to research at every level of society that reflects the enormity of the impact of arthritis on our collective prosperity.

Pain is only one aspect of that impact, but it’s a vital one. It’s been decades since there was a new therapy for pain relief. Current options are not well suited for relief of chronic pain: drugs like opioids and NSAIDs pose significant health risks when used long-term.

We need more and better options for pain relief. That’s why The Arthritis Society, Canada’s leading non-government funder of arthritis research, has committed funds to research the potential benefits of medical cannabis. And it’s why we are calling on Canada’s governments to do the same.

But new research and discoveries are only useful if people can access them.

That’s why we also need to create a national pharmacare program — one that provides all Canadians with equitable access to the advances made possible by research. One that will plug the gaping holes in coverage that currently face people living with chronic pain. One that will expand access to medicines, boost productivity, and combat inflammation and pain.

Based on the experience of those with arthritis, the need is pronounced.

In hospitals, the cost of treatments are covered. But if you’re living with arthritis, you’re seldom in hospital — you’re trying to cope with pain and fatigue at home and work. This means you’re relying on your own coverage to pay for the cost of these medications, and that coverage can be maddeningly inconsistent.

Nearly 4 in 10 Canadians do not have access to drug coverage through their employer. That leaves large numbers of Canadians working less or retiring early — even when they lack the financial security to do so.

Those with private plans experience a litany of challenges. Some drugs are covered but others are not. Co-pays are rising. Benefit caps are becoming more common. Most concerning of all, choice can be limited with access to newer therapies strictly monitored — even when those treatments can make an enormous difference in quality of life.

For that reason, pharmacare must not be built solely around the notion of lower cost. It must also be designed with a substantial commitment to wide choice.

For many, the driving purpose of national pharmacare is to reduce the price we pay for expensive drugs. By establishing a larger, even a nation-wide, formulary, we can use our bargaining power to drive down costs, buy in bulk, and save billions of dollars.

We would applaud that. But in so doing, we cannot risk establishing a formulary or group of formularies that are restricted to a very narrow range of preferred medicines. The reality is people living with arthritis will respond to different drugs; therefore, a range of choice is critical.

It’s not a simple matter. Expanding choice will offset some of the savings. It will affect the bulk purchase strategy so fundamental to diving down costs. But a balance is required in establishing a system that truly serves the needs of Canadians — especially those with chronic pain.

We need to prioritize research that will drive solutions. And we need a national pharmacare program that will put those solutions into the hands of Canadians.

Bill, Genevieve, and the millions of other Canadians living in pain are counting on us.