Socioeconomic and health disparities compromise a person’s well-being, with specific risks for their brain health, writes Elisa de Paula França Resende, MD, Jorge Jesus Llibre Guerra, MD, MS and Bruce Miller, MD, of the Global Brain Health Institute (GBHI). In a recent article in Jama Neurology, the authors emphasize how these disparities influence dementia prevalence in communities across the globe.
“A reasonable proportion of risks are attributable to conditions that can be changed across an individual’s life span,” the authors say.
Can is the operative word. With risk factors for dementia such as access to quality education, healthy diet, treatments for ongoing health conditions, and protection against head injuries not equally available across countries, widespread and timely access to these basic resources is crucial. Access also requires will – both political and economic – to create change.
The statistics they cite are sobering. Dementia is more prevalent and occurs 10 years earlier in low- and middle-income countries than in high-income countries. Further, low educational attainment is associated with higher risk of developing symptoms and earlier symptom onset. Equally concerning is the limited access to affordable and healthy food as well as the increased cognitive risk of highly stressful situations on vulnerable individuals.
The authors make recommendations on how to advance equity:
Increase funding for research on dementia prevention.
Advance policies that address socioeconomic and health inequities related to dementia and having dementia plans prioritize actions to reduce inequities in prevention and care.
Seek additional measures to define neurogenerative disease internationally since biomarkers are not accessible in many parts of the world.
Increase widespread awareness of health and socioeconomic inequities that put people at risk for dementia.
Two of the authors, Resende and Llibre Guerra, are Senior Fellows from the Atlantic Fellows for Equity in Brain Health program at GBHI, a training program based at University of California, San Francisco and Trinity College Dublin that aims to address inequities in brain health.
“The rigorous training of new leaders in brain health around the world gives societies everywhere a chance to transform how they view and care for their elders,” says Miller, co-director of GBHI.
The authors also highlight the important role of nonprofit organizations such as Alzheimer’s Disease International and the Alzheimer’s Association. With partnerships on the ground, these groups generate information such as comprehensive global dementia reports and provide funding for training programs and research.
Since the article’s publication, the authors have received positive feedback.
“My colleagues from Brazil thank me for addressing such an important issue for our country and for the world,” says Resende. “This Viewpoint article allowed us to spread worldwide the GBHI core message: we need to address inequities if we want a world without dementia and brain diseases in the future.”
Their call to action is timely, with the prevalence of dementia expected to increase in the years ahead and the sharpest increases expected in the low- and middle-income countries.
The neurologist trio strikes a chord of hope as representatives of a larger global network of seven Atlantic Fellows programs. The Atlantic Fellows program at GBHI and its sister programs work to advance fairer, healthier, more inclusive societies. With a cadre of leaders completing intensive training and gaining connections with peers around the globe, fellows return to their communities upon completion of their training to use newly-honed skills to be change makers and champions for equity.
“I am excited about the Atlantic Fellows program,” says Llibre Guerra. “It’s unique in our focus on equity, vulnerable populations, a global approach, and a powerful mix of disciplines. As a result, the Atlantic Fellows will help to translate research evidence and innovation into more informed and effective policies targeting vulnerable populations and shaping a recipe for global equity.”