Equity across the life course matters for brain health

Fostering equitable access to healthcare is very important for better brain health across the lifespan. But we must also understand the many nonmedical forces that are rooted in societal norms and practices that result in racial and ethnic discrimination and ageism and that often affect health and well-being outside of the health system. Strategies to optimize cognitive wellness must address the social and environmental context in which individuals make decisions and maintain long-term habits. Public policy and private sector innovations are part of the answer. Technology, environmental design, local services, zoning and access to the many resources that promote health and longevity can all contribute to cognitive wellness.

For these reasons, the GCBH believes that efforts to improve brain health should be a holistic, coordinated and mutually reinforcing approach across varied sectors, including public, private, faith-based and nonprofit advocacy groups. Communities must be engaged in ways that optimize their current strengths and build new approaches to sustaining brain health across the lifespan. None of this is meant to minimize the importance of individual choice. Rather, it is a way to build a foundation in all communities that empowers health-fostering actions and the ability to sustain those actions at the individual level.

The local natural and built environment is a crucial factor¹⁰. Neighborhood design and planning can affect brain health for better or worse. Consider the importance of schools, parks and recreational facilities, transportation, and businesses that provide products and services. Are they affordable, accessible and appealing? Do they encourage engagement and active living? Architects, urban and rural design planners and other local officials can be highly influential in shaping an environment that supports cognitive resilience.

Technology is another underutilized solution to enhance brain health and encourage equity. Consider all the people in the world who possess smartphones. At the tip of their fingers, they have access to platforms such as YouTube and TikTok that could provide access to videos that raise awareness of brain health issues in a manner that is educational and entertaining. The simple ability to push out a message may be all the nudge a person needs to remind them to move rather than sit.

Continued efforts to promote basic brain health are needed. At the same time, widespread misconceptions — such as the mistaken view that dementia is an inevitable feature of aging — need to be addressed. Greater community engagement should be part of the answer. Community leaders can step up their advocacy for brain health and have a larger role in raising awareness of brain health within their constituencies. They also can serve as resources for information and connections to services. Innovative new initiatives, campaigns and partnerships are required to raise public awareness and knowledge — efforts that must be culturally appropriate and grounded in science.

However, initiatives in education, outreach and communication must be crafted and delivered in a manner that resonates with the target audience to be effective. Messages should be simple and straightforward, avoiding language that may sound like gobbledygook to much of the public. Communications about brain health and cognitive impairments also should be culturally sensitive. Content should recognize important community values, such as how a community wants to treat older individuals, how it views the responsibilities of family members and whether care may seem undignified or disrespectful to those receiving it.

Within the healthcare system, providers should prioritize prevention and establish brain health baselines and evaluation as a routine part of check-ups for aging adults and others who may be at risk. People who require long-term care support owing to cognitive impairments often do not know where to turn for help, even when services are available. Healthcare providers working along with social workers should be aware of community-based resources so they can make referrals. And those community-based resources need adequate funding.

Empowering family caregivers is another underutilized way to strengthen brain health and assist individuals who need care. In many cultures, concerns of stigma and shame may inhibit families from seeking outside help for issues of cognitive decline or mental illness. Community leaders and influencers can do a great service by trying to counteract these harmful attitudes.

When family caregivers do connect with the healthcare system, providers should treat them as vital members of the healthcare team. Employers can further support family caregivers through leave policies and flexible work arrangements that enable them to help at home while keeping up with their job duties.

Achieving equity calls for transforming the paradigm of how society thinks about challenges to brain health. Public policy and cultural values will have to change. Scientific research must adapt in a way that recognizes population diversity — an awareness that applies to funding opportunities and participation in clinical trials. Scientists should establish standard health equity and quality measures that provide meaningful data on brain health across communities. Although we already have substantial scientific knowledge about brain health, much more remains to be learned about the barriers to cognitive well-being that are faced in distinct communities and how to address them.