Nearly half of the world’s population suffers from some form of neurological condition ranging from simple migraines to Alzheimer’s, and yet in low-income countries, more than 75% of those needing treatment cannot access care, according to a World Health Organisation report released on Tuesday (World Brain Day).
The treatment gap – the difference between the number of people with a condition and those receiving treatment for it – is the combined result of misconceptions about neurological diseases, low diagnostic capacity and limited access to medicines, reports Health Policy Watch.
“Most people with neurological disorders struggle to get the treatment they need because these medicines do not reach them or are too expensive,” said Dévora Kestel, director of the WHO’s Department of Mental Health, Brain Health and Substance Use.
If that were to change, the impact of neurological disorders could be significantly decreased and quality of life improved.
Using epilepsy and Parkinson’s disease as tracer conditions, the report identifies bottlenecks in existing treatments, particularly access to care in remote and rural areas, and calls for more education about neurological disorders to reduce stigma.
More than 80% of premature deaths from these conditions occur in low- and middle-income countries, which have only 0.1 neurologist, on average, per 100 000 people, compared with 7.1 neurologists per 100 000 people in high-income countries.
On a more positive note, when diagnosis and treatment are available, then some 90% of strokes, 40% of dementia cases, and 30% of epilepsies are preventable.
Neurological conditions were a leading cause of healthy life years lost (disability-adjusted life years, or DALYs) in 2021, ahead of cardiovascular diseases, said the researchers, and over the past three decades, DALYs associated with neurological conditions rose by 18% – and are likely to increase further because of ageing populations and lifestyle and environmental risks.
The report recommends that neurological treatments be integrated more completely into the essential medicines lists (EMLs) of national authorities as well as WHO’s own recommended essential medicines listing.
Local healthcare systems also need to budget for procurement of such medications, while international donors and agencies consider how to make treatments more affordable, including through donor-supported funding, it suggested.
Barriers to global goals
The report identifies barriers limiting attainment of goals set by the World Health Assembly in 2022 to improve access to neurological care and treatment by 2031.
The goals, laid out in the Intersectional global plan on epilepsy (IGAP), are to have four out of five countries providing essential medicines and technologies to manage these disorders in primary healthcare settings within the coming decade.
The paucity of medicines available in pharmacies and clinics was also highlighted by country-level surveys included in the report, which emphasised the need for regional manufacturing of vital medicines as well as more robust supply chains, overall, to ensure the drugs were accessible.
Additionally, it called for more specialised healthcare staff, especially in rural areas, as well as more systematic data collection to improve surveillance.
Neurological disorders
See more from MedicalBrief archives:
Neurological conditions now the number one cause of disease globally
The high lifetime risk of neurological disease
Environmental factors worsen neurologic health – US review of 30 years’ research