Thinking About Brain Health

OPINION


The conditions in which we live, learn, work, and play profoundly affect our health. These conditions, referred to by scholars as “social determinants of health,” impact our ability to receive good health care and practice healthy behaviors. They influence our overall quality of life and shape our lifetime health risks and outcomes.


The social determinants of health start with access to quality health care (including mental health care), but they include access to a stable income, good education, quality housing, nutritious food, safe streets, community connections, and a healthy environment.


The social determinants of health are critically important when we consider Alzheimer’s disease and other causes of dementia. As we await hoped-for treatment breakthroughs, research continues to highlight the role of so-called “modifiable risk factors” in preventing dementia in the first place. These risk factors include high blood pressure, lack of physical exercise, obesity, diabetes, depression, hearing loss, smoking, social isolation, low educational attainment, excessive alcohol intake, traumatic brain injury, and air pollution.


An August 2020 report from the Lancet Commission on Dementia Prevention, Intervention, and Care said that addressing the 12 risk factors listed above could delay or prevent 40% of dementia cases worldwide.


Yet the social determinants of health directly affect our ability to address and “modify” these “modifiable risk factors.” Most of the risk factors require access to good health care, while others are impacted by income, access to healthy food, adequate housing, strong educational institutions, connectedness in communities, and clean air. These resources are not equally available across the globe. Nor are they shared equitably among all Americans.


Many voices are calling for more funding for dementia research. We support this call and hope for more progress. Other voices call for Americans to change their health-risking “lifestyles” to avoid dementia. But these voices rarely acknowledge what resources are required to make these changes, to “modify” these “risks.”


Ultimately, our ability to prevent dementia may depend the most on our willingness to address policies that directly impact the social determinants of health in our communities and across the nation.