Healthy Brain Initiative Road Map

The number of Americans living with Alzheimer's is growing fast. People living with dementia require more and more support as cognitive, behavioral and physical functioning worsens over time, increasing Medicare and Medicaid costs. The additional burden on family caregivers is endangering their own health. A strategic public health response is needed to mitigate this impact on all communities. 

To help public health leaders chart a course to prepare all communities for Alzheimer’s and other dementias, the Alzheimer’s Association and the Centers for Disease Control and Prevention (CDC) jointly developed the Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map (HBI Road Map, PDF). This guidebook leads state and local public health agencies through 25 actions to act quickly and strategically to stimulate positive changes in policies, systems and environments. A companion guide — the Healthy Brain Initiative Road Map for Indian Country — helps American Indian and Alaska Native leaders begin addressing dementia in their communities.

Road Map to guide the public health response

The Alzheimer's disease continuum spans decades, providing many opportunities for public health to change outcomes across communities. The HBI Road Map (PDF) serves state and local public health leaders as a quick-start guide to help them mitigate the future impacts of dementia, particularly among vulnerable populations.

Developed with expert and practitioner leadership, the HBI Road Map aligns with the Essential Public Health Services to ensure Alzheimer's initiatives can be easily and efficiently incorporated into existing public health efforts.

The agenda contains a flexible menu of 25 actions that public health agencies and their partners can pursue to promote brain health, improve diagnoses and care for people living with cognitive impairment, and better support caregivers in their essential role.

Cross-sector partnerships, data, and elimination of health disparities are critical to achieving major gains against Alzheimer's — just as they underlie public health successes in other major health threats. The HBI Road Map outlines the most needed and practical steps that state and local public health departments can accomplish.

• HBI Road Map 2018-2023 (PDF).
• Executive Summary (PDF).

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Looking to the future 

To continue guiding state and local health departments as they address brain health across the life course, the CDC and the Alzheimer's Association are undertaking a year-long process to develop the next edition of the HBI Road Map. Read about the current progress.

Broad Engagement

Participation from multiple sectors remains a key feature of the development process to identify priorities, inform strategy, and support sustainable implementation and impact of the HBI Road Maps. Several methods are being used to engage, elicit input, and foster collaboration including a Leadership Committee (read the press release about the kickoff meeting), expert workgroups, and input from state and local public health leaders through listening sessions and an open feedback process.

Publication and promotion of the next HBI Road Map is expected in mid-2023. Stay updated on the development and release of the next edition by signing up for our Alzheimer's Public Health Newsletter.

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Get started: Resources for action

To aid implementation of HBI Road Map, several ready-made tools and resources can help state and local public health leaders prioritize actions and tailor their response to best fit the needs of the community.

• Planning for Action: Initial Steps for Implementing the Healthy Brain Initiative Road Map (PDF) — outlines six planning steps for public health practitioners to get started, develop an action plan, and begin implementation. The planning guide helps public health leaders align the HBI Road Map to current state and local priorities. The tool's easy-to-use worksheets and resources help prioritize, plan and promote HBI Road Map actions. 
• Dissemination Guide (PDF) — contains media engagement templates to help public health practitioners disseminate information on the HBI Road Map, including sample social media posts, talking points, and key facts.
• HBI Webinar and Video Catalog (PDF) — links to videos and recordings that explain or relate to HBI Road Map actions and examples. The catalog offers overviews and timestamps to quickly locate videos of interest.

Topic-specific issue maps explore public health issues that address Alzheimer's and other dementias. Each issue map explains the need for action, suggests related HBI Road Map actions and provides case studies to demonstrate successful intervention. Issue maps are available on:
 

• Early Detection and Diagnosis — describing the population health benefits of early detection and diagnosis of dementia.
• Risk Reduction — detailing ways public health can reduce the risk of cognitive decline across the community.
• Data, Assessment, and Analysis — explaining the need for data collection, needs assessment, evaluation and the use of evidence to inform policies, programs and practices.
• Health Professionals Education — showing the need to build the competencies of the public health and health care workforces as the population of people living with Alzheimer’s grows.
• Caregiver Support — outlining a public health approach to help meet the needs of dementia caregivers.

Local health departments (LHDs) are on the front lines of addressing the growing impact of Alzheimer's, cognitive decline, and dementia caregiving. Local health departments are using innovative approaches to incorporate and elevate attention to health aging, older adults and dementia. The following materials are specifically developed to help LHDs implement actions in the HBI Road Map and learn how other LHDs are currently engaged in these areas.
 

• Case study — County of San Diego (PDF).
• Case study — City of Boston (PDF).
• Best practices — Getting started (PDF).
• Best practices — Local data utilization (PDF).
• Best practices — Engaging the aging network (PDF).

A scan of each state's most recent Alzheimer's plan shows growing public health involvement in the development and implementation of the fight against Alzheimer’s. This brief (PDF) details ways state public health officials can become more involved in the planning process for state plans and how the state plan can maximize the strengths of public health agencies in addressing Alzheimer's.  

The HBI Road Map Implementation database includes examples of how state and local public health departments are addressing Alzheimer's, brain health, and caregiving.

The HBI Road Map Resources database includes guidance, information and tools that public health practitioners can adapt or use directly.

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Conceptual framework

The HBI Road Map is aligned across four Essential Public Health Services:

• Assure a competent workforce: Public health assures that the public and personal health care workforce have essential competencies in Alzheimer’s, dementia, and caregiving.
• Monitor and evaluate: Public health monitors the health status of communities to identify and solve health problems, and to evaluate the effectiveness, accessibility, and quality of personal and population-based health services.
• Develop policies and mobilize partnerships: Public health develops policies and plans that support people and community health efforts and mobilize community partnerships to identify and solve health problems.
• Educate and empower the nation: Public health informs, educates and empowers people about health issues to improve their quality of life and well-being.

 

In addition to these four traditional domains of public health, the HBI Road Map is guided by three core principles: eliminate health disparities, collaborate across multiple sectors and leverage resources for sustained impact. These principles are essential to address the rising number of people living with Alzheimer’s and other dementias, particularly among traditionally underserved populations.

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About Healthy Brain Initiative Road Map series 

The current HBI Road Map is the latest in a series of guidebooks developed by the Alzheimer’s Association and Centers for Disease Control and Prevention (CDC) to help public health agencies advance cognitive health as an integral component of public health.

The second HBI Road Map was The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018. This guidebook expanded the role that state and local public health agencies and partners could play in promoting cognitive functioning, addressing cognitive impairment and Alzheimer's disease, and helping meet the needs of caregivers. Public health action in response to the growing Alzheimer's crisis largely occurred during the second HBI Road Map.
 
The first HBI Road Map — National Public Health Road Map to Maintaining Cognitive Health — was released by the Alzheimer's Association and CDC in 2007. It was the first framework for viewing cognitive health and Alzheimer's disease as a public health issue and drove action against dementia, particularly at the national and federal level.

Progress reports on Road Map implementation

Measuring progress in the fight against Alzheimer’s is important to help guide future actions. The CDC has issued progress reports on the first and second road maps:

• Second HBI Road Map Progress Report: The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018, Interim Progress Report (2015) (PDF). 
• First HBI Road Map Progress report: The CDC Healthy Brain Initiative, Progress 2006–2011 (2011) (PDF).

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