the roots of conflicts and the causes and consequences of climate change. A supportive environment means redressing the growing inequalities among and within societies. To tackle these challenges, we need healthy brains, and mental and social health. In the digital age and a knowledge-based economy – where human brain capital is the basic currency – lifelong learning and its application are essential. This integration is necessary to achieve the overarching vision of holistic brain health for all, for maximising human creativity, productivity, development and evolution. This common vision will create synergy among all individuals and organisations that share the vision. In this era, when humans have created artificial intelligence with phenomenal capacities, our focus should be on enhancing individual and collective human intelligence. We need to understand why dementia occurs, and also to unravel the determinants of superlative human intelligence towards achieving ‘supermentia’. We need to characterise various types of human intelligence and understand the genetic and environmental factors that could be optimised to achieve supermentia in the highest possible number of humans. This may be facilitated by various forms of brain computer interfaces. This will require integration among all spheres of human development and technological advancement. TOWARDS INTEGRATIVE SOLUTIONS Integration could occur around the concept of holistic brain health. At the “ Anyone dealing with human behaviour and motivation should begin thinking about how these problems relate to the brain and anyone dealing with the brain needs greater understanding of the behavioural consequences of healthy and afflicted brains”
global level the WHO could do more to customise its recommendations beginning with ‘best buys’, provide more guidance about individual and collective motivation, and share strategies for implementation. Also at the global level, primary health care forms the essential basis for surveillance, prevention, care and rehabilitation. At the national level, brain plans are a first step to action. These plans could serve as an intersectoral integration of non-governmental organisations, identifies gaps and allows economies of scale. Integration ensures that the whole is greater than the sum of its parts by facilitating a synergistic yield that has a greater impact than the additive effects of isolated efforts. Perhaps the most promising is at the local level, in populations small enough to have a sense of community. The approach needs to be comprehensive to identify the most important and addressable problems, and thus is customised and cost-effective. Additionally, the ABC of whole health – activity and rest including sleep, a balanced diet, and connecting with others – needs to be implemented. It should be simple: identify the minimum that yields the maximum to assure that the majority of the population can practise their ABC. ‘Think globally, but act locally’ continues to be good advice. Small gains communities and individuals. Integration avoids duplication, in a population are equivalent to big gains in a minority of individuals. For example, a 2 mmHg decrease in systolic blood pressure is desirable but barely meaningful. An equal decrease at the population level translates into a 24% reduction in the occurrence of stroke. A stroke doubles the chances of developing dementia. So implementing the ABC addresses the common risk factors of stroke, ischemic heart disease and dementia, while promoting holistic brain health, productivity and well-being. So, we need to: 1. Adopt holistic brain health as the overarching integrating goal by all. 2. Fund the development of a core, actionable holistic brain health ‘Wikipedia’. 3. Pilot new approaches to promote holistic brain health at the global, national and community levels. By promoting holistic brain health for all by all, we will facilitate integration, resulting in better brains to build a better world. ▪
VLADIMIR HACHINSKI Vladimir Hachinski is a Distinguished University Professor in the Department of Clinical Neurological Sciences at the Robarts Research Institute of Canada’s Western University and the former president of the World Federation of Neurology. He has made major contributions to the understanding, diagnosis, treatment and prevention of stroke and dementia, and leads a dementia prevention/brain health initiative.
MAYOWA OWOLABI Mayowa Owolabi is a professor and the director of the Center for Genomic and Precision Medicine at the University of Ibadan. He is an expert in brain health, global health, neurorehabilitation, implementation science and genomic epidemiology of hypertension, stroke and other non-communicable diseases. He won the 2021 World Stroke Organization Global Award for Outstanding Contributions to Clinical Stroke Research. He is lead co-chair of the WSO-Lancet Commission on stroke and a member of the World Health Organization Technical Action Group on NCDs (Research and Innovation).
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Health: A Political Choice – From Fragmentation to Integration
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