Road Map for Indian Country

Eight public health strategies can help American Indian and Alaska Native communities learn about and begin planning their response to dementia.

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The number of Americans living with Alzheimer's is growing — and growing fast. People living with dementia will require more and more support as cognitive, behavioral and physical functioning worsens over time, increasing Medicare and Medicaid costs. And, 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. 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. There is also a newly released Road Map for Indian Country.

Road Map to guide the public health response

New Road Map 2018-2023

Experts have developed 25 actions for public health leaders to promote brain health, better care for people with cognitive impairment and increase attention to caregivers.


The Alzheimer’s disease continuum spans decades, providing many opportunities for public health to change outcomes across communities. The Healthy Brain Initiative (HBI) State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map 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 an expert and practitioner leadership committee, the HBI Road Map aligns with Essential Services of Public Health to ensure Alzheimer’s initiatives can be easily and efficiently incorporated into existing public health efforts.

The action agenda contains a flexible menu of 25 actions that public health agencies and their partners can pursue over the next five years 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.

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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 — outlines six planning steps for public health practitioners to get started, develop and action plan, and begin implementation. The planning guide helps public health leaders align the HBI Road Map to current state and local priorities while the tool’s easy-to-use worksheets and resources help prioritize, plan and promote HBI Road Map actions. 
  • Dissemination Guide — quick and ready media engagement templates to help public health practitioners disseminate information on the HBI Road Map. The guide includes media templates, sample social media posts, talking points, and key facts.
  • HBI Webinar and Video Catalog — 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 delve in-depth on current public health issues that address Alzheimer's and other dementias. Each issue map offers compelling data on the topic, a primer explaining the need for action, suggests related HBI Road Map actions, and provides case studies to demonstrate successful intervention. Issue maps are available on the following topics:
  Local health departments (LHDs) are on the frontlines of addressing the growing impact of Alzheimer’s, cognitive decline, and dementia caregiving. More and more 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  local public health officials implement actions in the HBI Road Map and learn from how other LHDs are currently engaged in these areas. 
  Increasingly, state public health agencies are becoming more involved in their state Alzheimer's plans. A scan of each state's most recent state Alzheimer's plan shows growing public health involvement and alignment to public health capabilities. This brief details ways state public health officials can become more involved in the planning process and how the overall plan can better utilize the agency's full abilities to address Alzheimer's. 

Use the following search bars to view successful examples of existing HBI Road Map implementation as well as tools and resources that can help public health leaders take action against dementia.
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Conceptual framework

Explore public health action against Alzheimer’s

Go in-depth on areas essential to addressing Alzheimer's from a public health perspective.

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To ensure Alzheimer’s can be easily and efficiently incorporated into existing public health efforts, the HBI Road Map is aligned across Essential Service of Public Health:

  • 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 evaluate 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 as well as 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. These principles — eliminate health disparities, collaborate across multiple sectors and leverage resources for sustained impact — are central to public health and essential to effectively address the rising number of people living with Alzheimer’s and other dementias, particularly among traditionally underserved populations.

Conceptual Framework for the Healthy Brain Initiative Road Map
The Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map is informed by four Essential Services of Public Health — assure a competent workforce, monitor and evaluate, develop policies and mobilize partnerships, and educate and empower the nation. Action within each of these four domains is guided by three core principles to best eliminate health disparities, collaboration across multiple sectors, and the need to leverage resources for sustained impact.

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Road Map for Indian Country

Learn more about how public health systems serving American Indians and Alaska Natives can address Alzheimer's and cognitive health.

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About Healthy Brain Initiative Road Map series 

The Alzheimer’s Association and Centers for Disease Control and Prevention (CDC) have developed a series of Healthy Brain Initiative guidebooks to advance cognitive health as an integral component of public health. The current HBI Road Map — State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map — is the third in this series, released in October 2018.

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.

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Progress reports on Road Map implementation

CDC has issued progress reports on the first and second road maps:

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