More and more communities around the country are taking a public health approach to address Alzheimer’s, a pivotal public health issue requiring bold action as the crisis grows. With the number of Americans living with dementia growing — and growing fast — robust public health responses are needed to mitigate these future impacts.
Why is Alzheimer’s a public health issue?
Alzheimer’s is the most under-recognized threat to public health in the 21st century.
Dr. David Satcher, former U.S. Surgeon General and former CDC Director
Alzheimer’s and other dementias have become a public health issue because:
- The burden is large.
- The impact is major.
- There are ways to intervene.
Today, nearly 6 million Americans are living with Alzheimer’s, and the annual cost of caring for them exceeds a quarter of a trillion dollars. This burden is only projected to grow. By 2050, as many as 14 million could be living with Alzheimer’s, with costs exceeding $1 trillion. Federal and state governments shoulder two-thirds of the cost of Alzheimer’s through Medicaid and Medicare.
More than one quarter of all hospitalizations of people with dementia are preventable — at a cost to Medicare of nearly $2.6 billion in 2013. Further, 95 percent of people living with Alzheimer’s and other dementias have at least one other chronic condition — such as heart disease, diabetes, or stroke. Alzheimer’s complicates the management of these chronic conditions resulting in poorer health outcomes and increased health care costs.
Alzheimer’s impacts more than just the individual with the disease: more than 16 million family and friends provide over 18 billion hours of unpaid care annually resulting in an additional $10+ billion in increased health care costs due to the burden of caregiving.
A strong public health response can mitigate the future impact of Alzheimer’s by utilizing common public health tools and techniques. These include early detection and diagnosis, reducing risky health behaviors, collecting and using surveillance data, developing workforce competencies, and mobilizing partnerships across entire communities. These population-level interventions help improve the well-being and quality of life for people living with Alzheimer’s and reduce the costs associated with it. To help shape that response, the Alzheimer’s Association and the Centers for Disease Control and Prevention (CDC) developed the Healthy Brain Initiative (HBI), including its signature guidebook — State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map
Alzheimer's as a Public Health Issue
Historically, Alzheimer's disease has been seen as an aging issue, but more and more people are viewing Alzheimer's as a public health issue because the burden is large, the impact is major, and there are ways public health can intervene.
How does public health address Alzheimer’s?
Public health works to improve the health and well-being for the whole community — at any stage of life, at any age. While historically, Alzheimer’s had been viewed primarily as an aging issue, today we understand that the brain changes associated with Alzheimer’s begin to take root many years, even decades, before symptoms appear. That is why a life-course approach to Alzheimer’s and other dementias is needed and why public health must intervene across the lifespan.
This illustration provides a life-course view for people who may eventually develop dementia. The semi-circle in purple shows different stages of cognitive functioning from birth to death — beginning with healthy cognition and moving through the pre-symptomatic and mild cognitive impairment stages, and then to dementia. The blue segments show the three major opportunities for public health interventions across the life-course consistent with the stage of cognitive functioning:
- reduce risk of cognitive decline or progressing to other stages
- encourage early detection and diagnosis of cognitive impairment and dementia
- ensure quality of care for and safety of people affected by cognitive impairment and dementia.
These essential public health strategies help reduce burden, improve health outcomes, and promote health and well-being throughout the continuum. It is important to note that most older adults do not develop mild cognitive impairment or dementia.
Across the life-course, public health has numerous opportunities to intervene and lessen the burden of Alzheimer’s, just as public health has helped reduce the burden of heart disease, HIV/AIDs, and cancer.
- Risk Reduction: At any stage of life, public health can reduce the risk of cognitive decline by promoting brain health and health behaviors — such as quitting smoking, protecting the head from brain injuries, and being physically active.
- Early Detection: Public health can increase early detection and diagnosis by ensuring that the general public understands the early warning signs of cognitive decline and that the healthcare provider community is up-to-date on cognitive issues.
- Safety and Quality of Care: Finally, for people living with dementia, public health can enhance the quality of care through provider education and educate caregivers about available services and supports in the community.
The Healthy Brain Initiative Road Map provides state and local public health agencies with 25 actions to mitigate the future impacts of dementia, particularly among vulnerable populations.
What is public health?
If you are new to public health, you may be wondering “What exactly is public health?” It’s often helpful to view public health as it relates to health care. Public health promotes and protects the health of people and communities, across the entire population while health care delivers medical care to individuals. Public health works to prevent groups of people from getting sick or injured in the first place. And, public health goes even further than prevention — by encouraging healthy behaviors, public health promotes overall wellness and well-being.
Public health is all around us — in our schools, in our workplace, in the grocery store and hospitals, in the air we breathe and the water we drink. Common public health efforts include:
- Protecting drinking water and clean air
- Preventing and slow disease outbreaks
- Reducing injuries and illness
- Promoting healthy behaviors
- Improving the management of chronic conditions
For example, smoking bans in public areas are one classic example of public health intervention. Secondhand smoke in public spaces was a public health issue since 1) the burden of secondhand smoke was large (potentially affecting all individuals in a public space), 2) the impact was major (contributing to lung disease and disorders), and 3) there were ways governmental public health agencies could intervene (writing policies that banned smoking in public areas). These actions help protect the health and well-being of the entire community.
Public health works across a wide variety of settings, among diverse populations, and expands the reach of health and health care access to as many people as possible.
Learn more about public health
from the Centers of Disease Control and Prevention.