Dementia is a challenge to the entire planet

NHS England’s National Clinical Director for Dementia reports from Geneva on the first World Health Organisation Ministerial Conference (WHO) on Global Action Against Dementia:

This landmark meeting brought together senior representatives from 80 countries plus a number of clinical experts, researchers, 80 philanthropic foundations, 45 non-governmental organisations and four United Nations agencies to discuss and debate the global challenge posed by dementia.

The primary aim was to increase awareness of the global burden of dementia – which currently affects more than 47 million people worldwide with the number expected to triple by 2050 – and that by placing it centre stage on the global public health agenda, the implications of the burden can be addressed.

The specific objectives were to highlight evidence relating to the global burden and impact of dementia and encourage governments worldwide to take action to prevent dementia and improve care services based on current scientific knowledge, available evidence and global experience.

It highlights the need to discuss assessing dementia care and monitoring progress while also identifying cures or disease-modifying therapies for dementia.

It further emphasises the need for increased investment in research, while also reviewing global actions undertaken between 2011 and 2014. It urges exploring possibilities of supporting global cooperation and to move from commitment to action, in coordination with all stakeholders.

Day one of the conference consisted of presentations with global information about dementia, including a session that I chaired about treatment, research, risk reduction and care.

There were policy presentations on the impact of dementia and the perspectives from individuals living with dementia and their carers were characteristically powerful.

Nearly 60 percent of people with dementia live in low and middle-income countries, and this proportion is expected to increase rapidly during the next decade.

Day two was about living well with dementia, improving awareness and consolidating global action on dementia.

Margaret Chan, the director-general of WHO, was instrumental in supporting this unique event which made a declaration with the driving principles of empowering and engaging the full and active participation of people living with dementia, their caregivers and families, as well as overcoming stigma and discrimination.

It aims to foster collaboration between all stakeholders to improve prevention and cure, while also incorporating the aspects of dementia prevention, care and rehabilitation in policies related to ageing, disability and non-communicable diseases, including mental health.

It further pledges to build on and utilise existing expertise, collaborative arrangements and mechanisms to maximise impact, while also  balancing prevention, risk reduction, care and cure so that while efforts are directed towards finding effective treatments and practices and risk reduction interventions, continuous improvements are made on care for people living with dementia and support for their caregivers.

It further advocates an evidence-based approach and shared learning, allowing advances in open research and data sharing to be available to facilitate faster learning and action, while also emphasising that policies, plans, programmes, interventions and actions are sensitive to the needs, expectations and human rights of people living with dementia and their carers.

It also embraces the importance of universal health coverage and an equity-based approach in all aspects of dementia efforts, including facilitation of equitable access to health and social care for people living with dementia and their carers.

The main points in the declaration were:

  • Raising the priority accorded to global efforts for dementia;
  • Strengthening capacity, leadership, governance, multi-sector action and partnerships;
  • Promoting a better understanding of dementia, raising public awareness and engagement, including the respect for their human rights,
  • Reducing stigma and discrimination, and fostering greater participation, social inclusion and integration of people living with dementia;
  • Advancing prevention, risk reduction, diagnosis and treatment of dementia, consistent with current and emerging evidence;
  • Facilitating technological and social innovations;
  • Increasing collective efforts in dementia research;
  • Facilitating the coordinated delivery of health and social care for people
  • Capacity building of the workforce, supporting mutual care taking across generations on an individual, family and society level, and strengthening support and services for their caregivers and families;
  • Supporting a gender-sensitive approach;
  • Promoting further work in identifying barriers to dementia care;
  • Strengthening international efforts to support plans and policies at all levels for people living with dementia, in particular in low- and middle-income countries;
  • Supporting the efforts of the World Health Organisation.

This was a historic event and never before have there been so much international consensus around dementia.  Time will tell what practical actions come from the conference but the seed for change has been sewn and the UK is at the forefront of initiatives in the field.

Details of the meeting are available on the World Health Organisation (WHO) website.

Professor Alistair Burns

Alistair Burns is Professor of Old Age Psychiatry at The University of Manchester and an Honorary Consultant Old Age Psychiatrist in the Greater Manchester Mental Health NHS Foundation Trust. He is the National Clinical Director for Dementia and Older People’s Mental Health at NHS England and NHS Improvement.

He graduated in medicine from Glasgow University in 1980, training in psychiatry at the Maudsley Hospital and Institute of Psychiatry in London. He became the Foundation Chair of Old Age Psychiatry in The University of Manchester in 1992, where he has variously been Head of the Division of Psychiatry and a Vice Dean in the Faculty of Medical and Human Sciences, with responsibility for liaison within the NHS. He set up the Memory Clinic in Manchester and helped establish the old age liaison psychiatry service at Wythenshawe Hospital. He is a Past President of the International Psychogeriatric Association.

He was Editor of the International Journal of Geriatric Psychiatry for twenty years, (retiring in 2017) and is on the Editorial Boards of the British Journal of Psychiatry and International Psychogeriatrics. His research and clinical interests are in mental health problems of older people, particularly dementia and Alzheimer’s disease. He has published over 300 papers and 25 books.

He was made an honorary fellow of the Royal College of Psychiatrists in 2016, received the lifetime achievement award from their old age Faculty in 2015 and was awarded the CBE in 2016 for contributions to health and social care, in particular dementia.