Brain Health, Worldwide Efforts

This Editorial welcomes the first issue of a new journal, Brain Health, devoted entirely to brain health and its many ramifications. Brain health is a subject of great interest to the public and helps raise awareness for neurology and persons affected by neurological diseases. Facets of brain health include prevention, treatment, and disability, which are relevant for all age groups [1]. A journal devoted to these important aspects of brain health will help define the scientific and practical aspects of the field and identify new research directions. The “Zeitgeist” (https://en.wikipedia.org/wiki/Zeitgeist), which makes us dependent on the influences of contemporary events that may vary with time. An example are the changing relationships between patients and physicians others are changing concepts of disease and treatment often requiring “unlearning” [2]. The second aspect regards “powerful structures,” which exert influence on the perception and definition of brain health, such as pharma's interest and promotion, prejudice and stigma, “prestige” of diseases [3], cultural and ethical issues, and last, but not least, political influence or pressure that can be misused to decide on brain health issues. For the field of neurology, brain health is the healthy and functioning brain at all ages and under all conditions. The functioning brain is determined by the absence of illness and disease, normal motor, sensory, and autonomic function, and, most of all, neuropsychological and mental function. This simplified formulation already demonstrates the difficulties delineating the borders of mental health and psychiatric conditions. We also need to explore the meaning of brain health for individuals, who may have congenital or acquired deficits in brain functions, for example, children with intellectual disabilities https://www.unicef.org/press-releases/nearly-240-million-children-disabilities-around-world-unicefs-most-comprehensive, acquired severe brain trauma and dementia. Although, from the somatic view, brain function may be impaired, these persons may still have a different perception of brain health from their own view. Would we consider these persons to have an unhealthy brain and further categorize and stigmatize them? With regards to epidemiology, the Global Burden of Disease (GBD) 2024 report is an important resource [4]. The study found that an alarming 43% of the world population is affected by a neurological disease. The GBD study has gained significant momentum; however, its classification, although practical and useful, diverges from the WHO International Classification of Diseases, 11th Revision (https://icd.who.int/en/), which needs to be considered in future evaluations of the global burden of neurological disease. Moving forward, brain health research will need large joint and shared databases using data based on blockchain technology [5]. Other priorities include the development of methods to assess and quantify brain health, increase knowledge on brain function and dysfunction, and identify approaches to prevent and treat neurological diseases that compromise brain health. These tasks are included in the overarching WHO mission on brain health through IGAP, which will be continued until 2031 and will provide a strong platform to promote brain health (https://www.who.int/health-topics/brain-health#tab=tab_1, https://wfneurology.org/activities/wfn-and-who/wfn-and-igap/who-igap-toolkit/who-igap-implementation-toolkit). Inevitably, around 60-70 million persons die yearly, with, it is estimated, most arising from heart disease and cancer deaths (https://ourworldindata.org/births-and-deaths, https://www.ncesc.com/geographic-pedia/how-many-deaths-are-there-worldwide-each-year/#:~:text=). However, according to the United Nations, one sixth of the world population dies from neurological disease (https://news.un.org/en/story/2007/02/210312#:~:text). This substantial number of neurological disease needs to be tackled during lifetime with preventative efforts, but, also, make provisions for disability, long-term, and palliative care [6]. Age is a non-influential factor and according to[MGS8] (https://ourworldindata.org/grapher/population-by-age-group-with-projections). Presently, of the 8 billion world population, 2 billion are under 14 years and 780 million are over 65 years. Both groups are especially vulnerable and have different needs for brain health and care. And, starting as early as possible in the life course, prevention is critical and individuals have the responsibility to avoid unhealthy habits, improper diets, and alcohol, tobacco, and other so-called recreational drugs. In addition to prevention, interventions based on environment, nutrition, and lifestyle habits also need to be developed. This can be stated for high, an possibly high middle income countries, but in many low middle and low income countries, choices for environment, nutrition and diets are not available. Finally, concerning the future plans to advance and disseminate the content of brain health, our efforts must be directed to reach the public through education and health campaigns, and integrate neurology into primary care worldwide (https://www.who.int/health-topics/primary-health-care#tab=tab_1). This will need organization, rethinking, and prioritization of the population and patients to the top of our strategies. This can be analogized to the concept of the inverted pyramid in journalism (https://en.wikipedia.org/wiki/Inverted_pyramid_(journalism)), which places the top story and result at the start of the article. Health hierarchies, including activities for brain health, often use the pyramidal top-town structure, which may not be effective enough to undertake the task of improving brain health globally. Although we should be aware of science and our scientific approach, our main focus, however, should be patients, persons with lived experience, and integrating neurology into primary care, since this large workforce will be beneficial, particularly in lower income countries. Define brain health and epistemology, Generate accurate information on epidemiology of neurological diseases, in particular data from the GBD, Establish joint databases, Implement the WHO concept of brain health and IGAP as platforms, Implement brain health for all age groups and avoid stigma, Develop preventative approaches to mitigate the development of neurological disease with aging. We anticipate that the new journal Brain Health will bring all these issues and research on brain health to the forefront, underscoring its importance worldwide at all ages. Wolfgang Grisold: writing – original draft. The author declares no conflicts of interest. The author has nothing to report.