Global action plan on the public health response to dementia 2017 2025

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Global action plan on the public health response to dementia 2017 2025
Global action plan
 on the public health
response to dementia
     2017 - 2025
Global action plan on the public health response to dementia 2017 2025
Global action plan
 on the public health
response to dementia
     2017 - 2025
Global action plan on the public health response to dementia 2017 2025
                                                                                                                                       Dementia is a major cause of disability           families. It is an important opportunity
    Global action plan on the public health response to dementia 2017–2025                                                             and dependency among older adults                 for individuals, communities and Member
                                                                                                                                       worldwide, affecting memory, cognitive            States to realize the vision of a world in
    ISBN 978-92-4-151348-7
                                                                                                                                       abilities, and behavior, ultimately interfering   which dementia is prevented and people
                                             © World Health Organization, 2017                                                         with one’s ability to perform daily               with dementia and their carers receive
                                                                                                                                       activities. The impact of dementia is not         the care and support they need to live a
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    IGO licence (CC BY-NC-SA 3.0 IGO;                                          only significant in financial terms, but also     life with meaning and dignity. The World
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                                                                                                                                       physical, mental and social wellbeing for         for present and future generations.
                                                                                                                                       people with dementia, their carers and
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Global action plan on the public health response to dementia 2017 2025

Overview of the global situation                                          2

Vision, goals and cross-cutting principles                                4

Actions and targets for Member States, the Secretariat and
international, regional and national partners                             6

Action areas                                                              8
  Action area 1: Dementia as a public health priority                    10
  Action area 2: Dementia awareness and friendliness                     14
  Action area 3: Dementia risk reduction                                 18
  Action area 4: Dementia diagnosis, treatment, care and support        22
  Action area 5: Support for dementia carers                             26
  Action area 6: Information systems for dementia                        30
  Action area 7: Dementia research and innovation                        32
Appendices                                                               36

  Decision on the global action plan on the public health response       36
  to dementia
  Indicators for measuring progress towards the defined targets of       37
  the global action plan on the public health response to dementia
  and means of verification
  Links to other global action plans, strategies and programmes          43

  List of other documents that are linked to the global action plan on   43
  the public health response to dementia

Global action plan on the public health response to dementia 2017 2025
OVERVIEW OF                                                                                                                                 worldwide, having a significant impact
                                                                                                                                                not only on individuals but also on
                                                                                                                                                                                                                          dementia in low- and middle income
                                                                                                                                                                                                                          countries will contribute further to

    THE GLOBAL                                                                                                                                  their carers, families, communities and
                                                                                                                                                societies. Dementia accounts for 11.9%
                                                                                                                                                                                                                          increasing inequalities between
                                                                                                                                                                                                                          countries and populations.

    SITUATION                                                                                                                                   of the years lived with disability due to a
                                                                                                                                                noncommunicable disease.1 In light of the
                                                                                                                                                improved life expectancy globally, this
                                                                                                                                                                                                                    6. Currently, the gap is wide between
                                                                                                                                                                                                                        the need for prevention, treatment
                                                                                                                                                figure is expected to increase further.                                 and care for dementia and the actual
                                                                                                                                                                                                                        provision of these services. Dementia
    1. Dementia is an umbrella term for several                        3. Crucially, although age is the strongest                       5. Dementia leads to increased costs for                                    is underdiagnosed worldwide, and, if
        diseases that are mostly progressive,                               known risk factor for the onset of                                governments, communities, families and                                    a diagnosis is made, it is typically at
        affecting memory, other cognitive                                   dementia, it is not an inevitable                                 individuals, and to loss in productivity                                  a relatively late stage in the disease
        abilities and behaviour, and that interfere                         consequence of ageing. Further, dementia                          for economies.                                                            process. Long-term care pathways (from
        significantly with a person’s ability to                            does not exclusively affect older people,                                                                                                   diagnosis until the end of life) for people
        maintain the activities of daily living.                            with young onset dementia (defined as                               ●● In 2015, dementia costs2 were                                        with dementia are frequently fragmented
        Alzheimer disease is the most common                                the onset of symptoms before the age                                   estimated at US$ 818 billion, equivalent                             if not entirely lacking. Lack of awareness
        form of dementia and may contribute                                 of 65 years) accounting for up to 9%                                   to 1.1% of global gross domestic                                     and understanding of dementia is often
        to 60–70% of cases. Other major forms                               of cases.4 Some research has shown a                                   product, ranging from 0.2% for low-                                  to blame, resulting in stigmatization
        include vascular dementia, dementia with                            relationship between the development of                                and middle-income countries to 1.4%                                  and barriers to diagnosis and care.
        Lewy bodies, and a group of diseases that                           cognitive impairment and lifestyle-related                             for high income countries. By 2030, it                               People with dementia are frequently
        contribute to frontotemporal dementia.                              risk factors that are shared with other                                is estimated that the cost of caring for                             denied their human rights in both the
        The boundaries between different forms                              noncommunicable diseases. These risk                                   people with dementia worldwide will                                  community and care homes. In addition,
        of dementia are indistinct and mixed forms                          factors include physical inactivity, obesity,                          have risen to US$ 2 trillion, a total that                           people with dementia are not always
        often coexist.                                                      unbalanced diets, tobacco use and                                      could undermine social and economic                                  involved in decision-making processes
                                                                            harmful use of alcohol as well as diabetes                             development globally and overwhelm                                   and their wishes and preferences for
                                                                            mellitus and mid-life hypertension. Other                              health and social services, including                                care are often not respected.
    2. In 2015, dementia affected 47 million                               potentially modifiable risk factors more                               long term care systems specifically.3
        people worldwide (or roughly 5% of the                              specific to dementia include mid-life                                                                                                   7. WHO and the World Bank estimate
        world’s elderly population), a figure that                          depression, low educational attainment,                             ●● People with dementia and their                                       a need by 2030 for 40 million new
        is predicted to increase to 75 million in                           social isolation and cognitive inactivity.                             families face significant financial                                  health and social care jobs globally
        2030 and 132 million by 2050. Recent                                Additionally, non-modifiable genetic risk                              impact from the cost of health and                                   and about 18 million additional health
        reviews estimate that globally nearly 9.9                           factors exist that increase a person’s risk                            social care and from reduction                                       workers, primarily in low-resource
        million people develop dementia each                                of developing dementia.5 There is also                                 or loss of income. In high-income                                    settings, in order to attain high and
        year; this figure translates into one new                           evidence suggesting that overall more                                  countries, the costs related to                                      effective coverage with the broad
        case every three seconds. Nearly 60%                                women develop dementia than men.3                                      dementia are shared between                                          range of necessary health services.
        of people with dementia currently live in                                                                                                  informal care (45%) and social care                                  In addressing dementia, expanding
        low- and middle-income countries and                                                                                                       (40%). In contrast, in low- and                                      the health and social care workforce
        most new cases (71%) are expected to                            4. Dementia is a major cause of disability                                middle-income countries social care                                  with appropriate skill mixes as well as
        occur in those countries.2,3                                        and dependency among older adults                                      costs (15%) pale in comparison to                                    available interventions and services will
                                                                                                                                                   informal care costs.3 The expected                                   be essential to prevent, diagnose, treat
                                                                                                                                                   disproportionate increase in                                         and care for people with dementia.
    2.   WHO. The epidemiology and impact of dementia: current state and future trends. Geneva: World Health Organization; 2015,
         Document WHO/MSD/MER/15.3, available at
         epidemiology.pdf (accessed 8 March 2017).                                                                                         1.    Prince M, Albanese E, Guerchet M, Prina M. World Alzheimer Report 2014. Dementia and risk reduction: an analysis of
    3.   Prince M, Wimo A, Guerchet M, Ali GC, Wu Yutzu, Prina M. World Alzheimer Report 2015. The global impact of dementia: an                 protective and modifiable risk factors. London: Alzheimer’s Disease International; 2014 (
         analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; 2015.                                    WorldAlzheimerReport2014.pdf, accessed 8 March 2017).
    4.   Alzheimer’s Disease International and WHO. Dementia: a public health priority. Geneva: World Health Organization; 2012 (http://   2.    Direct medical and social care costs and costs of informal care., accessed 8 March 2017).                                          3.    Prince M, Wimo A, Guerchet M, Ali GC, Wu Yutzu, Prina M. World Alzheimer Report 2015. The global impact of dementia: an
    5.   Loy CT, Schofield PR, Turner AM, Kwok JBJ. Genetics of dementia. Lancet. 2014;383(9919):828-40. doi:          analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; 2015.
2                                                                                                                                                                                                                                                                          3
Global action plan on the public health response to dementia 2017 2025
VISION,                                                                                           HUMA
                                                                                                     RIGH N
    GOALS AND                                                                                            TS

    CUTTING                                                                                   a.	Human rights of people        b.	Empowerment and              c.	Evidence-based

    PRINCIPLES                                                                                   with dementia
                                                                                                Policies, plans, legislation,
                                                                                                                                   engagement of people
                                                                                                                                   with dementia and
                                                                                                                                                                    practice for dementia
                                                                                                                                                                    risk reduction and care
                                                                                                                                   their carers
                                                                                                programmes, interventions                                          Based on scientific evidence
                                                                                                and actions should be             People with dementia,            and/or best practice, it
                                                                                                sensitive to the needs,           their carers and                 is important to develop
    Vision                                         Cross-cutting                                expectations and human            organizations that               strategies and interventions

    8. T
        he vision of the global action            principles                                   rights of people with
                                                                                                dementia, consistent with
                                                                                                                                  represent them should be
                                                                                                                                  empowered and involved
                                                                                                                                                                   for dementia risk reduction
                                                                                                                                                                   and care that are person-
       plan on the public health response                                                       the Convention on the             in advocacy, policy,             centred, cost-effective,
                                                10. The global action plan is                  Rights of Persons with            planning, legislation,           sustainable and affordable,
       to dementia is a world in which
                                                     grounded in the following                  Disabilities and other            service provision,               and take public health
       dementia is prevented and people
                                                     seven cross-cutting principles.            international and regional        monitoring and research          principles and cultural
       with dementia and their carers
                                                                                                human rights instruments.         of dementia.                     aspects into account.
       live well and receive the care and
       support they need to fulfil their
       potential with dignity, respect,
       autonomy and equality.

    9. The goal of the global action plan is
        to improve the lives of people with      d.	Multisectoral collaboration on the       e.	Universal health and             Equity
                                                                                                                                f.	                             g.	Appropriate attention
        dementia, their carers and families,        public health response to dementia           social care coverage                                               to dementia prevention,
        while decreasing the impact of                                                                                            All efforts to implement
                                                                                                 for dementia                                                       cure and care
        dementia on them as well as on             A comprehensive and coordinated                                                public health responses
                                                   response to dementia requires                Designing and                     to dementia must support         Steps to realize this focus
        communities and countries.
                                                   collaboration among all stakeholders         implementing health               gender equity and                include using existing
                                                   to improve prevention, risk reduction,       programmes for universal          take a gender-sensitive          knowledge and experience
                                                   diagnosis, treatment and care.               health coverage must              perspective, keeping in mind     to improve prevention,
                                                   Achieving such collaboration requires        include financial risk            all vulnerabilities specific     risk reduction, care and
                                                   engagement at the government level           protection and ensuring           to each national context,        support for people with
                                                   of all relevant public sectors, such as      equitable access to a             consistent with the 2030         dementia and their carers
                                                   health (including alignment of existing      broad range of promotive,         Agenda for Sustainable           and generation of new
                                                   noncommunicable disease, mental              preventive, diagnostic and        Development, which               knowledge towards
                                                   health and ageing efforts), social           care services (including          recognizes that people who       finding disease-modifying
                                                   services, education, employment,             palliative, rehabilitative        are vulnerable, including        treatments or a cure,
                                                   justice, and housing, as well as             and social support) for all       people with disabilities,        effective risk reduction
                                                   partnerships with relevant civil society     people with dementia and          older people and migrants,       interventions and
                                                   and private sector entities.                 their carers.                     must be empowered.               innovative models of care.

4                                                                                                                                                                                                 5
Global action plan on the public health response to dementia 2017 2025
    11. Effective implementation of the           12. The roles of these four groups often
        global action plan on the public                overlap and can include multiple
        health response to dementia will                actions cutting across the areas of
        require actions by Member States, the           governance, health and social care
        Secretariat and international, regional,        services, promotion of understanding
        national and subnational partners.              and prevention in dementia, and
        Depending on national context, these            information, evidence and research.
        partners include but are not limited to:        Country-based assessments of the
                                                        needs and capacities of different
       ●● development agencies, including               partners will be essential to clarify the
          international multilateral agencies           roles and actions of stakeholder groups.
          (for example, OECD, United
          Nations development agencies             13. Targets included in this global action
          and the World Bank), regional                 plan are defined for achievement
          agencies (for example, regional               globally. Each Member State can be
          development banks), subregional               guided by these global targets when
          intergovernmental agencies and                setting its own national targets, taking
          bilateral development aid agencies;           into account national circumstances.
                                                        Each Member State will also decide
       ●● academic institutions and research            how these global targets should
          agencies, including the network               be adapted for national planning,
          of WHO collaborating centres for              processes (including data collection
          mental health, ageing, disability,            systems), policies and strategies.
          human rights and social determinants
          of health, and other related networks;   14. The global action plan recognizes
                                                        that each Member State faces specific
       ●● civil society, including people               challenges in implementing these
          with dementia, their carers and               action areas and therefore suggests a
          families and associations that                range of proposed actions that each
          represent them, and other relevant            Member State will need to adapt to the
          organizations;                                national context.

       ●● the private sector, health insurance,
          and the media.
6                                                                                                   7
Global action plan on the public health response to dementia 2017 2025
Action areas
15. The global action plan comprises seven action areas, which form the
     underlying structural framework:

    Dementia as a                               Dementia awareness         Dementia            Dementia diagnosis,
    public health priority                      and friendliness           risk reduction      treatment, care and

     1                                            2                         3                   4

    Support for                                 Information systems        Dementia research
    dementia carers                             for dementia               and innovation

     5                                            6                         7

8                                                                                                                    9
Global action plan on the public health response to dementia 2017 2025
Action area 1:                                                                                                          20. Promote mechanisms to monitor                  entity responsible for noncommunicable
                                                                                                                                  the protection of the human rights,            diseases, mental health or ageing within

     Dementia as a
                                                                                                                                  wishes and preferences of people with          the health ministry (or equivalent body),
                                                                                                                                  dementia and the implementation of             in order to ensure sustainable funding,
                                                                                                                                  relevant legislation, in line with the         clear lines of responsibility for strategic
     public health                                                                                                                objectives of the Convention on the
                                                                                                                                  Rights of Persons with Disabilities and
                                                                                                                                                                                 planning, implementation, mechanisms
                                                                                                                                                                                 for multisectoral collaboration, service
     priority                                                                                                                     other international and regional human
                                                                                                                                  rights instruments. These mechanisms
                                                                                                                                                                                 evaluation, monitoring and reporting
                                                                                                                                                                                 on dementia.
                                                                                                                                  include safeguards for concepts such
                                                                                                                                  as legal capacity, self determination,      22. Allocate sustainable financial resources
                                                                                                                                  supported decision-making, and power             that are commensurate with the
                                                                                                                                  of attorney, and for protection against          identified service need and human and
     16. Given the range of the population                                    comprehensive, multisectoral approach              exploitation and abuse in institutions as        other resources required to implement
          affected directly or indirectly by                                   will support the recognition, and address          well as in the community.                        national dementia plans and actions,
          dementia and the complexity of this                                  the complex needs, of people with                                                                   and set up mechanisms for tracking
          condition, dementia requires a whole-                                dementia within the context of each           21. Set up a focal point, unit or functional         expenditures on dementia in health,
          of-government, broad, multistakeholder,                              country. This approach is in line with the         division responsible for dementia or             social and other relevant sectors such as
          public health approach. Such an                                      principle of universal health coverage and         a coordination mechanism within the              education and employment.
          approach will lead to a comprehensive                                the standards outlined in the Convention
          response from the health and social                                  on the Rights of Persons with Disabilities.
          care system (both public and private)
          and other government sectors, and will
          engage people with dementia and their                           18.	Global       target 1:                        ACTIONS FOR THE SECRETARIAT
          carers and other relevant stakeholders                          	75% of countries will have
          and partners.                                                                                                      23. Offer technical support, tools and                 partners and establishing or
                                                                            developed or updated national
                                                                                                                                  guidance to Member States, and                     strengthening national reference
     17. Rationale. The development and                                    policies, strategies, plans or                        strengthen national capacity in:                   centres, WHO collaborating centres
          coordination of policies, legislation,                            frameworks for dementia, either                                                                          and knowledge-sharing networks;
          plans, frameworks and integrated                                  stand-alone or integrated into                      ●● leadership within health ministries
          programmes of care through a                                      other policies/plans, by 2025.1                        and other relevant sectors for the            ●● coordinating programmes on
                                                                                                                                   development, strengthening and                   dementia with those on related
                                                                                                                                   implementation of evidence-based                 noncommunicable diseases, ageing,
                                                                                                                                   national and/or subnational strategies           mental health and health systems, and
                                                                                                                                   or plans and associated multisectoral            with service delivery and processes to
     PROPOSED ACTIONS FOR MEMBER STATES                                                                                            resource planning, budgeting and                 ensure maximum synergy and optimal
                                                                                                                                   tracking of expenditure on dementia;             use of existing and new resources.
     19. Develop, strengthen and implement                                    and disability (or equivalent). These
          national and/or subnational strategies,                              undertakings should give consideration           ●● evaluating and implementing                24. Compile and share knowledge and best
          policies, plans or frameworks that                                   to equity, dignity and the human rights             evidence-based options that suit                practices on existing policy documents
          address dementia, whether as separate                                of people with dementia and support                 Member States’ needs and capacities             dealing with dementia, including
          instruments or integrated into other                                 the needs of carers, in consultation                and assessing the health impact                 codes of practice and mechanisms to
          planned actions for noncommunicable                                  with people with dementia and other                 of public policies on dementia by               monitor the protection of human rights
          diseases, mental health, ageing,                                     relevant stakeholders.                              supporting national and international           and implementation of legislation,

     1.   The global target indicators and means of verification are provided in the Appendix.

10                                                                                                                                                                                                                             11
consistent with the Convention on the             principle of universal health coverage.
        Rights of Persons with Disabilities and           Collaboration and partnerships should
        other international and regional human            include all relevant sectors: health,
        rights instruments.                               justice and social services sectors, civil
                                                          society, people with dementia, carers
     25. Promote and support collaboration               and family members, and organizations
         and partnerships with countries at               in the United Nations system, United
         international, regional and national levels      Nations interagency groups and
         for multisectoral action in the response         intergovernmental organizations.
         to dementia and aligning these with the

     26. Create and strengthen associations and          paying explicit attention to the human
         organizations of people with dementia,           rights of people with dementia and their
         their families and carers, and foster their      carers as well as their empowerment,
         collaboration with existing disability (or       engagement and inclusion.
         other) organizations as partners in the
         prevention and treatment of dementia.         28. Support the development and
                                                           application of national dementia policies,
     27. Motivate and actively engage in dialogue         legislation, strategies and plans, and the
          between associations representing                creation of a formal role and authority for
          people with dementia, their carers and           people with dementia and their carers
          families, health workers and government          to influence the process of designing,
          authorities in reforming health and social       planning and implementing policies, laws
          laws, policies, strategies, plans and            and services related to dementia.
          programmes relevant to dementia, while

12                                                                                                       13
Action area 2:                                                                                        34.   Global target 2.1:                                              35.   Global target 2.2:
                                                                                                           	100% of countries will have at                                      	50% of countries will have
     Dementia                                                                                                least one functioning public
                                                                                                             awareness campaign on
                                                                                                                                                                                   at least one dementia-
                                                                                                                                                                                   friendly initiative to foster a
     awareness and                                                                                           dementia to foster a dementia-
                                                                                                             inclusive society by 2025.1
                                                                                                                                                                                   dementia-inclusive society
                                                                                                                                                                                   by 2025.1
                                                                                                           PROPOSED ACTIONS FOR MEMBER STATES
     29. There is a common misconception that              aspects of dementia friendly initiatives       36. In collaboration with people with                                    inclusive and age- and dementia-
          dementia is a natural and inevitable part         include safeguarding the human rights               dementia, their carers and the                                       friendly, promoting respect and
          of ageing rather than a disease process,          of people with dementia, tackling the               organizations that represent them, the                               acceptance in a manner that meets the
          resulting in barriers to diagnosis and care.      stigmatization associated with dementia,            media and other relevant stakeholders,                               needs of people with dementia and
          The lack of understanding also causes             promoting a greater involvement of                  organize national and local public                                   their carers and enables participation,
          fear of developing dementia and leads             people with dementia in society, and                health and awareness campaigns that                                  safety and inclusion.
          to stigmatization and discrimination.             supporting families and carers of people            are community- and culture-specific.
          Furthermore, people with dementia are             with dementia. The concept of dementia-             This cooperative action will improve                            38. Develop programmes, adapted to
          frequently denied their human rights in           friendliness is tightly linked to societies         the accuracy of the general public’s                                 the relevant context, to encourage
          both the community and care homes.                also being age-friendly. Both age- and              knowledge about dementia, reduce                                     dementia-friendly attitudes in the
                                                            dementia-friendly initiatives should take           stigmatization, dispel myths, promote                                community and the public and
     30. Dementia-awareness programmes                     into account the fact that a significant            early diagnosis, and emphasize the                                   private sectors that are informed
          should: foster an accurate understanding          number of older people are living alone             need for gender- and culturally-                                     by the experiences of people with
          of dementia and its various subtypes as           and are sometimes very isolated.                    appropriate responses, recognition                                   dementia and their carers. Target
          clinical diseases; reduce stigmatization                                                              of human rights and respect for the                                  different community and stakeholder
          and discrimination associated with             32. Dementia-awareness campaigns and                  autonomy of people with dementia.                                    groups, including but not limited to:
          dementia; educate people about the                  dementia-friendly programmes that are                                                                                  school students and teachers, police,
          human rights of people with dementia                tailored to the cultural contexts and        37. Support changing all aspects of the                                  ambulance, fire brigades, transport,
          and the Convention on the Rights of                 particular needs of a community can              social and built environments, including                              financial and other public service
          Persons with Disabilities; enhance the              promote enhanced health and social               the provision of amenities, goods and                                 providers, education and faith-based
          general population’s ability to recognize           outcomes that reflect the wishes and             services, in order to make them more                                  organizations, and volunteers.
          early symptoms and signs of dementia;               preferences of people with dementia,
          and increase the public’s knowledge of              as well as improve the quality of life for
          risk factors associated with dementia,              people with dementia, their carers and
          thereby promoting healthy lifestyles and            the broader community.                       ACTIONS FOR THE SECRETARIAT
          risk reduction behaviour in all.
                                                         33. Rationale. Increasing public awareness,      39. Offer technical support to Member                                         organizations that represent them
     31. A dementia-friendly society possesses               acceptance and understanding of                   States in strengthening global, regional                                  in decision-making within WHO’s
          an inclusive and accessible community               dementia and making the societal                  and national capacity:                                                    own processes and on issues that
          environment that optimizes opportunities            environment dementia-friendly will                                                                                          concern them;
                                                                                                                 ●● to engage and include people
          for health, participation and security for          enable people with dementia to
                                                                                                                    with dementia, their carers and                                    ●● for the selection, formulation,
          all people, in order to ensure quality of           participate in the community and
          life and dignity for people with dementia,          maximize their autonomy through
          their carers and families. Shared key               improved social participation.               1.    The global target indicator and means of verification are provided in the Appendix.

14                                                                                                                                                                                                                             15
implementation and dissemination                                  of what works in different contexts and
              of best practices for awareness-                                  disseminate this information.
              raising and reduction of
              stigmatization and discrimination                        41. Promote awareness and understanding
              towards people with dementia.                                of dementia, the human rights of people
                                                                           with dementia and the role of families
     40. Building upon the WHO Global                                     and/or other carers as well as maintain
         Network of Age-friendly Cities and                                and strengthen partnerships with
         Communities and its dedicated                                     organizations representing people with
         website,1 integrate and link dementia-                            dementia and their carers.
         friendly initiatives by documenting and
         evaluating existing dementia-friendly                         42. Develop guidance for Member States
         initiatives in order to identify evidence                          on how to implement, monitor and
                                                                            evaluate dementia-friendly initiatives.

     43. Encourage all stakeholders to:                                     ●● redress the inequities in vulnerable
          ●● raise awareness of the magnitude of
             the social and economic impact of                         44. Ensure that people with dementia
             dementia;                                                     are included in activities of the wider
                                                                           community and foster cultural, social
          ●● include people with dementia, their                           and civic participation by enhancing
             carers and families in all aspects                            their autonomy.
             of developing and strengthening
             services that support the autonomy                        45. Share in the development and
             of people with dementia;                                       implementation of all relevant
                                                                            programmes to raise awareness about
          ●● protect and promote human rights of                            dementia and make communities more
             people with dementia and support                               dementia-friendly and -inclusive.
             their carers and their families;

     1. (accessed 8 March 2017).

16                                                                                                                        17
Action area 3:

                                                                                                                                PROPOSED ACTIONS FOR MEMBER STATES
     Dementia risk
                                                                                                                                50. Link dementia with other programmes,        51. Develop, deliver and promote evidence-
                                                                                                                                    policies and campaigns on                        based, age-, gender-, disability- and
                                                                                                                                    noncommunicable disease risk reduction           culturally sensitive interventions
                                                                                                                                    and health promotion across relevant             and training to health professionals,
                                                                                                                                    sectors by promoting physical activity,          especially within the primary health
                                                                                                                                    healthy and balanced diets. Specific             care system, to improve knowledge and
                                                                                                                                    actions include weight management for            practices of such staff, and proactively
                                                                                                                                    obese individuals, cessation of tobacco          manage modifiable dementia risk factors
                                                                                                                                    use and the harmful use of alcohol, formal       when conducting counselling about
     46. Growing evidence suggests an                                   and the harmful use of alcohol, social
                                                                                                                                    education and mentally stimulating               risk reduction. Routinely update these
         interrelationship between dementia                              engagement, promotion of cognitively
                                                                                                                                    activities as well as lifelong social            interventions as new scientific evidence
         on one side and noncommunicable                                 stimulating activities and learning as
                                                                                                                                    engagement in line with the principle of         becomes available.
         disease and lifestyle-related risk factors                      well as prevention and management of
                                                                                                                                    balancing prevention and care.
         on the other. These risk factors include                        diabetes, hypertension, especially in
         physical inactivity, obesity, unbalanced                        mid-life, and depression.
         diets, tobacco use, harmful use of
         alcohol, diabetes mellitus and mid-                       48. Rationale. By improving the capacity
         life hypertension. In addition, other                          of health and social care professionals                 ACTIONS FOR THE SECRETARIAT
         potentially modifiable risk factors                            to provide evidence-based,
         are more specific to dementia and                              multisectoral, gender and culturally-                   52. Linking to the actions specified in the        ●● support the formulation and
         include social isolation, low educational                      appropriate interventions to the                            global action plan for the prevention and          implementation of evidence-based,
         attainment, cognitive inactivity and                           general population, educate about and                       control of noncommunicable diseases                multisectoral interventions for
         mid-life depression. Reducing the                              proactively manage modifiable risk                          2013–2020, offer technical support and             reducing the risk of dementia.
         level of exposure of individuals and                           factors for dementia that are shared                        strengthen global, regional and national
         populations to these potentially                               with other noncommunicable diseases,                        capacities and capabilities to:              53. Strengthen the evidence base and
         modifiable risk factors, beginning in                          the risk of developing dementia can be                                                                       share and disseminate evidence
         childhood and extending throughout                             reduced or its progression delayed.                        ●● raise awareness of the links                   to support policy interventions for
         life, can strengthen the capacity of                                                                                         between dementia and other                     reducing potentially modifiable risk
         individuals and populations to make                                                                                          noncommunicable diseases;                      factors for dementia by providing a
         healthier choices and follow lifestyle                                                                                                                                      database of available evidence on the
         patterns that foster good health.
                                                                   49.   Global target 3:                                          ●● integrate the reduction and control of         prevalence of those risk factors and the
                                                                   	The relevant global targets                                      modifiable dementia risk factors into          consequences of reducing them.
     47. There is growing consensus that the                                                                                         national health planning processes
                                                                     defined in the Global action
          following measures are protective and                                                                                       and development agendas;
                                                                     plan for prevention and control
          can reduce the risk of cognitive decline
          and dementia: increasing physical
                                                                     of noncommunicable diseases
          activity, preventing and reducing                          2013–2020 and any future
          obesity, promotion of balanced and                         revisions are achieved for risk
          healthy diets, cessation of tobacco use                    reduction and reported.1

     1.   See document WHA66/2013/REC/1, Annex 4, available at
          pdf#page=87, accessed 20 September 2017.

18                                                                                                                                                                                                                              19
     54. Encourage all stakeholders to engage      ●● take particular actions that have
         in activities to:                             been shown to reduce the risk of
                                                       dementia, particularly during mid-life;
        ●● promote and mainstream population
           health strategies that are age-          ●● support national efforts for
           inclusive, gender-sensitive and             prevention and control of
           equity-based at national, regional          noncommunicable diseases in
           and international levels in order to        general and dementia in particular,
           support a socially active lifestyle         for example, through exchange of
           that is physically and mentally             information on evidence-based
           healthy for all, including people with      best practices and dissemination of
           dementia, their carers and families;        research findings.

20                                                                                               21
Action area 4:                                                                                          people with dementia and community                              59. Rationale. The needs and preferences
                                                                                                             psychosocial support are widely available.                          of people with dementia can be met

     Dementia                                                                                           58. Adequately trained and qualified
                                                                                                                                                                                 and their autonomy from diagnosis
                                                                                                                                                                                 to the end of life respected through

     diagnosis,                                                                                              workforces are required to provide
                                                                                                             these interventions. The continuity of
                                                                                                                                                                                 integrated, culturally appropriate,
                                                                                                                                                                                 person-centred, community-based

     treatment, care                                                                                         care between different care providers,
                                                                                                             multiple sectors and system levels and
                                                                                                                                                                                 health, psychosocial, long-term care and
                                                                                                                                                                                 support and, where appropriate, the

     and support
                                                                                                             active collaboration between paid and                               inputs of families and carers.
                                                                                                             unpaid carers are crucial, from the first
                                                                                                             symptoms of dementia until the end
                                                                                                             of life. Integrated, evidence-based,
                                                                                                             person-centred care is required in all
     55. Dementia is associated with complex           term care covers all activities, whether             settings where people with dementia                             60. Global        target 4:
         needs and high levels of dependency            these are provided by health, social or              live, ranging from their homes, the
         and morbidity in its later stages,             palliative care services or result from a                                                                            	In at least 50% of countries,
                                                                                                             community, assisted-living facilities and
         requiring a range of health and social         dementia-friendly environment. Palliative            nursing homes to hospitals and hospices.                          as a minimum, 50% of
         care, including long-term-care services.       care is a core component of the                      The skills and capacity of the workforce                          the estimated number of
         People with dementia are also less likely      continuum of care for people living with             and services are often challenged by the                          people with dementia are
         to be diagnosed for comorbid health            dementia from the point of diagnosis                 complex needs of people with dementia.                            diagnosed1 by 2025.2
         conditions, which, when left untreated,        through to the end of life and into the
         can cause faster decline, and to receive       bereavement stages for families and
         the care and support they need to              carers. It provides physical, psychosocial
         manage them. The services that they            and spiritual support for people with
         require include case-finding, diagnosis,       dementia and their carers including             PROPOSED ACTIONS FOR MEMBER STATES
         treatment (including pharmacological           support with advance care planning.
         and psychosocial), rehabilitation,                                                             61. Develop a pathway of efficient,                                 62. Build the knowledge and skills of
         palliative/end-of-life care and other       57. The global action plan proposes some              coordinated care for people with                                      general and specialized staff in the
         support such as home help, transport,            principles for organizing and developing          dementia that is embedded in the health                               health workforce to deliver evidence-
         food and the provision of a structured           health and social care, including long-           and social care system (including long-                               based, culturally-appropriate and human
         day with meaningful activities.                  term care systems for dementia. Providing         term care), to provide integrated, person-                            rights-oriented health and social care,
                                                          sustainable care across the continuum             centred care as and when it is required.                              including long-term care services for
     56. People with dementia should be                  from diagnosis to the end of life requires:       The pathway should provide quality care                               people with dementia. (Mechanisms
          empowered to live in the community              timely diagnosis; the integration of              and management that integrates multiple                               may include teaching the core
          and to receive care aligned with their          dementia treatment and care into primary          services, including primary health care,                              competences of dementia diagnosis,
          wishes and preferences. To ensure that          care; coordinated continuity of health            home care, long-term care, specialist                                 treatment and care in undergraduate
          people with dementia can maintain               and social care including long-term care          medical care, rehabilitation and palliative                           and graduate medical and paramedical
          a level of functional ability consistent        between different providers and system            services, household help, food and                                    training, and continuing training
          with their basic rights, fundamental            levels, multidisciplinary collaboration and       transport services, other social welfare                              programmes for all health and social
          freedoms and human dignity, they                active cooperation between paid and               services and meaningful activities, into                              care professionals, in collaboration with
          need integrated, person-centred,                unpaid carers. Planning responses to and          a seamless bundle that enhances the                                   key stakeholders such as regulatory
          accessible, affordable health and social        recovery from humanitarian emergencies            capacity and functional ability of people                             bodies.) Earmark budgets and resources
          care, including long-term care. Long-           must ensure that individual support for           with dementia.                                                        for in-service training for these

                                                                                                        1.   All people who are diagnosed should receive appropriate post-diagnostic health and social care.
                                                                                                        2.   The global target indicator and means of verification are provided in the Appendix.

22                                                                                                                                                                                                                            23
professionals, or include such budgets                         community-based care settings and
          and resources in specific programmes.                          multidisciplinary, community-based

     63. Improve the quality of care towards the
                                                                         networks that integrate social and
                                                                         health systems and provide quality care
                                                                                                                    PROPOSED ACTIONS FOR INTERNATIONAL,
          end of life by: recognizing advanced                           and evidence-based interventions.          REGIONAL AND NATIONAL PARTNERS
          dementia as a condition requiring
          palliative care; promoting awareness                      65. Enhance access to a range of               69. Support people with dementia and             teaching institutions in revising the
          about advanced care planning for                               person-centred, gender-sensitive,               their families and carers, for example,      contents of curricula so as to place
          all people living with dementia to                             culturally-appropriate and responsive           by developing evidence-based, user-          greater emphasis on dementia, and
          document their wishes for the end of                           services including liaison with local           friendly information and training tools      ensuring that people with dementia
          their life; using validated end-of-life                        nongovernmental organizations and               concerning dementia and available            are engaged, as appropriate, in
          pathways and ensuring that people                              other stakeholders in order to provide          services to allow timely diagnosis           the development and provision of
          with dementia have their values and                            information that empowers people with           and enhance the continued provision          education and training.
          preferences respected and are cared for                        dementia to make informed choices               of long-term care, or by setting up
          in their place of choice; and providing                        and decisions about their care. Respect         national helplines and websites with      71. Promote community-based rehabilitation
          training for health care professionals and                     their rights and preferences and foster         information and advice at local levels.        as an effective strategy to enable
          palliative care specialists.                                   active collaboration between the person                                                        and support people with dementia in
                                                                         with dementia, their families and carers   70. Support the training of health and             preserving their autonomy and rights and
     64. Systematically shift the locus of                              and service providers from the first           social care personnel to provide                ensuring that the person with dementia
          care away from hospitals towards                               symptoms through to the end of life.           evidence-based treatment and care for           remains at the centre of all discussions on
                                                                                                                        people with dementia, by developing             diagnosis, treatment and care.
                                                                                                                        training relevant to needs, supporting

     66. Offer technical support to Member                             identification of gaps, specific needs
          States for documenting and sharing                            and training requirements for health and
          best practices of evidence-based                              social care workers as well as graduate
          service delivery and care coordination,                       and undergraduate education about
          and provide support to Member States                          integrated provision of long-term care
          in developing dementia care pathways                          that is person-centred from diagnosis to
          in line with the principle of universal                       the end of life.
          health coverage.
                                                                    68. Provide guidance on strengthening
     67. Develop and implement guidelines,                              the implementation of the dementia
         tools and training materials, such as                           component of the WHO Mental Health
         model training curricula, covering core                         Gap Action Programme1 to enhance
         competencies relating to dementia for                           capabilities of existing human resources
         health and social care workers in the                           and train more staff, and on improving
         field. Provide support to Member States                         the ability to provide quality care and
         in the formulation of human resource                            evidence-based interventions through
         strategies for dementia, including the                          primary health care.

     1.   See (accessed 8 March 2017).

24                                                                                                                                                                                                                    25
Action area 5:

                                                                                                                           PROPOSED ACTIONS FOR MEMBER STATES
     Support for
     dementia carers
                                                                                                                           76. Provide accessible and evidence-based                       78. Develop or strengthen protection of
                                                                                                                                information, training programmes,                               carers, such as social and disability
                                                                                                                                respite services and other resources                            benefits, policies and legislation
                                                                                                                                tailored to the needs of carers to                              against discrimination, for example in
                                                                                                                                improve knowledge and caregiving                                employment, and support them beyond
                                                                                                                                skills, such as coping with challenging                         their caregiving role in all settings.
                                                                                                                                behaviour, to enable people with
                                                                                                                                dementia to live in the community and                       79. Involve carers in the planning of care,
                                                                                                                                to prevent stress and health problems                            with attention being given to the
     72. Carers can be defined by their                                        and well-being and social relationships.                                                                         wishes and preferences of people with
                                                                                                                                for their carers.
          relationship to the person with dementia                              Health systems must consider both                                                                                dementia and their families.
          and their care input. Many dementia                                   the substantial need of people with        77. P
                                                                                                                                rovide training programmes for
          carers are relatives or extended family                               dementia for help from others and              health care and social care staff for the
          members, but close friends, neighbours                                its significant impact on carers and           identification and reduction of stress
          and paid lay persons or volunteers can                                families, including economic impact.           and burn-out of carers.
          also take on responsibilities for caring.                             Carers should have access to support
          Carers are involved in providing “hands-                              and services tailored to their needs
          on” care and support for people with                                  in order effectively to respond to and
          dementia or play a significant role in                                manage the physical, mental and social
          organizing the care delivered by others.
          Carers often know the person with
                                                                                demands of their caring role.              ACTIONS FOR THE SECRETARIAT
          dementia well, and therefore are likely                         74. Rationale. The creation and                 80. Build evidence on and articulate the                        81. Facilitate access to affordable, evidence-
          to have knowledge of and information                                 implementation of means to deliver               importance of carers in the lives of                             based resources for carers to improve
          about the person with dementia that                                  multisectoral care, support and                  people with dementia, while raising                              knowledge and skills, reduce emotional
          is crucial for developing effective                                  services for carers will help to meet            awareness about the disproportionate                             stress and improve coping, self-efficacy
          personalized needs-based treatment                                   the needs of carers, and prevent a               effect on women, and offer technical                             and health by making use of information
          and care plans. Carers should therefore                              decline in their physical and mental             support to Member States by                                      and communication technologies
          be considered essential partners in the                              health and social well-being.                    monitoring trends in availability of                             such as Internet and mobile phone
          planning and provision of care in all                                                                                 carer-support services. Provide support                          technologies (for instance, WHO
          settings according to the wishes and                            75.   Global target 5:                                to Member States in developing                                   iSupport2), for education, skills training
          needs of the person with dementia.                                                                                    evidence-based information, training                             and social support.
                                                                          	75% of countries provide support
                                                                                                                                programmes and respite services for
     73. It should be noted that being a carer                             and training programmes for
                                                                                                                                carers, using a multisectoral approach,
          for someone with dementia may affect                              carers and families of people
                                                                                                                                and foster outcome measurement.
          the carer’s physical and mental health                            with dementia by 2025.1

                                                                                                                           2.   WHO iSupport: e-programme for caregivers of people living with dementia (
     1.   The global target indicator and means of verification are provided in the Appendix.                                   dementia/isupport/en/, accessed 8 March 2017).

26                                                                                                                                                                                                                                                     27
     82. Increase awareness of the involvement,      in accessing health and social care,
          and its consequences, of carers and         including long-term care services.
          families in the lives of people with
          dementia, protecting them from           83. Assist in carrying out appropriate
          discrimination, supporting their              training programmes: for carers
          ability to continue their caregiving          and families to enhance knowledge
          in a gender-sensitive manner, and             and caregiving skills across the
          empowering carers with opportunities          progression of dementia; and on a
          to develop self-advocacy skills to            person-centred approach to promote
          be able to meet specific challenges           respect and well-being.

28                                                                                           29
Action area 6:                                                                                                        88. Update or create supportive policy           routine reporting on dementia.

                                                                                                                               or legislation pertaining to the
                                                                                                                               measurement, collection and sharing        89. Collect and use the necessary data
                                                                                                                               of data on health and social care for           on epidemiology, care and resources
     systems for                                                                                                               dementia and integrate this information
                                                                                                                               routinely into national health
                                                                                                                                                                               relating to dementia in the country in
                                                                                                                                                                               order to implement relevant policies

     dementia                                                                                                                  information systems so as to facilitate         and plans.

                                                                                                                           ACTIONS FOR THE SECRETARIAT
                                                                                                                           90. Offer technical support to Members           guidance, training and technical
                                                                                                                                States as they:                              assistance on capturing information
     84. Systematic, routine population-level                            85. Rationale. Systematic monitoring
                                                                                                                                                                             and facilitating the use of these data
          monitoring of a core set of dementia                                 and evaluation of the usage of health
                                                                                                                              ●● develop and/or reform national data         to monitor outcomes. WHO’s Global
          indicators provides the data needed                                  and social care systems can provide
                                                                                                                                 collection systems, including health        Dementia Observatory provides the
          to guide evidence-based actions to                                   the best available evidence for policy
                                                                                                                                 information systems, in order to            mechanism to monitor systematically
          improve services and to measure                                      development and service delivery,
                                                                                                                                 strengthen multisectoral dementia           and facilitate the use of data from these
          progress towards implementing                                        and can improve prevention and the
                                                                                                                                 data collection;                            core indicators, offering a platform for
          national dementia policies. By building                              accessibility and coordination of care
                                                                                                                                                                             the exchange of data and knowledge
          and/or strengthening information                                     for people with dementia across the
                                                                                                                              ●● build national capacity and                 in order to support evidence-based
          systems for dementia, the functional                                 continuum, from risk reduction to the
                                                                                                                                 resources for systematic collection,        service planning, sharing of best
          trajectories of people with dementia,                                end of life.
                                                                                                                                 analysis and use of dementia specific       practices and strengthening of both
          their carers and families can be
                                                                                                                                 data through development of                 policies on dementia and health and
          improved. However, this will require
                                                                                                                                 targets and indicators that account         social care systems.
          significant changes, while respecting                           86. Global        target 6:
                                                                                                                                 for national circumstances, yet are
          existing regulatory frameworks, to the
                                                                          	50% of countries routinely collect                   aligned as closely as possible with      92. Offer technical support to Member States
          routine collection, recording, linkage
                                                                            a core set of dementia indicators                    indicators and targets of the global          in generating and providing information
          and disaggregation for the sharing of
                                                                            through their national health and                    monitoring framework.                         for monitoring of global, regional and
          health and administrative data of each
                                                                            social information systems every                                                                   national targets as required, through the
          encounter of a person with dementia
                                                                                                                           91. Develop a core set of indicators in            Global Dementia Observatory.
          with the health and social care system.                           two years by 2025.1
                                                                                                                               line with this action plan and provide

     PROPOSED ACTIONS FOR MEMBER STATES                                                                                    PROPOSED ACTIONS FOR INTERNATIONAL,
     87. Develop, implement and improve,                                      access to health and social care            REGIONAL AND NATIONAL PARTNERS
          as needed, national surveillance and                                 data and map available services and
          monitoring systems, including registers                              resources at national and regional levels   93. Provide support to Member States and         dementia, carers and families; and enable
          that are integrated into existing                                    in order to improve service delivery and         the Secretariat in developing tools and      an assessment of trends over time.
          health information systems, in order                                 coverage across the care continuum               strengthening capacity for surveillance
          to improve availability of high-quality,                             from prevention through risk reduction           and information systems that: capture     94. Advocate the involvement of people
          multisectoral data on dementia. Enable                               to the end of life.                              data on core indicators on dementia;           with dementia and their families and
                                                                                                                                monitor usage of health and social care        carers in the creation, collection,
                                                                                                                                and support services for people with           analysis and use of data on dementia.

     1.   The global target indicator and means of verification are provided in the Appendix.

30                                                                                                                                                                                                                         31
Action area 7:

                                                                                                                               PROPOSED ACTIONS FOR MEMBER STATES
     Dementia research
     and innovation
                                                                                                                               100. Develop, implement and monitor                promote projects that: support
                                                                                                                                    the realization of a national research         collaborative national and international
                                                                                                                                    agenda on prevention, diagnosis,               research; promote sharing of and open
                                                                                                                                    treatment and care of people with              access to research data; generate
                                                                                                                                    dementia in collaboration with                 knowledge on how to translate what
                                                                                                                                    academic and research institutions;            is already known about dementia into
                                                                                                                                    this work could be stand-alone or              action; and support the retention of
                                                                                                                                    integrated into related research               the research workforce.
                                                                                                                                    programmes that focus on filling
     95. If the incidence of dementia is to be                                 agenda, will increase the likelihood of                                                        102. Foster the development of
                                                                                                                                    gaps in evidence to support policy or
          reduced and the lives of people with                                  effective progress globally towards                                                                 technological innovations that, in terms
                                                                                                                                    practice. Strengthen research capacity
          dementia are to be improved, research                                 better prevention, diagnosis, treatment                                                             of design and evaluation, respond to
                                                                                                                                    for academic collaborations on national
          and innovation are crucial, as is their                               and care for people with dementia.                                                                  the physical, psychological and social
                                                                                                                                    priorities for research into dementia
          translation into daily practice. It is                                                                                                                                    needs of people with dementia, their
                                                                          97. There is a growing interest in, and call for,        by engaging relevant stakeholders,
          important not only that funding and                                                                                                                                       carers or people at risk of developing
                                                                               the use of innovative health technologies            including people with dementia.
          appropriate infrastructures for dementia                                                                                                                                  dementia; these innovations include
                                                                               in prevention, risk reduction, early                 Relevant steps may include: improving
          research and innovation are available                                                                                                                                     but are not limited to diagnosis,
                                                                               diagnosis, treatment, care and support               research infrastructure for dementia and
          but also that mechanisms are in place                                                                                                                                     disease monitoring and assessment,
                                                                               relating to dementia. These innovations              related fields, enhancing competence
          that assist appropriate recruitment of                                                                                                                                    assistive technologies, pharmaceuticals
                                                                               aim to improve knowledge, skills and                 of researchers to conduct high-quality
          people with dementia, their families and                                                                                                                                  and new models of care or
                                                                               coping mechanisms in order to facilitate             research, and establishing centres of
          carers into research studies. Research                                                                                                                                    forecasting/modelling techniques.
                                                                               and support the daily lives of people                excellence for research into dementia.
          and development costs are higher for
          dementia than other therapeutic areas,                               with dementia and their carers while
                                                                                                                               101. Increase investment in dementia           103. Following the national ethical
          because of lower success rates, longer                               meeting, in particular, identified needs in
                                                                                                                                    research and innovative health                   requirements for research, promote
          development times, and low recruitment                               an evidence-based and age-, gender- and
                                                                                                                                    technologies and improve research                equitable opportunities and access
          rates into trials; this disproportion                                culturally-sensitive manner.
                                                                                                                                    governance as an integral component              for people with dementia and their
          discourages investment in this area.                                                                                      of the national response to dementia.            carers to be part of clinical and social
                                                                          98. Rationale. The successful implementation
          Research is needed to find a cure                                                                                         In particular, allocate budgets to               research that concerns them.
                                                                               of research into dementia aligned
          for dementia, but research is equally
                                                                               with identified research priorities and
          needed into prevention, risk reduction,
                                                                               social and technological innovations
          diagnosis, treatment and care, including
                                                                               can increase the likelihood of effective
          the disciplines of social science, public
                                                                               progress towards better prevention,
          health and implementation research.
                                                                               diagnosis, treatment and care for people        ACTIONS FOR THE SECRETARIAT
     96. Collaboration among and between                                      with dementia.
                                                                                                                               104. Draw up a global research agenda               research, capacities, methods
         Member States and relevant                                                                                                  and work together with Member                  and collaboration in the fields of
         stakeholders, with a particular focus                            99.   Global target 7:
                                                                                                                                     States to strengthen and build                 biomedical and social sciences
         on strengthening North–South, South–                             	The output of global research                            capacity in the area of dementia               research, inter alia, through a network
         South and triangular cooperation, to                               on dementia doubles between                              research by incorporating it in                of WHO collaborating centres,
         implement a global dementia research                               2017 and 2025.1                                          national and subnational policies and          countries from all WHO regions, and
                                                                                                                                     plans relating to dementia. Advocate           civil society organizations.
                                                                                                                                     increased investment in dementia
     1.   The global target indicator and means of verification are provided in the Appendix.

32                                                                                                                                                                                                                              33
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