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Building Equity in Global Brain Health

Learn how dementia and other brain diseases impact disadvantaged populations worldwide, and how research is helping address disparities in brain health.


Of the 50 million people impacted by dementia worldwide, the highest toll is experienced by at-risk and disadvantaged populations—and the number of people affected is increasing rapidly. The World Health Organization estimates that there will be 152 million people living with dementia by the year 2050. Without intervention, a disproportionate number of these individuals will be from underprivileged communities, with an increasingly high number of these cases being preventable.

We explored this issue in a recent webinar with Bruce Miller, MD, FAAN, director of the UCSF Memory and Aging Center and director of the Global Brain Health Institute. Dr. Miller shared his insights about how at-risk and disadvantaged populations around the world are affected by dementia and what the scientific community is doing to address it. Learn what Dr. Miller had to say as well as how you can support critical brain disease research below.

What does equity have to do with global brain health?

Equity refers to justice and fairness for all people. It means acknowledging that we don’t all start with the same opportunities and access to resources, and making adjustments to address imbalances. Health equity ensures that everyone has a fair opportunity to live a healthy life, regardless of their social and economic status. Achieving health equity requires ongoing efforts to address injustices that impact communities’ current and future health and eliminate preventable health disparities.

So why are we talking about equity when we discuss global brain health? Economically disadvantaged populations are often at higher risk of developing health issues and frequently experience the highest impact of major brain diseases. Part of the reason for this is that underserved communities have less access to health and medical resources. However, on a larger scale, low- and middle-income countries often lack the training and infrastructure to support optimal brain health among their more at-risk populations.

Researchers are finding that even factors like access to education—which may not seem to be immediately tied to health outcomes—can impact brain health in disadvantaged global populations. Dr. Miller points to a study in Brazil that found that people over the age of 60 who were illiterate or had less than four years of education had a smaller hippocampus than people the same age who had learned to read. The hippocampus is the region of the brain involved in learning and memory.

“Just the simple measure of how big is your hippocampus—how big is this tiny little region in the brain where Alzheimer’s disease starts, and which helps us to remember from moment to moment? Think of the inequity of this,” says Dr Miller. “You come from a poor family, you don’t learn how to read, you don’t develop the connections in your memory system that might help you navigate life. Then on top of it, this increases the likelihood that you develop cognitive impairment later in life.”

How do modifiable risk factors affect dementia?

Modifiable risk factors are changeable conditions that can increase or decrease your chance of developing a disease. According to studies, modifiable risk factors are responsible for up to 40% of worldwide dementia cases.

While genetics certainly play a role in developing dementia, numerous modifiable risk factors are also involved—many of them impacting people even in early childhood. Factors like access to education, clean air and a safe living environment, and familial health factors can all impact brain health.

“We believe that social determinants of health are ultimately the determinants of how well our brain ages. For example, if you could intervene around education early in life, it would have a positive outcome across the lifetime of that person,” Dr. Miller explains. “So it’s really an equity issue. If you’re not given the chance to develop your brain…you are going to suffer consequences across your lifespan.”

What is being done to address equity in global brain health?

The Global Brain Health Institute (GBHI) was formed in 2016 with a mission to protect the brain health of the world’s aging populations. Created with the help of Irish-American philanthropist Chuck Feeney, GBHI is a partnership between the University of Southern California, San Francisco (UCSF), and Trinity College Dublin (Trinity). 

The institute supports equity in global brain health in several ways. When it was initially founded, Mr. Feeney donated seven billion dollars to invest in health infrastructure for low- and middle-income countries. These funds went toward creating hospitals and providing vital equipment like MRI machines in underserved areas. Another billion dollars went toward creating GBHI’s Atlantic Fellows program, which provides comprehensive training and support for emerging leaders to improve global brain health and reduce the impact of dementia on at-risk populations. 

“The idea is we will train fellows. They will mostly come from low- and middle-income countries or communities in the United States and Ireland. They will try to reduce the scale and impact of dementia worldwide,” Dr. Miller explains. “Changes in lifestyle will be important, and many of the fellows are thinking about changing lifestyles in their own countries…We think that a broad education for these fellows is really going to be important, because they’re going to have to talk to their health ministers in their countries and convince them that brain health is important, [and that] it may even be cost effective.”

GBHI also works with the Alzheimer’s Association and the Alzheimer’s Society UK to offer a pilot project program. Each GBHI fellow is eligible to participate and create a pilot project they can bring back to their country of origin. Many smaller-scale projects lead to larger projects with a significant impact. Past projects have included a widely-used kid-friendly video teaching children about the importance of brain health and an initiative to improve the brain health of illiterate people over 60 by teaching them how to read.

Why Funding Research Is So Important to Global Brain Health

We all deserve to enjoy life without brain disease, but there is a great deal of work and research that must be done for that to be possible. Across the world, we need ongoing research efforts as well as outreach and education programs in underserved communities. At the American Brain Foundation we work to connect donors and researchers in the fight against brain disease, because we know that without research, there will be no cures. 

Interested in learning how you can help us address inequities in global brain health? There are many ways to support our mission. Your donation enables countless critical research programs to make important discoveries that will lead to treatments and, one day, cures for all brain diseases and disorders.

The American Brain Foundation was founded to bring researchers and donors together in the fight against brain disease. Learn more about brain disease or make a gift to support groundbreaking brain disease research.