Six Action Steps to Address Global Disparities in Parkinson Disease A World Health Organization Priority
The World Health Organization convened a committee to discuss global challenges in Parkinson’s disease (PD) and one of us (M.O.) was part of the effort and follow-up publication. In an ironic twist of fate, our first meeting was cancelled due to a new global health challenge; COVID-19. The group persisted, and together we recognized there was a huge unmet need. We came up with 6 steps to address global disparities in PD. We considered these “6 workable avenues for action in the domains of disease burden; advocacy and awareness; prevention and risk reduction; diagnosis, treatment, and care; caregiver support; and research.” This article was published as a special communication in JAMA Neurology.
It is estimated that PD caused 329 000 deaths in 2019, an increase of more than 100% since 2000.
Additionally, the Global Burden of Disease study conducted between 1990 and 2016 which was based on a global study of 195 countries and territories, identified PD as the fastest growing neurological disorder when measured using death and disability.
Most people affected by PD actually live in low- and middle-income countries (LMICs) and experience large inequalities in access to neurological care and essential medicines.
The 73rd World Health Assembly (WHA) of resolution 73.10 developed an intersectoral global action plan for epilepsy and other neurological disorders in consultation with member states.
Parkinson’s disease became one of the neurological disorders.
Here were the priorities for “actionable steps.”
Priority 1: Disease Burden
“In sub-Saharan Africa, a lack of reported PD case studies has led to the belief that PD is less common in Africa than the rest of the world. However, current evidence suggests that, in reality, people with PD in Africa and other resource-limited areas often have poor access to health care and are thus often unidentified.”
Priority 2: Advocacy and Awareness
“Increased awareness of PD and improved clinical diagnostic skills are possible contributing factors to the rise in PD incidence and prevalence. Advocacy and awareness are particularly important, as factors such as young age at onset of PD and sex and race differences can factor into a potential for disparate care and delays in diagnosis.”
Priority 3: Prevention and Risk Reduction
“A substantial need remains to specifically identify clear risks for PD, particularly the modifiable ones.”
Increased risk exposure to pesticides, amphetamines, methamphetamine, lack of physical activity, heavy metals, air pollution, traumatic brain injury, and industrial solvents, such as trichloroethylene (TCE).
Priority 4: Diagnosis, Treatment, and Care
Strengthening Health and Social Systems and Building Capacity
“Appropriately trained non-physician health care workers could potentially diagnose PD in rural clinics. This approach has already made headway, with PD specialist courses for health care professionals in countries such as Tanzania, Ghana, South Africa, and Ethiopia and also online in 2021.”
Ensuring the Availability of Essential Drugs, Diagnostics, and Interdisciplinary Therapies
“According to the WHO Atlas for Neurological Disorders, only 37 of 110 countries had levodopa/carbidopa consistently available in primary care settings.”
Mucuna pruriens (velvet beans) and the Vicia faba (broad bean) contain measurable and clinically active levodopa levels; could we consider as a substitute for levodopa in resource-limited countries.
Priority 5: Caregiver Support
“Caregivers can experience limitations in social interactions, frustrations with medication administration, and limitation in their capabilities to provide care as the disease progresses, which may ultimately catalyze the difficult decision to consider an alternative living facility.”
Priority 6: Research
“Promoting research in low to middle income countries (LMICs) is crucial to investigate cultural and population differences of variable risk factors, genetics, and phenomenology of PD.”
Global and Regional Health Policies to Implement the PD Strategies
“The adoption of the intersectoral global action plan on epilepsy and other neurological disorders20 will be paramount to coordinating efforts and leveraging momentum to advance the agenda of neurological conditions, such as PD, in all settings.”
Bottom line: It is time for actionable steps to be taken before Parkinson’s overwhelms the planet.