Kapittel 7International knowledge and experience concerning brain health

The Directorate of Health believes that international exchange of experience concerning brain health would provide an opportunity to learn from other countries and share knowledge, which in turn can promote brain health in Norway. In addition, international collaboration can be important for promoting better brain health globally. The Directorate of Health has therefore reviewed strategies, programmes and plans for brain health from other countries and held meetings with relevant professionals and organisations. This chapter gives a concise account of the key aspects of international strategies, plans and programmes for brain health. To understand the content of the various international brain health plans, it is recommended that they be read directly, as translations may be imprecise.

7.1 World Health Organization

In 2022, the WHO launched a global strategy for brain health. This strategy describes what brain health entails, identifies factors that help promote brain health throughout a life course and identifies the basis for good brain health. During the development of this strategy, the Directorate of Health was in regular contact with the WHO. As a result of the WHO’s initiative, Norway’s experiences of coordinating the country’s brain health strategy are referred to in the WHO’s global brain health strategy (on page 69, box 9) (World Health Organization, 2022).

The WHO describes five factors, or areas, that affect brain health throughout a life course. These areas apply at both individual and system level. The factors are: (1) physical health, (2) health-promoting environment and climate, (3) safety and security, (4) learning and social connection and (5) equitable access to high-quality services. The five areas have many underlying goals that can help optimise brain health throughout a life course. The goals under the five areas primarily target the health and care sector, education, legislation, finance and economics, work and infrastructure (ibid.).

7.2 European Academy of Neurology

The European Academy of Neurology (EAN (ean.org)) is an association for national neurology associations in Europe. The association has developed a brain health strategy called “One brain, one life, one approach”, which was launched in 2022. The strategy was created by researchers and specialists from institutions and organisations across Europe (Bassetti et al., 2022).

The EAN’s brain health strategy contains five key points: (1) collaboration concerning brain health to promote brain health globally, (2) support for European neurological communities and health policymakers in initiating campaigns aimed at individuals and their needs. They (3) also encourage research into how brain diseases can be prevented and brain health safeguarded and (4) work to increase knowledge of brain health among students, neurologists, general practitioners, health professionals, patients, caregivers and the rest of the population. They also want (5) to raise awareness among the general population of brain diseases and the importance of good brain health (ibid.).

7.3 Sweden

The Swedish Brain Foundation (2022; 2023a) has developed a plan called “A plan for the brain”. The aim of this brain plan is to urge the Swedish Government to draw up a national strategy and action plan for the brain.

The Swedish Brain Foundation proposes six target areas:

1. Well-being throughout life: Promote the well-being and health of citizens as an investment, with continuous preventive measures.
2. Learning environment: Provide all children and adolescents with the prerequisites necessary to achieve goals at kindergarten and school, with inclusive and safe learning environments and competent staff.
3. Safeguarding and care of the brain: Organise health and care services with the right skills and continuous follow-up, reduce the number of stroke cases and suicide through prevention and treatment.
4. Better support for relatives: Ensure the safety of and support for relatives of individuals with brain disease, injuries and functional impairments.
5. Research, development and innovations for the brain: Increase government funding for brain research and strengthen multidisciplinary collaboration.
6. Brain-friendly education and societal development: Promote well-being and development, reduce negative factors for the brain and prevent brain diseases and injuries

7.4 Finland

The Finnish National Brain Health Programme (Aivoliitto, 2022a) was launched by the Finnish Brain Association (Aivoliitto) in 2022. The programme period will last at least seven years, from 2023 to 2029. The Finnish Brain Association and partners are responsible for implementing the programme. The programme is aimed at three age groups, with common objectives adapted to each group. It emphasises result-oriented thinking and a proactive approach, focusing on protective factors. The long-term aim is to create a sustainable society that supports brain health, with the following performance goals to achieve this:

• Understanding brain health and brain diseases and valuing brain well-being have been strengthened
• Brain ergonomics has been applied to workplaces
• Everyone has an opportunity to have refreshing and restorative sleep
• The sense of belonging has been strengthened – everyone is a citizen, together.

In addition to these four performance goals, there is a particular focus on adequate physical activity, healthy nutrition and abstinence from drugs, all of which are fundamental to good brain health. Practical implementation began in 2023 with communication and training and in 2024 the theme is sleep (national brainwashing – with sleep). Finland has also produced an English translation and a Swedish summary (Aivoliitto, 2022b).

7.5 Germany

In 2022, the German Brain Council (2022) launched the German brain plan. The plan period lasts until 2030. The German Brain Council has produced a roadmap, a timeline with focus areas:

• 2022/2023: Raise public awareness of the German Brain Plan, networking and identify deficiencies in care.
• 2024/2025: Pilot projects concerning traumatic brain injury and depression, promoting early diagnosis and treatment and rehabilitation
• 2026/2027: Implementation of research findings in clinical practice and improvement of treatment for all brain diseases
• 2028/2029: Assessment of new areas to focus on in further work (ibid.)

7.6 Scotland

Alzheimer Scotland launched a strategy for brain health and dementia research in 2021. This work was carried out in collaboration with various academic and research communities (Alzheimer Scotland, 2021). The strategy will serve as a framework for organisations to create their own action plans to ensure the safeguarding of brain health and research concerning dementia, both locally and nationally.  To facilitate this, the strategy recommends four approaches (Alzheimer Scotland, 2021) as follows:

• the creation of local research boards for brain health and dementia
• the establishment of a national forum
• a national survey to identify bottlenecks and barriers that hinder research into brain health and dementia at every level
• the establishment of a national board to oversee the implementation of the strategy across Scotland

7.7 Switzerland

The Swiss Brain Health Plan (Bassetti et al., 2023) has a duration of ten years, from 2023 to 2033. The plan was drawn up by clinicians and researchers with a range of professional backgrounds within the health sector.

The Swiss Brain Health Plan has five goals:

1. Raise awareness of brain health and brain diseases among the general population and health professionals and increase the political focus on the topic.
2. Strengthen education and training of health professionals in brain health and brain diseases.
3. Promote research into brain health, as well as prevention and treatment of brain diseases.
4. Prioritise a holistic approach to brain health with measures at individual, community and global level and promote collaboration between different groups.
5. Support and involve patients and relatives, increase user participation, reduce stigma and assess societal and economic benefits

7.8 Poland

The Brain Plan for Poland was developed by specialists in law, economics, neurology and psychiatry, as well as patient organisations. The group that led the work was established by the Neuropozytywni Foundation, the Institute of Healthcare Management at Lazarski University and the law firm DZP. The brain plan was launched in 2019. There is also a summary of the Brain Plan for Poland, which has been translated into English (NeuroPozytywni, undated).

The brain plan includes an analysis of the key systemic challenges within prevention and treatment, as well as direct and indirect costs of five brain diseases (MS, depression, Parkinson’s disease, schizophrenia and stroke). The brain plan has four primary objectives and a number of sub-objectives. In summary, the four primary objectives are as follows:

1. Introduce the definition of brain diseases and include the prevention of brain diseases in the directory of health priorities.
2. Prevent, diagnose and treat brain diseases through national programmes and the training of doctors.
3. Increase investments in brain research and development through the state medical research agency.
4. Improve the quality of life of patients and their families through coordinated services.

The Brain Plan for Poland has not been adopted at Ministry of Health level through a government document and brain health has not yet been recognised as a priority within health policy in Poland (Izabella Dessoulavy-Gładysz, personal communication, 28.10.24).

7.9 Italy

The Italian Brain Health Strategy was developed by the neurological association Società Italiana di Neurologia (2024a), abbreviated as SIN. The strategy was launched in connection with World Brain Week in March 2024 (Società Italiana di Neurologia, 2024b) and is based on their manifesto of “One Brain, One Health”. The strategy period covers eight years, from 2024 to 2031. The plan was drawn up in order to implement the WHO’s global and cross-sector action plan for epilepsy and other neurological disorders (World Health Organization, 2023a). Italy supports the WHO’s definition of the term ‘brain health’ as described in the WHO’s global brain health strategy, “Optimizing brain health across the life course” (World Health Organization, 2022).

The goals of the Italian Brain Health Strategy are to:

1. Implement the WHO Global Action Plan in Italy, including health planning, prevention, research, diagnosis, treatment, rehabilitation and social factors.
2. Promote brain health for all citizens of all ages to reduce the impact of brain diseases.
3. Initiate a constructive dialogue with patients, health professionals, partners, politicians and the general population.
4. Launch a national brain health programme with the active involvement of all stakeholders.
5. Collate different aspects of brain diseases to create a holistic understanding, in line with the EU initiative “Healthier Together”.
6. “One Brain, One Health” is placed high on the agenda to ensure greater awareness and focus on the concept.