WHO Releases Six ‘Action Steps’ to Combat PD Global Disparities

A World Health Organization (WHO) consultation workshop on global disparities in Parkinson’s disease (PD) has suggested six avenues for action to address the needs of these patients.

Since 2000, PD has increased 81% and related deaths have increased 100% globally. In addition, many patients affected by PD live in low- and middle-income countries and experience large inequalities in access to neurologic care and essential medicines.

To address these issues, the Brain Health Unit at the WHO developed six “action steps” it says are urgently required to combat global disparities in PD.

The need for action is great, lead author Nicoline Schiess, MD, MPH, a neurologist and technical officer in the WHO’s Brain Health Unit in Geneva, Switzerland, told Medscape Medical News.

“In adults, disorders of the nervous system are the leading cause of disability adjusted life years, or DALYs, and the second leading cause of death globally, accounting for 9 million deaths per year,” Schiess said.

The WHO’s recommendations were published online recently as a “Special Communication” in JAMA Neurology.

Serious Public Health Challenge

Parkinson’s disease is the fastest growing disorder in terms of death and disability, and it is estimated that it caused 329,000 deaths in 2019 — an increase of more than 100% since 2000.

“The rise in cases is thought to be multifactorial and is likely affected by factors such as aging populations and environmental exposures, such as certain pesticides. With these rapidly increasing numbers, compounded by a lack of specialists and medicines in low- and middle-income countries, PD presents a serious public health challenge,” Schiess  said.

The publication of the six action steps is targeted toward clinicians and researchers who work in PD, she added. The steps address the following areas:

1. Disease burden

2. Advocacy and awareness

3. Prevention and risk reduction

4. Diagnosis, treatment, and care

5. Caregiver support

6. Research

Schiess noted that data on disease burden are lacking in certain areas of the world, such as low- and middle-income countries, and information “based on race and ethnicity are inconsistent. Studies are needed to establish more representative epidemiological data.”

She said that advocacy and awareness are particularly important since young people may not be aware they can also develop PD, and sex and race differences can factor in to the potential for delays in diagnosis and care. “This is often due to the incorrect perception that PD only affects older people,” she noted.

In addition, “a substantial need exists to identify risks for PD — in particular the risks we can mitigate,” said Schiess, citing pesticide exposure as one example. “The evidence linking pesticide exposure, for example paraquat and chlorpyrifos, with the risk of developing PD is substantial. And yet in many countries, these products are still being used.”

Under the heading of diagnosis, treatment, and care, Schiess noted that patients with PD in “low resource settings” and low-to-middle income countries are unable to obtain “even the most basic medications” to treat PD.

“Strengthening health and social systems, and building capacity to improve medical care, including rehabilitation and palliative care and medication access, are vital. Also, education and training of primary healthcare professionals, growing the neurological workforce, and increasing the use of digital technology such as telemedicine, are key mechanisms to improving diagnosis and sustainability of care,” she said.

For caregiver support, Schiess pointed out that the progressive nature of the disease and timing of onset are contributors to increased caregiver burden. Other contributors, as the disease advances in a patient, include the development of cognitive impairment, psychiatric manifestations, and sleep disruption.

“Solutions that could decrease the burden on caregivers includes providing an accurate and timely diagnosis and training and education to caregivers, such as the WHO iSUPPORT program, as well as psychosocial, financial, and community-based support,” said Schiess.

For research, she noted that the amount of studies in the field of PD has grown because of increased funding and a greater number of initiatives over the past two decades.

“Continuing to build on this momentum is important in order to generate new treatment options, better care, and research capacity, especially in low- and middle-income countries,” she said.

Schiess emphasized the urgency for adopting these measures as cases of PD continue to rise.

“The take-away message for clinicians is that Parkinson disease is a growing global public health issue and there is a pressing need for a global public health response to address health and social requirements for people with PD,” she said.

Schiess reports having received grants from the Edmond J. Safra Foundation paid to her institution during the conduct of the study.

JAMA Neurol. Published online July 11, 2022. Full text

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