Ep05: Brain Health and Alzheimer's: Global Strategies for Collaboration

Episode Transcript

[00:00:04] Dan Kendall: Welcome to the Brain Health News podcast, part of Health Unmuted. This podcast was created by Mission Based Media in association with the Davos Alzheimer's Collaborative. This episode was recorded live in January, 2024 at the World Economic Forum Annual Meeting in Davos, Switzerland. 

In this episode, Health Policy Watch board member and reporter Carlos Dora interviews two esteemed guests. The conversation touches on the importance of collaboration between nations, the role of international organizations like the UN in addressing brain health and the need to tackle stigma and discrimination related to mental health in communities. 

Now let's jump into the conversation with your host, Carlos Dora. 

[00:00:44] Carlos Dora: Good afternoon from the World Economic Forum Annual Meeting in Davos, Switzerland, and welcome to Davos Brain Health Impact conversations. This is curated by the Davos Alzheimer Collaborative. My name is Carlos Dora, and I'm at the board of the Health Policy Watch, which is a global network of journalists that produces public health news globally in a regular basis.

Today you have in the studio the fortune of having his excellency Luis Gallegos, an Ecuadorian diplomat who is the president of the board of the UN training and research organization UNITAR. He also serves as the president of the global initiative on aging foundation and is the former minister of foreign affairs of Ecuador.

Those are some of his many roles and functions, and we look forward to hearing more as our discussions answers. We're also fortunate to be joined by the founding director of the Brain and Mind Institute of the Aga Khan University, Dr. Zul Merali. Zul is a neuroscientist and a pharmacologist by training in over 40 years of academic engagement.

Welcome to both and let's get started right into it. We're here talking about brain health and Alzheimer's disease. So Zul, could you bring us up to date, up to speed with what is brain health and what are the main elements and risk factors to it, so we know what we're talking about. 

[00:02:20] Zul Merali: Thank you. And that's a big question.

Brain health, in essence, like when you talk about, let me use an analogy. We use your heart health, for example. What does that mean? That means that the organ heart is functioning properly, is pumping properly, arteries are clear, that the rhythm of the heart is responsive to the demands. In effect, the organ is working well.

So brain health is very similar in the sense that you want your brain to be functioning smoothly, efficiently, properly. Now, brain turns out to be one of the most complex organisms in the universe. Billions of neurons interconnected into this three pound mush between your ears. But the functioning is very critical, and it's very sensitive because 

many things can disrupt the functioning of the brain. Brain uses electrical signals and chemical signals to send messages across these wires, the circuits within the brain. When something goes awry and damages that functioning, then you have consequences, and the consequences could be so diverse because everything you see, do, think, act, is controlled by your brain.

So, all those functions can be damaged, or altered if the functioning of the brain is not going on smoothly.

[00:03:39] Carlos Dora: And here in the Davos Alzheimer's Collaborative, what is it that you're proposing, that the collaborative is proposing as things to be done to protect brain health? Can you bring us up to speed to that?

[00:03:49] Zul Merali: Yes, so there's many things you can do to protect brain health. For example, you can prevent damage, just like what would you do for your heart, like cardiovascular. They'll tell you don't smoke, you can do exercise, things like that to keep the heart healthy. Similarly, for the brain, we're learning many, many different things influence brain function.

 Such as exercise, such as diet, such as cognitive stimulation of the brain, such as even social connectedness, all that influence the functioning of the brain. We want to find ways of promoting it. But in addition to that, so this is kind of prevention promotion kind of thing. But when something starts going to go awry in the brain, you need to figure out what is causing the disruption

in the brain circuits, and then you need to treat those. So there are medications, drugs that actually influence how the brain functions. So there are many different ways in which you can keep the brain healthy. You keep it healthy, or once it gets impacted, then you treat the symptoms of what's disrupting the functioning of the brain.

[00:04:53] Carlos Dora: Excellent. Thank you for bringing us up to date with the complexity, but also with the fact that there's a handful of things, or some fingers perhaps, as analogy used, that can be done to improve brain health. Now, this is an international forum of people from low and middle income countries, rich countries, businesses.

Ambassador Gallegos, what can you tell us about how do we bring that power of the connectedness across countries, both in the global South, in the global North, to play in favor of protecting brain health.

[00:05:31] Luis Gallegos: I think that you have in the structure of the world the necessity of a South South and North South cooperation.

The development of this issue is a worldwide phenomenon, and we need worldwide solutions for it. I think many of the things that are being done so interestingly in the university in Kenya, for example, can be expanded to other countries that don't have that capacity of analysis and can be shared.

In many of the cases, South South is not intensive in financial resources, but in methodologies and in capabilities, it would be extremely important. What we're talking about, brain health. What are the parameters that we can jointly use all over the world in the global south? From the global north

what we expect, of course, is more technology, more advanced technology and medicines, a solution to a vaccine for Alzheimer's and others. But we also require more understanding of this process as a joint venture of the world. I think the multilaterals, the World Health Organization, the United Nations have a role to play in that dissemination

and the components of how cooperation should be guided. 

[00:06:42] Carlos Dora: You're very experienced in international diplomacy and you've been playing various roles. What do you see are the mechanisms? Because for people on the ground, it may feel very dispersed and what different governments are doing. 

Can they do something useful, and what are the mechanisms that they can come together? How is it that they can come together to create something which is tangible and then can, lead to immediate results to people on the ground?

[00:07:08] Luis Gallegos: I think the discussions on the level of the world scenarios in the multilateral forum, both in the World Health Organization or in the UN in general and whatever are the agencies, you have to, go back to the territories in the ground.

What affects the people? How can you impact the lives of human beings? If not, it's theoretic. It's the basis of a new topic solution or an ideal solution, which we all think is important. But, the effect on the ground, the effect on every individual, and the capacity of giving hope to the populations that are under this situation, as we move forward an agenda for the future, we have to look into how we solve the problems of the people of the world in a tangible way, in a way they feel integrated, in which societies are brought to the medium range and to solve the problems of health,

you need also the component of conviction, of narrative, of expertise. I think all of those count when you look into the solution on the ground. 

[00:08:07] Carlos Dora: Let me press you for something specific there. The Convention for Disability played an enormous role in bringing disability to the fore. People didn't know, didn't realize that there were disabled people, etc.

The convention has created a co-momentum. Do you see that there's a space for that in this space? In brain health and in Alzheimer's? 

[00:08:29] Luis Gallegos: I had the honor of chairing the working group that developed the convention for persons with disabilities. Let me tell you that I never thought that the convention would be so successful. So universal in the sense that 187 countries are members of the convention and that obligate these countries in the compliance with the mandates of the convention to protect the rights of persons with disabilities.

I firmly believe that in aging, we must have a U. N. convention that generalizes and constitute a framework for the obligations of state to protect the 1 billion people who are aging now. We are more aging than children being born, and by the year 2050, which is only 26 years from now, we will be 2 billion people who are aging.

Therefore, what we are talking about is a paradigm shift in the component of population that will change our societies drastic. 

[00:09:23] Carlos Dora: Excellent. Dr. Merali, perhaps you can add something.

[00:09:27] Zul Merali: I wanted to pick up a point there, and that is how can there be north south, south south collaborations?

A lot of the information that we have about Alzheimer's disease and dementia comes from the global north. Is it applicable in the south? Is the biology the same? Are we going to respond to the medications the same way? We need to understand the biology that is impacting the people more directly,

and hence, then we need to figure out the correlatory between the north and the south. But if we don't address this issue of the biological basis of the populations that we're talking about, we might develop a trajectories of treatments that might be very different. 

[00:10:10] Carlos Dora: I know you're doing some enormous pieces of research and collaborating internationally from Kenya.

Can you tell us about your experience? What are you doing exactly in terms of research to respond to some of these questions, but also reflecting on the international cooperation around research?

[00:10:28] Zul Merali: Yeah, so on that front, what we're trying to do is actually collect biological data on the people like the genetic makeup, the neurochemical signals, the hormonal changes that you can pick up, in the blood or in saliva or in urine samples.

We need to study those, because I think through those we'll be able to develop biomarkers that identify who's at risk, who needs what kind of treatment and things like that, that's one aspect. The other aspect is that the primary care system in the developing countries is very different from what we're used to in the global north.

You don't have the same type of an infrastructure that we're used to in the global north. And we imagine that the same thing is happening in global south, but it's not. So what we're trying to do is not rely so much on that system, but essentially go right to the community level, go door to door and be able to assess and provide low level interventions

right at their doorstep. Because these people who are poor, sometimes don't have transportation, sometimes don't have the time, and they can't get to the clinics, it's expensive. So, we need to figure out a way of how can we address those that are marginalized right at their doorstep.

[00:12:43] Carlos Dora: And what are you doing specifically in terms of the interventions? Are you following the Five FINGERS? Are you doing other interventions? Tell us a bit about that. 

[00:11:50] Zul Merali: So because we're following a cohort of 100,000 people, we're looking at them across the lifespan. Depending upon the age bracket, for the very young ones, we're trying to implement programs in the schools to increase their knowledge and teach how them looking after their own health.

Physical and mental health is going to be protective for them when they grow older. But then when you look at young people, youth, for example, that are at risk because they develop a lot of mental ill health, for example, a lot of pressures. They become much more vulnerable to developing dementia and Alzheimer's disease.

So can we prevent that and hence prevent consequently Alzheimer's disease development? Then you go into the elderly population, and of course, these are people that are most at risk. So what can we do for them? Those that are asymptomatic right now and for those that are starting to develop symptoms of dementia and Alzheimer's.

[00:12:46] Carlos Dora: Two issues come to mind. One is the fact that people avoid talking about these things, stigma. And the other is, how do you get governments to buy into funding 100,000 people for cohort study, which I'm sure many researchers would be interested in hearing from you. But I would like to hear from both of you about engaging governments in a specific way as you are, but also addressing stigma.

 

[00:13:13] Zul Merali: So in terms of engaging governments, we're fortunate in Kenya because our governments are very forward thinking. They've done risk analysis for the country. They've come up with plans about how to implement interventions, and how to make a case for support, but that's as far as it goes.

So they're very forward thinking, intellectually, but when it comes to resourcing, their priorities are very different. So they are not able to resource funding the work directly. So we work with partners. Davos Collaborative, Alzheimer's Collaborative is an example where they're funding or helping us implement some of our thinking and our tests, helping us develop tests that are ideal, more culturally sensitive for the populations that you're dealing with.

For example I’ll tell you, one of the standard tests for dementia is that you get a person to draw a clock face with the time on it. in these marginalized communities many people have not seen a clock face, or if they've seen a clock face, it's a digital one. So are those tests appropriate?

So we need to have what we're doing with the Davos Alzheimer Collaborative is to develop much more specific, culturally sensitive tests in those populations. 

[00:14:22] Carlos Dora: And do they link with a normal health system, or is it completely in parallel? 

[00:14:26] Zul Merali: It's a very good question. So that's exactly what we're doing. We are using standardized tests that have been developed in North America on standardized population that have been diagnosed already clinically,

and then we're using our new tests and see how well they correlate and how effective they are at picking up dementia very early on. 

[00:14:45] Carlos Dora: Super. Ambassador, tell us about stigma. You work with disability, which is an issue which has been, plagued by stigma. How do you get around that with governments with other partners?

[00:14:58] Luis Gallegos: I think we have a problem of ageism historically, we have a problem of thinking that people beyond 60 beyond 65 are to go into retirement. They're not supposed to do anything. When the world has changed and there is very active capabilities in persons who are living longer, who are healthier, who are living for up to a hundred years.

I think a child born today will very easily get to a hundred years in the future. Ageism is an issue that is also registered in law because, the age of 65 comes from the 1800s. Your bank will not loan you money, your car dealer will not sell you a car on loan,

your insurance company begins to raise a series of legal matters that tend to affect the lives of people who are aging. And this has an enormous implications in the economy, in the banking system. Most of the people who we're talking about who are aging now have worked all their lives to have a house, to have a car, to better their lives, to better the lives of their children, to educate their families.

Nowadays, people, prefer not to own cars, prefer not to own apartments, to live in what is called liquid society. So I think the transition is here. We must learn to adapt to these new formulations, but the discussion is ongoing, even in the elections as you know, in the United States and others are talking about the issue of age.

So I think it's very proper that we look into this very pointedly to the level of how you discriminate against persons who are aging. 

[00:16:28] Zul Merali: And if I may say one more thing about discrimination, is that when you are diagnosed with mental ill health or dementia, for example, in some of the developing countries.

Because they don't understand that it is something has gone awry with the brain, they start ascribing what is behaviorally observable in people who are impacted, to things that are beyond their control. So they'll think about, maybe somebody gave you an evil eye, or maybe you were not religious enough and you're being punished, or all kinds of strange constructs.

And as a consequence people develop stigmas against those people. So, for example, it's not unusual for people who have worse behaving strangely, in older age or when you have dementia for example, they might say that they turn into witches, for example, and then they will be treated accordingly. 

Sometimes very harshly by the community they'll be ostracized. So the stigma can go pretty far in terms of impacting the well being of the people. 

[00:17:25] Carlos Dora: What brings to mind is how then do you engage communities in changing this understanding? How do you involve them? Do you have experience of that in Kenya, and in the international conventions? 

[00:17:38] Luis Gallegos: Yes, I think you have to look into what the experience is on hate language, the use of stereotypes. And this is not only for people who are with mental illness like Alzheimer's. You have challenges in gender. You have challenges in other aspects of being discriminated against, because of religion, because of race and so on.

The world is still in a process of building an agenda where the narrative is equilibrium, where the inclusion, where you have differences as a positive, not as a negative. But I see with fear the construction of a narrative that is a narrative of hate, anti migrant, anti racial, which preoccupies me very much.

So what we have just been talking about is the use of a stereotype of Alzheimer's as an issue of negative, active racism or active segregation that is not acceptable under international law. 

[00:18:36] Carlos Dora: What have you experienced in Kenya, for example, working with communities? How can you deal with that? I mean, do you bring communities on board?

[00:18:43] Zul Merali: Yeah, so what we do is we actually have a couple of anthropologists, medical anthropologists and social anthropologists that work with us. We go in the community and talk to them and ask them how do they recognize dementia, for example. Do they recognize dementia? How do they treat them and how do they look after this?

So we actually get, from the communities themselves, we extract information about what language they use, how do they define all these disorders and these conditions. And then, once we understand what needs to be corrected, then there is a matter of education. We need to talk to them and give them information about why people are acting the way they are to point out that it has to do with the functioning of the brain.

They become much more kinder and much more gentler in their empathy for those that are suffering kicks in, because now they know they are not to blame, that it's not an evil spirit that possessed them, but it's something that's going wrong with their brains. 

[00:19:43] Carlos Dora: We're coming to the end of our interview, but I would like to give you a space for pointing out what you think is the way to start.

The Davos Alzheimer's Collaborative on brain health has covered and has spans a lot of social issues, there's medicines, there's technologies like vaccines and immune products, there's also the understanding of social and behavior and risk factors. Considering the complexity and the links with social issues, with employment issues, with economic issues, I mean

where do you see are we now and where do you see are the main points to move this agenda forward? 

[00:20:23] Zul Merali: That's a big question. And I think what I can say is that at least what we're trying to do is what we're calling a living lab approach. In other words, you don't just go and collect data on a single time frame that we're collecting data longitudinally from communities over a long period of time, across the lifespan.

So we develop knowledge and impact of our interventions in a very systematic way. And I think that way we will not only find out what works, what doesn't work, what works in prevention, what works in treatment, but also what are the long term implications and how do we change the cultures along the way.

It takes a lot of work. It takes a village to change the construct that we're thinking about. 

[00:21:07] Luis Gallegos: I think that, if we are in Davos in the World Economic Forum and we're discussing Alzheimer's, I think that there is a consciousness and this collective is extremely important that you have this type of effect in societies that will bring not only economic consequences, but profound social change. As you have in the aging population, as you have the construction of a new paradigm in societies worldwide, with instant communication with the systems of social media, you need to construct a narrative and build a positive aspect.

But more so, I think that If you're talking also about bridging the frontier and having a vaccine and looking into what aging will represent for the future of society, it is a time for valuable discussion. It's a time for experts to sit down and look at it from different angles and be able to suggest to policymakers, to civil society, to the media,

what the solutions for the future agenda should be and what a society as we foresee in the future should have as a component of inclusion, justice and equity. 

[00:22:15] Carlos Dora: That's brilliant. Very pleased to be here with you and that the Davos Collaborative is putting forward brain health and is bringing all these people together, including yourselves.

So thank you for your insights ambassador Luis Gallegos, thank you professor Merali. Very pleased to have you here and up to next time, up to the next conversation.

[00:23:22] Dan Kendall: Thanks for tuning in to the Brain Health News podcast by Health Unmuted. Be sure to visit healthunmuted.com for more information about brain health. 

Please also visit www.davosalzheimerscollaborative.org for more information about the work they're doing to promote brain health and end Alzheimer's globally.