Brain disorders where resources are scarce: The unfinished agenda

Abstract

In the aggregate, neurologic, psychiatric, and developmental disorders (NPDDs) are the largest contributor to the global burden of disease. Further, more than 90% of the world's NPDDs occur in low- and middle-income countries, while less than 10% of global resources that are intended to alleviate these problems are available to these countries. The “burden” is even larger than usually cited, since many of the disorders that neurologists are called upon to manage are the result of factors arising outside the nervous system, and these entities are not fully captured, as currently tabulated. For example, dementia and depression caused by HIV/AIDS is not fully accounted for within NPDDs. Awareness of the enormous impact of NPDDs globally, and in low- and middle-income countries specifically, is increasing.1 However, translation of this awareness into improved patient care has proceeded slowly. I will explore some of the factors involved in attempting to reduce the health disparity affecting the hundreds of millions of individuals with NPDDs in low- and middle-income countries. NPDDs occur in often-difficult local environmental contexts. Where famines occur, the consequences of malnutrition dominate. Where HIV is prevalent, its nervous system consequences overwhelm other NPDDs. Armed conflict and forced migration make health care delivery difficult to impossible. Where immunization programs are impeded, brain infections flourish. Where alcohol abuse is epidemic, its developmental and adult effects on the nervous system are also epidemic. Local belief systems, stigma, and other cultural features impede recognition and treatment. Poverty alone produces both human capital and facility shortages. All of these fundamental issues are interwoven with national and regional politics and corruption, and all lead to enormous disparities in comparison with wealthy countries. While many of these …