The key to all health

Building brain and mental health can unlock good health, productivity and well-being – and the G20 leaders are uniquely placed to develop, fund and implement the measures needed to reduce the burden of neurological disease

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he human brain mediates our thoughts, behaviour and action, and in turn is shaped and changed by our behaviour, experiences and physical environments. Good brain and mental health hold the key to overall health, wealth and well-being, and strategies to promote it create a knowledge-based society that makes the right decisions for its people. 

The ongoing crises

Several recent and ongoing crises are adversely affecting brain and mental health. Populations are rapidly rising in the numbers of older aged adults, who face serious social isolation, risk of disease and disability, and economic problems that compromise their independence and quality of life. Stroke, dementia and major depressive disorders are leading contributors to disease among older people, and 87% of deaths due to neurological disease are caused by stroke and dementia. This rise in the burden of neurological diseases is having a major impact on brain and mental health globally.

The Covid-19 crisis has had an unprecedented effect on brain and mental health, due to the combination of social isolation, adverse effects of the virus on the brain and poor prioritisation of resources for the vulnerable during the pandemic. Ongoing crises related to conflict are also taking their toll. War, violence, politics, ideologies and, at a more interpersonal level, conflict among family and communities can cause long-standing psychological problems. Additionally, the climate crisis is contributing to poor brain and mental health – and pollution is a recognised major risk factor for stroke and dementia. All these crises are happening at the same time, and, importantly, they are not just exacerbating each other but are linked and interconnected in their causation and consequences.

A unifying, catalysing approach

The good news is that a common strategy that addresses these conditions together and combines resources will promote overall health and well-being. Solutions must be found not one at a time but approached together for global impact. To achieve this, brain and mental health should be made a top priority by all countries, governments, communities and individuals. Most neurological and mental health diseases such as stroke, dementia and major depressive disorders share common risk factors including hypertension, obesity, physical inactivity, lack of sleep, low education and stress. Therefore a combined approach needs to be developed to prevent neurological and mental health disorders together. Building cognitive and emotional resilience is crucial to protect against the effects of ongoing and future crises. Key strategies to promote brain and mental health are regular exercise, healthy dietary habits, active social engagement and adequate sleep. Periodic monitoring of blood pressure and weight from midlife significantly reduces the risk of neurological diseases. Reducing stress is also key to mental, physical and social well-being. Education is critical. Progress in the ongoing technological, digital and artificial intelligence revolution needs pedagogical methods that focus on the ability to innovate and constantly adapt, both mediated through the brain. The capacity to evaluate risk appropriately and change behaviour to improve brain and mental health needs to be inculcated.

Ongoing challenges and opportunities

To address this challenge globally, the World Health Organization is developing the Intersectoral Global Action Plan on epilepsy and other neurological disorders for promoting optimal brain health throughout life. Although brain and mental health disorders represent a global problem, given the diversity in sociocultural factors, and differences in healthcare systems, strategies must be developed to respond to national, regional and local needs. The inclusion of these diverse perspectives is crucial to identify novel and equitable solutions that can combat the rising challenge of neurological disorders. Working with natural leaders of local communities, micro-credentialling and the use of digital technology can be effective in implementing global policy in local contexts. In India an innovative public health initiative for brain health has been developed based on global recommendations but adapted to local needs in the state of Karnataka, in a synergistic collaboration among the think tank NITI Aayog, the state health ministry, and primary, secondary and tertiary levels of healthcare systems. A Virtual Behavioural Medicine programme from Canada has successfully harnessed digital technology to develop a novel model of care for dementia – another example of international and local synergistic collaboration addressing brain and mental health to promote overall health, prosperity and harmony.

Suggested next steps

The G20 leaders with their significant resources, political will and health awareness are uniquely placed to develop, fund and implement effective measures in their countries to reduce the burden of neurological disease.

Specifically, we suggest that:

• Brain and mental health become a top priority.
• Governments sponsor new approaches to the joint prevention of stroke, ischemic heart disease and mental disorders through a lifespan focus on championing brain and mental health.
• The philosophy is adopted that education is the best vaccination to prevent disease and nurture brain and mental health for promoting productivity and well-being.

The G20, as a forum of leaders, has an opportunity to catalyse and foster new relationships among international organisations and commit to improving brain and mental health and ensure a better world for the future.