Yesterday on HIFA we circulated the new WHO guideline on interventions for reducing the risk of cognitive decline and dementia:
The new print issue of The Lancet (18 May 2019) has a lead editorial on the subject. Below are the citation and selected extracts. The editorial welcomes the guideline but suggests it is 'potentially rather unambitious' and 'there remains a pressing need for recommendations on stronger public health policies'. This may be so, but I would argue that guidelines are essentially normative rather than advocatory. Advocacy for change would be based on the evidence presented in the guideline rather than be part of it. That said, perhaps there is a case for a closer look at the impact of different public health policies on reducing the risk of dementia (the current guideline focuses on interventions rather than the policies needed to drive such interventions).
The authors of the editorial also say 'WHO has also not provided much guidance on execution, lacking recommendations for measurement and targets, or an assessment of economics'. Again, this arguably belongs 'downstream'. Page 50 of the guideline says 'The guidelines will be disseminated through both the mental health and NCD dissemination activities of the Global action plan on the public health response to dementia 2017–2025... Dissemination will be supported by the publication of selected systematic reviews and evidence in peer review journals, and presentations and workshops at key conferences and events'.
CITATION: Reducing the risk of dementia
Editorial The Lancet volume 393, issue 10185, p2009, may 18, 2019
Published: May 18, 2019 DOI: https://doi.org/10.1016/S0140-6736(19)31085-2
Dementia is one of the fastest growing public health problems. According to data from the 2016 Global Burden of Disease Study, the number of people living with dementia worldwide more than doubled from 20·2 million in 1990, to 43·8 million in 2016. This number is expected to double again by 2030, with the steepest rises in low-income and middle-income countries where the effects of rapid population ageing are driving the increase in dementia...
Similar to the Lancet Commission on dementia prevention and care, the new WHO guidelines summarise the knowledge base for health-care providers, governments, policy makers, and other stakeholders on factors known to reduce the risk of cognitive decline and dementia. The guidelines make strong recommendations on the potential of physical activity interventions and tobacco cessation for risk reduction...
The release of these guidelines by WHO is clearly a welcome and important step... However, by taking a relatively conservative approach towards dementia, which has only quite recently become a research priority, with the consequence of less accumulated evidence, the ensuing guidelines are potentially rather unambitious. WHO has also not provided much guidance on execution, lacking recommendations for measurement and targets, or an assessment of economics...
Although these guidelines, summarising risk factors, inform clinicians and policy makers, there remains a pressing need for recommendations on stronger public health policies... WHO needs to step up towards a global leadership role, be bolder, and demonstrate true leadership to effect the desperately needed change in the trajectory of dementia and other non-communicable diseases, in order to truly serve the needs of the millions of people living in the shadow of dementia.
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG email@example.com