A healthier brain for life

 It's never too early or too late to start caring for your brain. Knowing what to do and doing what you know to reduce risks can make a big difference to your brain's health. 

 The Facts

Brain health is about getting the best out of you brain: achieving the optimum state of cognitive sensorimotor, social-emotional, and behavioural functioning across the life course. The concept of brain health is more than the absence of brain disease. Rather it refers to optimizing and protecting brain functioning at each stage during the life course, to allow individuals to reach their full potential in terms of mental and physical health, wellbeing and engagement in activities that matter to them. Brain health is a positive non-stigmatising value, like physical fitness, and should be promoted at societal  and community levels because achieving better brain health improves wellbeing and quality of life for individuals

Promoting brain health must start early in life, indeed even before birth. The first 5-10  years of life are critical for brain development as that is where most brain plasticity and growth occurs hence the importance of education and positive environmental stimulation to good brain health.  The brain is plastic and it can respond and adapt to new experiences across the lifespan. Although early exposures are important, the brain’s plasticity continues even into old age and must be nurtured every step along the way.

 Brain health should be promoted and maintained even in the presence of brain illnesses such as dementia and optimised to reach the full potential of the individual to promote their, inclusion, wellbeing, and dignity. Rethinking dementia from the perspective of brain health is an important and hopeful narrative as it emphasises that even in the presence of disease, there are measures that can be taken to protect the brain, slow down or delay further decline and reduce further risk, for example stopping harmful medications, treating co-morbidities, addressing vascular risk factors and preventing delirium, all of which may improve outcomes and quality of life for people living with dementia and their care partners. .

Knowing What to Do

While there are some non-modifiable risks to brain health and the development of dementia (e.g., age and genetic factors) many risk factors are modifiable or treatable. Notable in this category are high blood pressure, diabetes, head injury and concussion, age-related hearing loss, pollution, excess alcohol,  smoking, lack of social connection, low education, low levels of physical exercise, poor sleep and depression. A public health approach that promotes protective factors and mitigates risk factors across the life course, appropriately mixing population-wide and at-risk targeted interventions, is the best way to optimise brain health and prevent cognitive decline and dementia.  

Efforts to address modifiable risk factors for heart disease have led to reduced deaths from heart attack and stroke, and although cardio-vascular diseases remain the leading cause of death globally, prevention efforts have been instrumental in decreasing deaths, disability and costs. Brain health can become the new heart health and should align with existing health promotion and prevention campaigns for cardio-vascular risk factors. Taking a similar prevention-oriented approach for brain health, there is enormous potential to reduce the number of people living and dying with dementia, especially if a focus on equity drives the design of global, national and local responses.

 

The importance of social determinants of brain health

The exposure to risk over the life course and the effects of such exposure on health outcomes is intricately linked to a complex set of socio-demographic, environmental and economic factors. A robust evidence base indicates that gender, race and ethnicity, educational achievement, employment status and financial security can turn into many sources of intersecting disadvantage, placing some population groups in positions of extreme vulnerability with high exposure to risks and limited ability to mitigate that risk. While sustained action within health systems can help reduce population level risk, and address inequalities in risk exposure and timely access to care to some extent, successful policies to optimise brain health must rely on more comprehensive, cross-sectoral approaches that address the root causes of inequity, alter social contexts and transform the systems and structures that reinforce socio-economic disadvantage. 

 

Doing What We Know

Key components of policy approaches that can optimise brain health for all

In order to achieve equity, effectiveness and sustainability, future policies  targeting brain health for all should prioritise three key components:

  1. Awareness and facilitating access to information for care professionals, individual and communities;
  2. Re-aligning health and social investments to promote healthy lifestyles and behaviours, as well as person-centred care models;
  3. Addressing head-on, through whole-of-government and society-wide approaches, the structural factors that determine health and wellbeing.