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Ok Submit Article Log in Register Log in Submit Article Log in Subscribe Claim Access provided by Editorial| Volume 21, ISSUE 10, P857, October 01, 2022 PDF [129 KB]PDF [129 KB] FiguresFigures Save Add To Online LibraryPowered ByMendeley Add To My Reading List Export Citation Create Citation Alert Share Share on Facebook Twitter LinkedIn Mendeley Sina Weibo more Reprints Request Top The debate on how to protect and restore brain health The Lancet Neurology The Lancet Neurology Search for articles by this author Published:October, 2022DOI:https://doi.org/10.1016/S1474-4422(22)00350-7 The debate on how to protect and restore brain health Next ArticleTreatment of asymptomatic carotid artery stenosis In a further development in a landmark year for the neurological community, on Aug 9, 2022, WHO released a position paper called Optimizing brain health across the life course. WHO describes this document as “a technical complement” to its Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022–2031 (IGAP), adopted by the World Health Assembly in May, 2022, which makes neurological disorders a policy priority and demands the creation of national strategic plans to reduce the burden of neurological diseases. Although targeted mostly at policymakers, this position paper is also highly relevant for neurologists, psychiatrists, and neuroscientists—who work at the forefront of the fight against the growing burden of brain diseases—because its main purpose is to guide the implementation of the IGAP. With that aim, WHO initiates a welcome debate on a subject with profound theoretical and practical consequences: the definition of brain health and its operationalisation. Since its foundation in 1948, WHO has defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity”. In the same ethos, WHO now considers brain health not only as the absence of a brain disease but also as either a capacity or state “of brain functioning across cognitive, sensory, social-emotional, behavioural and motor domains, allowing a person to realise their full potential over the life course”. According to this conceptualisation, brain health spans “a continuum that can be considered to range from well-being to disorders and disability across each of the aforementioned domains”. Many definitions of brain health have been debated over the years by the research community. In WHO's position paper, its conceptual framework is the result of an intricate and lengthy “iterative process of desk reviews, consultations, and peer review”, during which members of WHO's Brain Health Unit consulted with dozens of experts and included people with lived experience of brain disease. WHO also commissioned a scoping review of the academic literature, describing the attempts at defining brain health before coming up with its own definition, which is possibly the broadest and most ambitious definition of brain health yet and, consequently, might be the most difficult to operationalise. In WHO's view, five determinants influence the brain health of an individual: physical health; the environment; physical safety and financial security; opportunities for learning and social connections; and access to health and social services. Adding further complexity to their conceptualisation, brain health and mental health are considered intrinsically related but distinct. According to WHO, brain health is a lifelong determinant of mental health, which is “a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community”. The position paper concludes that the optimisation of brain health “improves mental and physical health”, in an assertion that rounds up WHO's holistic approach. Because of its institutional mission, which is “to transform public health” worldwide, WHO's stance on brain health cannot be reductionist and seems judicious. However, further evidence and debate are warranted to clarify WHO's conceptual framework of brain health. WHO's definition of health has received at least two major criticisms since it was established in the 20th century. First is the implicit medicalisation of societies: absolute “physical, mental, and social well-being” is unachievable; hence, this definition could transform every individual into a patient (with consequent potential gains for the pharmaceutical and other industries). Second is the idealistic nature of the definition, which makes health difficult to monitor with the precision that a more pragmatic definition could achieve. These criticisms could be now extended to WHO's definition of brain health. Policymakers and international institutions should note that neuroscience is the only window into how the brain works and, therefore, the cornerstone of understanding brain health and counteracting criticisms. This position paper is a necessary first step towards the implementation of the IGAP and to galvanise a crucial debate around brain health. The paper prudently acknowledges that brain health is “an evolving concept” and, hence, that further research is needed to establish measures to monitor brain health over a life course. Only with a substantial boost in funding for the neurosciences can WHO's holistic view on brain health be refined and operationalised. Neuroscience offers the most promising route to understanding how best to protect and restore brain health. View Large Image Copyright © 2022 Medical Body Scans/Jessica Wilson/Science Photo Library Article Info Publication History Published: October 2022 Identification DOI: https://doi.org/10.1016/S1474-4422(22)00350-7 Copyright © 2022 Published by Elsevier Ltd. 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