Article Text

The World Health Organisation’s work on public health aspects of neurology
  1. Aleksandar Janca,
  2. L Prilipko,
  3. J A Costa e Silva
  1. Division of Mental Health and Prevention of Substance Abuse, World Health Organisation, 1211 Geneva 27, Switzerland
  1. Dr A Janca.

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Promotion of public health aspects of different fields of medicine has always been one of the important objectives of the World Health Organisation (WHO). Over the years WHO has been undertaking public health related activities in the field of neurology ranging from the coordination of international research projects to the organisation of international meetings on public health aspects of specific neurological disorders such as epilepsy, dementia, and stroke. In the realisation of such activities WHO has been relying on a network of WHO Collaborating Centres (neurological institutions of excellence in different parts of the world); the WHO Expert Panel on Neuroscience (members of which are distinguished neuroscientists including Nobel Prize winners); and many international, professional, and non-governmental organisations working in the field of neurology and related disciplines —for example, the World Federation of Neurology, World Federation of Neurosurgical Societies, European Federation of Neurological Societies, International Federation of Multiple Sclerosis Societies, International League Against Epilepsy, International Bureau for Epilepsy, International Headache Society, and the International Association for the Study of Pain. Regular annual meetings with the presidents and representatives of the organisations mentioned above have been organised in Geneva, thus serving as an international platform for exchange of information on ongoing and future projects in the fields of neurology and neuroscience in general.

To give more prominence to the work of WHO on neuroscience and its public health aspects, a Unit on Neuroscience has recently been established in the WHO Division of Mental Health and Prevention of Substance Abuse and a Programme on Neuroscience has been created with the help of experts in the fields of neurology, neurosurgery, biological psychiatry, genetic epidemiology, etc.

The WHO Programme on Neuroscience covers both applied and basic neuroscience and is focused on development of new methods for prevention, diagnosis, and treatment of mental and neurological disorders. Particular attention has been given to standardisation of research and treatment methodology; development of guidelines and consensus statements on controversial issues in psychiatry and neurology (for example, ethical issues of molecular genetics); and development and coordination of educational and training programmes on research methodologies used in applied and basic neuroscience.1

The WHO Programme on Neuroscience covers three specific areas—namely, applied neuroscience in mental disorders, applied neuroscience in neurological disorders, and basic neuroscience. In the area of applied neuroscience in mental disorders, emphasis is given to psychopharmacology and biological psychiatry, as well as to neuroimaging, neuropathological, neurochemical, and molecular genetic investigations. Numerous research projects have been carried out in the framework of this part of the overall programme, including studies on biological markers of mental disorders; studies of environmental influences on brain function and development; studies of psychopharmacological drug effects in different populations; and development of consensus statements on major issues in biological research on mental disorders.

The activities in the area of applied neuroscience in neurological disorders are focused on prevention, diagnosis, and treatment of neurological disorders which are, due to their frequency and severe consequences, seen as a public health problem in developing and developed parts of the world. Utilising relevant diagnostic and therapeutic techniques, the main goal of this part of the overall programme is to ensure that an appropriate range of care is made available to all people with neurological disorders in each country. Such a goal can be achieved only if neurological treatment and care are incorporated into primary healthcare programmes, in which most people with neurological disorders all over the world receive their long term treatment and care. Consequently, priority is given to neurological disorders that are common and responsive to treatment, such as epilepsy, infectious diseases, cerebrovascular disorders, movement disorders, and headaches. Special attention is paid to the needs of children and elderly people.

The activities in the area of basic neuroscience are focused on the international coordination of basic neuroscience research in humans and animals, as well as on research on fundamental brain mechanisms in health and disorder. This part of the overall programme covers neuroimmunology; neurovirology; neurochemistry; molecular neurobiology; neuropsychopharmacology; neuropathology; behavioural and cognitive neuroscience; computational and mathematical neuroscience; and structural and functional brain imaging. The activities in the field of basic neuroscience relate to the coordination of research studies including multicentre collaborative trials; organisation of training on basic neuroscience for specialists in developing countries; and exchange of scientific information between developed and developing countries.

In the framework of the briefly described WHO Programme on Neuroscience, WHO launched a Global Initiative on Neurology and Public Health with the following objectives: (1) to draw attention to the frequency, severity, and consequences of neurological disorders and to have them acknowledged as public health problems by the Ministries of Health of the 190 WHO Member States; (2) to emphasise existing possibilities for the prevention of neurological disorders on a large scale basis; (3) to ensure that neurological treatment and care are provided at all levels of healthcare systems and in particular in primary care settings where most patients with neurological disorders in different parts of the world receive their treatment and care.2

The audience to which this WHO initiative is aimed includes neurologists, neuropaediatricians, neurosurgeons, neuropsychiatrists, neuropsychologists, specialists in neurorehabilitation, general practitioners and primary care physicians, specialists in public health, health planners and health economists, the mass media, and the general public.

The following aspects of neurological disorders are included in the agenda of this WHO initiative: epidemiology and health statistics; assessment of costs and health needs; organisation of services; measures aimed at reducing the burden on the family and the community; planning of programmes and policies for the control of neurological disorders and the factors that contribute to their incidence; research on risk and other public health factors relevant to the control of neurological disorders; education and training of healthcare workers dealing with patients with neurological disorders; and formulation and implementation of specific strategies for prevention of neurological disorders in developing and developed countries.

The first phase of the project was focused on the organisation of a series of symposia on public health aspects of neurology and meetings on public health aspects of specific neurological disorders such as dementia, stroke, headache, and epilepsy in Canada, China, France, Germany, India, Italy, Japan, Spain, and Turkey. A similar series of meetings on public health and neurosurgery was recently launched by WHO in Madrid and a WHO Working Group on Neurosurgery has been established in collaboration with the World Federation of Neurosurgical Societies.3

The main goal of the second phase of the WHO Global Initiative on Neurology and Public Health is to develop an educational programme on public health aspects of neurology including a set of training materials for different levels of health professionals (neurologists and residents of neurology; primary care physicians; and medical students). The training materials will be translated and tested in several countries representing different regions of the world and a network of WHO training and reference centres will be established. The elements of the educational programme will be introduced into the training curricula of medical and other schools in which neurology is taught, taking into account local practices and traditions.

In setting up the agenda and in carrying out educational and other activities of this global initiative, WHO has been closely collaborating with the World Federation of Neurology and other national and international, professional, and non-governmental organisations concerned with prevention and treatment of neurological disorders. The workshop on Neurology and Public Health in the United Kingdom, jointly organised with the Royal College of Physicians and Association of British Neurologists, serves as an excellent example of the WHO collaborative activities in the field of public health aspects of neurology and it is hoped that the papers presented at the workshop and published in this journal will raise awareness of neurologists and other professionals in the United Kingdom and elsewhere of the burden which neurological disorders pose on communities and societies all over the world.

Acknowledgments

Between 1993 and 1995, the WHO Global Initiative on Neurology and Public Health was coordinated by Dr Matilde Leonardi.

References

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