Maintaining brain health is arguably one of the greatest global health challenges of the 21st century, as few other issues will have a similar effect on humanity. Given the breadth of factors affecting brain health, we believe that large-scale diplomacy is necessary. Diplomacy is traditionally described as a formal exchange between countries, such as trade talks or negotiations to avoid armed conflict, carried out by formal representatives of nations (eg, emissaries and ambassadors). Yet, the field of diplomacy is far more nuanced, and the way in which diplomacy affects humanity, including health, is informed by a broader understanding of the topic. Large-scale diplomatic activities might include efforts to coordinate research across nations or the establishment of treaties (for example, to reduce air pollution). Activities of this type help to coordinate international projects in research, advocacy, clinical care, consumer participation, innovation, and public health.
At an individual level, threats to brain health include neurodevelopmental and neurodegenerative disorders, trauma (physical and psychological), unsafe living or working conditions, poor diet, environmental risk factors, and inadequate access to health care, as well as chronic and often multimorbid conditions, such as hypertension and diabetes. At the community level, risk factors include social isolation, low educational attainment, inconsistent health-care coverage, low socioeconomic status, violent crime, and contaminants and air pollution. At a macro level, the global challenges include climate change, population ageing, rising economic inequality, rural-to-urban migration and megacities with disrupted social safety nets, armed conflicts, mass migration, and the mass digitalisation of life.
We propose a brain-health diplomacy model to transcend disciplinary boundaries, and mobilise resources at sufficient scale to improve brain health. This model builds on several theoretical approaches, including health diplomacy, science diplomacy, innovation diplomacy, and convergence science.1–3 Brain health diplomacy is aimed at tackling threats to brain health throughout the life course, but in particular in later life; training and connecting the next generation of leaders in brain health; collaborating in expanding prevention and treatment interventions; sharing knowledge; and engaging in advocacy.
The Global Brain Health Institute (GBHI) is an exemplar of an organisation actioning brain health diplomacy (panel) through efforts to train a cross-cultural, interdisciplinary global community of emergent brain health leaders.4 Funded by the Atlantic Philanthropies and based at the University of California San Francisco, USA and Trinity College Dublin, Ireland, the GBHI works to reduce risk factors to brain health. The GBHI seeks to train brain-health leaders dedicated to advancing equity in brain health through the Atlantic Fellows for Equity in Brain Health programme. The Atlantic Fellows work on a diverse array of disciplines including medicine, law, business, social science, journalism, and the arts. Since the programme’s founding in 2015, 117 fellows have been trained from 37 countries. The interconnected disciplines span research, policymaking, medical care, and capacity building. The programme has funded 65 pilot projects (totalling US$1·6 million), implemented in 24 countries, such as the one in Peru to characterise the cognitive health and functional abilities of illiterate older people and inform national policy, and another in South Africa to estimate the potentially preventable burden of dementia. After their GBHI experience, 27 Atlantic Fellows have been awarded nearly $17 million to implement programmes, fund projects, and do research in their home regions. Future brain-health institutes affiliated with GBHI will support and expand these efforts, such as a centre at Chile’s Universidad Adolfo Ibáñez, to be launched in 2021. Education systems could reconfigure themselves to provide brain-health training for non-health professionals. A multi-year degree or fellowship focused on brain health might not always be the most affordable or suitable approach for all professionals, but a week-long certificate course can be easily delivered and scaled to meet demand. A similar approach has been proposed to combat global pandemics such as COVID-19.5
Panel: Brain health diplomacy.
Aims
To influence the global policy environment for brain health and bridge different disciplines to improve brain health around the globe
To protect the world’s populations from threats to brain health throughout the life course particularly in later life
To collaborate in expanding prevention and treatment interventions
Foundational disciplines
Health diplomacy; technology diplomacy; innovation diplomacy; science diplomacy; convergence science
Brain health threats to be addressed
Micro level—individual
Trauma, unsafe living and working conditions, poor diet, inadequate access to health care, lack of broadly available care for mental illness, environmental exposures, and inadequate treatment of chronic often multimorbid conditions such as hypertension and diabetes
Meso level—community
Social isolation, low educational attainment, inconsistent health care coverage, low socioeconomic status, lack of economic opportunities, violent crime, chemical contaminants, and air pollution
Macro level—national and transnational
Climate change, population ageing, rising economic inequality, ongoing rural–urban migration and megacities with disrupted social safety nets, large-scale armed conflicts and resulting mass migration, and the mass digitalisation of life
Exemplars of brain health diplomacy
Alzheimer’s Disease International
European Brain Council
Global Council on Brain Health
Brain health diplomacy is a global call to action with a goal of motivating others to join efforts to overcome the systemic challenges of brain health and urgently address growing unmet needs. The goal is to increase coordination in brain health across countries, disciplines, and sectors that are already working on these issues, with a view to accelerating opportunities to improve brain health outcomes.
Acknowledgments
WDD reports personal fees from AARP, Commonwealth Fund, Insights to Illuminate, Cognitive Solutions, Oregon Health Care Association, Splaine Consulting, and Mather, outside the submitted work; AI reports grants from FONCyT-PICT 2017-1818 & 2017-1820, FONDAP 15150012, Interamerican Development Bank (IDB), Alzheimer’s Association GBHI ALZ UK-20-639295, and the Multi-Partner Consortium to Expand Dementia Research in Latin America, supported by NIH NIA R01 AG057234, Alzheimer’s Association (SG-20-725707), Tau Consortium, and Global Brain Health Institute, outside the submitted work; JC reports grants from NIGMS P20GM109025, NINDS U01NS093334, and NIA R01AG053798 and P20AG068053; personal fees from Keep Memory Alive, during the conduct of the study; personal fees from Acadia, Actinogen, AgeneBio, Alkahest, Alzheon, Annovis, Avanir, Axsome, Biogen, Cassava, Cerecin, Cerevel, Cognoptix, Cortexyme, EIP Pharma, Eisai, Foresight, Green Valley, Grifols, Karuna, Nutricia, Orion, Otsuka, Probiodrug, ReMYND, Resverlogix, Roche, Samumed, Samus Therapeutics, Third Rock, Signant Health, Sunovion, Suven, and United Neuroscience pharmaceutical and assessment companies, and the Alzheimer Drug Discovery Foundation; and other from ADAMAS, BioAsis, MedAvante, QR Pharma, and United Neuroscience, outside the submitted work. In addition, JC has a patent Neuropsychiatric Inventory (NPI) with royalties paid and is the Chief Scientific Advisor of CNS Innovations and a Board member of Keep Memory Alive; KY serves on DSMBs for Eli Lilly and a National Institute on Aging-sponsored study, is a board member of Alector, and is also a member of the Beeson Scientific Advisory Board and the Global Council on Brain Health; HAE reports personal fees from CNSdose, Scioto Biosciences, Prodeo, and Altoida, outside the submitted work; KB, LB, MP-C, SY, IT, AC-H, TE, JK, and BLM declare no competing interests.
Contributor Information
Walter D Dawson, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239 USA; Institute on Aging, College of Urban and Public Affairs, Portland State University, Portland, OR 97201, USA; Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland.
Kirsten Bobrow, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland.
Agustin Ibanez, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Universidad San Andres, National Scientific and Technical Research Council, Buenos Aires, Argentina, Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibáñez, School of Psychology, Las Condes, Santiago, Chile, and Universidad Autónoma del Caribe, Barranquilla, Atlántico, Colombia.
Laura Booi, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Maritza Pintado-Caipa, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Research Unit of the Department of Neurology, Peruvian Institute of Neurosciences, Lince, Perú; Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA USA.
Stacey Yamamoto, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA USA.
Ioannis Tarnanas, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Hellenic Initiative Against Alzheimer’s Disease, Johns Hopkins Precision Medicine Center, Baltimore, MD, USA, BiHeLab, Ionian University, Kerkira, Greece, Swiss National Dementia Task Force, Federal Office of Public Health and Swiss Conference of the Cantonal Ministers of Public Health, Lucerne, Switzerland, and Altoida, Texas Medical Center Houston, Houston, TX, USA.
Timothy Evans, School of Population and Global Health, Faculty of Medicine, McGill University, Montreal, Canada.
Adelina Comas-Herrera, Department of Health Policy, London School of Economics and Political Science, London, UK.
Jeffrey Cummings, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, and Department of Brain Health, University of Nevada, Las Vegas, NV, USA.
Jeffrey Kaye, Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon 97239 USA.
Kristine Yaffe, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA USA.
Bruce L Miller, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Memory and Aging Center, School of Medicine, University of California, San Francisco, San Francisco, CA USA.
Harris A Eyre, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA; Global Brain Health Institute, Trinity College Dublin, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland; Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia, Deakin University, IMPACT SRC, School of Medicine, Geelong, VIC, Australia, Brainstorm Laboratory for Mental Health Innovation, Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA USA, and Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia.
References
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