Dementia

Dementia: A public health priority
> CHAPTER 7 > THE WAY FORWARD
The framework for action
The effective implementation of efforts to address the global
burden of dementia requires that certain actions be executed and
that they involve researchers, practitioners, civil society organizations,
policy-makers, health planners and international development
agencies. The key actions include advocacy and awareness-raising,
developing and implementing dementia policies and plans, health
system strengthening, capacity-building, supporting caregivers and
research. These actions need to be context-specific and culturally
relevant. All of them require financial, technical and human
resources.
Advocacy and awareness-raising
Advocacy for policy change and awareness-raising are two distinct
actions. Both approaches are critical and are complementary to
each other. The first targets governments at local, national and
international levels with the aim of encouraging policies that will
improve dementia care and services. The second focuses on
people with dementia, their families and society in general, aiming
to improve their understanding of dementia and to change public
attitudes and practices. This in turn creates a demand for services
and builds capacity for grass-roots advocacy and for holding
governments to account. Even in the absence of an ideal policy
environment, well-constructed population-level awareness-raising
efforts can help people with dementia and their families to be in a
stronger and better-informed position to seek a diagnosis, plan for
the future, and make more appropriate use of health and social
services. Advocacy efforts in high-income countries have grown
with increasing intensity over the past decades, with some initiatives
also from LMIC. Civil society organizations such as Alzheimer
associations have spearheaded this push (see chapter 6). The task
of convincing government financers, development assistance
agencies and other donors that investment in dementia care and
services is critical is a challenging one, especially in view of constrained
budgets and many competing health and development
priorities. Media advocacy, social marketing and social mobilization
can serve as conduits of information and as mechanisms for
advocacy to build support among the various global health and
development stakeholders.
Both in coordination with policy changes and as a separate action
for overcoming the stigma surrounding dementia, there is substantial
promise in implementing awareness-raising efforts. Public
communication efforts that are coordinated with policy changes
can enhance the effectiveness of both approaches and, together,
can help create an environment in which more targeted programmes
in health and social care systems and communities can
succeed. Depending on the infrastructure within a country, efforts
to raise awareness can occur at multiple levels, from the national
government to local authorities and community-based organizations.
Developing and implementing
dementia policies and plans
A coordinated multisectoral approach is required for comprehensive
policy development, involving relevant government departments,
civil society and the private sector. National action is
essential for systems change to become a reality. The issues and
actions related to dementia could be part of a separate strategy,
policy or plan or included in general health, ageing or mental health
policy, depending upon the country’s context.
The policies and plans will remain on paper unless implementation
issues are addressed. A broad-based set of programmatic initiatives
will need to be implemented in a sustained fashion in order to
improve dementia care and services. These programmes should
include a range of approaches such as awareness-raising, risk
reduction, early diagnosis and treatment, continuing and integrated
care through the health and social care sectors, financial and legal
protection, workforce education, and research. Financial commitment
is required for optimal implementation of dementia policies
and plans. Depending on the existing infrastructure, national and
subnational authorities are responsible for implementing public
health and health and social care programmes. Other programme
implementers include universities, NGOs and other organizations in
civil society and, in some LMIC, development agencies.
Health and social systems
strengthening
There is widespread acceptance that only through building or
strengthening health and social systems will outcomes for people
with dementia and their caregivers be improved. To achieve the
goals, it is essential that health and social services are equipped to
provide the range of care and services required for persons with
dementia and their caregivers. The capacity of health and social
workers needs to be built so that they work in ways that are
responsive, fair and efficient to achieve the best health outcomes
possible with the resources available. Investment in health information
systems is needed in order to develop, improve and standardize
methods for collection of data on the health determinants and
health status of people with dementia and their caregivers. In
addition, a good health financing system is required to ensure that
people with dementia and their caregivers can use needed services
and are protected from financial catastrophe or impoverishment if
they have to pay for them.
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