The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Department of Medicine, Division of Geriatrics, McGill University, Montreal, QC, Canada.
Int J Equity Health. 2024 Apr 16;23(1):75. doi: 10.1186/s12939-024-02166-8.
Considering that dementia is an international public health priority, several countries have developed national dementia strategies outlining initiatives to address challenges posed by the disease. These strategies aim to improve the care, support, and resources available to meet the needs of persons living with dementia and their care partners and communities. Despite the known impact of social determinants of health on dementia risk, care, and outcomes, it is unclear whether dementia strategies adequately address related inequities. This study aimed to describe whether and how national dementia strategies considered inequities associated with social determinants of health.
We conducted an environmental scan of the national dementia strategies of countries that are part of the Organisation for Economic Cooperation and Development (OECD). Included strategies had to be accessible in English or French. Sub-national or provincial plans were excluded. We synthesised information on strategies' considerations of inequity through a thematic analysis.
Of the 15 dementia strategies that met inclusion criteria, 13 mentioned at least one inequity (M = 2.4, median = 2, range:0-7) related to Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Age and disability were mentioned most frequently, and religion most infrequently. Eleven strategies included general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage changes, deadlines, or allocated budgets for achieving equity-related goals outlined in their strategies.
Understanding if and how countries consider inequities in their dementia strategies enables the development of future strategies that adequately target inequities of concern. While most of the strategies mentioned inequities, few included tangible objectives to reduce them. Countries must not only consider inequities at a surface-level; rather, they must put forth actionable objectives that intend to lessen the impact of inequities in the care of all persons living with dementia.
鉴于痴呆症是一项国际公共卫生重点，许多国家制定了国家痴呆症战略，概述了应对该疾病带来的挑战的举措。这些战略旨在改善为痴呆症患者及其照护者和社区提供的护理、支持和资源。尽管社会决定因素对痴呆症风险、护理和结果的影响是已知的，但尚不清楚痴呆症战略是否充分解决了相关的不平等问题。本研究旨在描述国家痴呆症战略是否以及如何考虑与社会决定因素相关的不平等问题。
我们对属于经济合作与发展组织（OECD）的国家的国家痴呆症战略进行了环境扫描。纳入的战略必须以英文或法文提供。排除了州或省级计划。我们通过主题分析综合了战略对不平等问题的考虑信息。
在符合纳入标准的 15 项痴呆症战略中，有 13 项至少提到了与种族/族裔、宗教、年龄、残疾、性取向/性别认同、社会阶层或农村地区有关的一种不平等现象（M=2.4，中位数=2，范围：0-7）。年龄和残疾被提及最多，宗教被提及最少。11 项战略包含一般性的不平等问题重点目标，而只有 5 项战略以具体的不平等问题重点目标的形式包含了明确的百分比变化、截止日期或为实现战略中概述的与不平等问题相关的目标而分配的预算。
了解国家是否以及如何在其痴呆症战略中考虑不平等问题，可以为制定未来的战略提供参考，以便更好地解决相关的不平等问题。尽管大多数战略都提到了不平等问题，但很少有战略包含具体的目标来减少这些不平等问题。各国不仅要在表面上考虑不平等问题，还要提出切实可行的目标，旨在减轻所有痴呆症患者护理中的不平等问题的影响。
