New ‘Neurology Atlas’ reveals treatment gap and disparities in distribution of resources

In the run-up to the World Congress of Neurology in Kyoto the new "Neurology Atlas" was published today. Even though there has been progress in the availability of neurological care worldwide and great improvement is being made in diagnostic and therapeutic tools, appalling disparities in the availability of treatment do persist. This treatment gap remains to be closed, experts point out. The good news is that the important impact of brain health on global health is increasingly recognized by international organizations and political decision makers.

There is no health without brain health, and therefore the prevention and management of neurological diseases must have a high priority in health policy and planning. It is very encouraging to see that this important insight is increasingly shared by political decision makers at different levels and that national governments as well as international organizations get more and more involved in the promotion of brain health", says Prof Raad Shakir, President of the World Federation of Neurology (WFN) on the eve of the organization's XXIII World Congress (WCN 2017). This major scientific event will bring together thousands of experts in Kyoto, Japan, from 16 to 21 September.

Neurology Atlas shows unequal distribution of resources

Several sets of new data will be presented at the WCN 2017 that document the importance of neurological conditions as well as the resources devoted to neurological care. A new study on the burden of neurological disease to be discussed at the Congress will show the high prevalence of brain diseases and their societal impact.  Furthermore the new WHO-WFN Neurology Atlas (Second Edition) published today shows that the resources available for neurological diagnosis, therapy and access to neurological care are very unevenly distributed globally. "These new data will give us additional arguments to make the point that sufficient resources for brain health have to be provided at all levels", states WFN President Shakir.

The Neurology Atlas is a project by the WHO in close collaboration with the WFN. „It is an important tool for developing and planning services for people with neurological disorders" Prof Shakir says. The second edition presented today compiles data from 132 countries and two territories, thus representing 94 percent of the world population.

"We still observe a treatment gap and disparities in the distribution of neurological resources that remain to be overcome", Prof Shakir says. "It is simply unacceptable that the question whether or not a neurological patient has access to fundamental therapeutic options largely depends on where he or she lives."

The Neurology Atlas draws a picture of the unjust distribution of resources in many respects.

For example, the global median of the total neurological workforce - defined as the number of neurologists, neurosurgeons and child neurologists available in a country - is 3.1 per 100.000 inhabitants. Low income countries report a median of 0.1 per 100.000 inhabitants, compared with a median of 7.1 per 100.000 in high income countries. There are also considerable disparities among the WHO regions with the European region showing a median neurology workforce of 9 per 100.000 while the African and the South East Asia Region report figures of 0.1 und 0.3 respectively which is far below acceptable levels, says Prof Shakir. "There have been considerable improvements as compared to the first Atlas Edition in 2004, but we have to consider that the highest improvements are again observed in the high income countries."

Another disturbing finding, according to Prof Shakir: "The access to essential medications for neurological disorders is low in primary care settings across WHO regions, particularly in the African and South-East Asia regions." Only half of the countries surveyed (55 percent) report the availability of one of more anticonvulsants at all times in primary care settings - in other words half of the people with epilepsy worldwide do not have access to these essentials medications at all times.

Other key results of the new WHO-WFN report concern policies on neurological disorders, legislation for these conditions, or financing for neurology. Only a total of 24 percent of countries report stand-alone neurological health policies, with a major deficit in low- and middle-income countries. A total of 41 percent of countries report the existence of legislation on epilepsy, and 30 percent report the existence of legislation relating to people with dementia. 58 percent of countries report the availability of financial support for people with neurological disorders, the figure for the low- and middle-income countries is 24 percent.

Political support for brain health

However there is also good news, according to the WFN President: „We can justifiably claim that brain health and the prevention and management of brain disorders are finally an integral part of the global political agenda of global health issues. The important impact of neurological diseases on global health is increasingly being discussed in the framework of international organizations, in particular the UN and the WHO."

For example, the WHO Global NCD Action Plan 2013 - 2020 emphasizes the importance of neurological conditions and their prevention. The same holds true for the Sustainable Development Goals of the United Nations which, in their target 3.4 on NCDs, aim at reducing by one-third premature mortality from non-communicable diseases by 2030 through prevention and treatment.

Prof Shakir: "Later this autumn we will also be able to contribute expertise to the WHO Global Conference on NCDs hosted by the President of Uruguay from 18 to 20 October in Montevideo. We will work hard to make sure that the summit will also be specifically targeting brain health." The outcomes of the meeting will serve as an input into the discussions at the World Health Assembly and the third High-level Meeting of the United General Assembly on NCDs in 2018.