Urgent plan to mitigate the impact of neurological disorders
POLICY RECOMMENDATIONS, PUBLISHED BY THE LANCET NEUROLOGY, AIM TO BRIDGE THE DISPROPORTIONATE GAP BETWEEN THE INCREASING GLOBAL BURDEN OF NEUROLOGICAL DISORDERS AND THE RESOURCES TO MEET THIS CHALLENGE.
The policy view, led by Professor Valery Feigin at Auckland University of Technology (AUT), proposes a three-tiered framework – consisting of minimal, essential and advanced levels of access to neurological services – to achieve the highest level of care realistically attainable across disparate countries, given local resources and practice.
Based on World Stroke Organisation (WSO) guidelines, the framework encompasses access to healthcare personnel, laboratory screening tests and imaging, medicines and other treatments, as well as preventative and rehabilitation services.
“Advances in the management of neurological disorders are not keeping up with the increasing burden of these diseases. From a public health perspective, this is worrisome because the affected people require adequate care, either in hospital or community settings, but health resources are already overstretched,” says Professor Feigin.
High-income countries have a median of 7.1 neurologists per 100,000 population. This represents a substantial shortage in the neurological workforce worldwide.
Professor Feigin estimates that New Zealand needs more than double the 40 neurologists that are currently practising.
“It is crucial to revitalise and expand the health workforce. This requires planning and funding for medical education, and other strategies to increase personnel to deliver the necessary neurological services. The curriculum could be enriched with basic understanding of neurological disorders, predominant risk factors and preventative lifestyle measures,” he says.
Neurological disorders are the leading cause of disability and second cause of death globally, and are likely to rise owing to population growth and ageing.
In New Zealand, one in five deaths are due to neurological disorders. Almost 6,000 people die each year – from Alzheimer’s and other dementias (46.3 percent), stroke (44.6 percent), cancers of the brain and nervous system (5.1 percent), motor neuron disease (2.4 percent), epilepsy (0.9 percent), and multiple sclerosis (0.7 percent).
Professor Feigin says, urgent action is needed to mitigate the impact of neurological disorders.
“Given the limited resources and competing health issues policymakers are facing around the globe, coordinated advocacy efforts are required at the individual, institutional, local and national government level,” he says.
Reliable data is the backbone of evidence-based healthcare planning, priority setting and resource allocation. Governments and policymakers are urged to make use of Global Burden of Disease (GBD) Study estimates of the burden of neurological disorders, their risk factors and trends – available at a global, regional and national level.
Priorities for research include further study into risk factors for neurological disorders in different countries and populations (by ethnicity, age and sex), including Māori and Pacific communities in New Zealand. Areas such as neurodegeneration and inflammatory mechanisms are currently underfunded. Additional studies into treatment, procedures and interventions in different ethnic populations, and the cost effectiveness of interventions, are also essential.
The policy view also noted that validated mobile technologies are evolving quickly and showing unprecedented uptake among the public and health professionals. They show promise for providing healthcare and education remotely for a wide range of neurological disorders. Further development and upscaling of widely accessible and proven effective mobile technologies should be a priority for funding.
Precision medicine and artificial intelligence are emerging technologies that could contribute to a reduction in the burden of neurological disorders through improved personalised detection, prevention and treatment.
There are several examples of successful implementation of evidence-based strategies for the prevention and management of neurological disorders. The most notable achievements have been for stroke, including the Stroke Riskometer mobile app developed at AUT. Evidence-based stroke management strategies in the U.S over the past 20 years (stroke units, thrombolysis and national anti-smoking campaigns) have shifted stroke from the second to fourth cause of death.
Professor Feigin, Director of the National Institute for Stroke and Applied Neurosciences at AUT, is considered one of the world’s most influential scientific minds – ranking among the top one percent by citations for his global research on the epidemiology, management and prevention of stroke and traumatic brain injury.
“For neurological disorders with established risk factors, such as stroke, efforts must be made to broaden the implementation of proven effective primary and secondary prevention strategies,” he says.
The Lancet Neurology policy view – The global burden of neurological disorders: translating evidence into policy – was funded by the Bill & Melinda Gates Foundation.