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Six Action Steps to Address Global Disparities in Parkinson DiseaseA World Health Organization Priority

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Abstract

Importance  The Global Burden of Disease study conducted between 1990 and 2016, based on a global study of 195 countries and territories, identified Parkinson disease (PD) as the fastest growing neurological disorder when measured using death and disability. Most people affected by PD live in low- and middle-income countries (LMICs) and experience large inequalities in access to neurological care and essential medicines. This Special Communication describes 6 actions steps that are urgently needed to address global disparities in PD.

Observations  The adoption by the 73rd World Health Assembly (WHA) of resolution 73.10 to develop an intersectoral global action plan on epilepsy and other neurological disorders in consultation with member states was the stimulus to coordinate efforts and leverage momentum to advance the agenda of neurological conditions, such as PD. In April 2021, the Brain Health Unit at the World Health Organization convened a multidisciplinary, sex-balanced, international consultation workshop, which identified 6 workable avenues for action within the domains of disease burden; advocacy and awareness; prevention and risk reduction; diagnosis, treatment, and care; caregiver support; and research.

Conclusions and Relevance  The dramatic increase of PD cases in many world regions and the potential costs of PD-associated treatment will need to be addressed to prevent possible health service strain. Across the board, governments, multilateral agencies, donors, public health organizations, and health care professionals constitute potential stakeholders who are urged to make this a priority.

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Article Information

Accepted for Publication: April 12, 2022.

Published Online: July 11, 2022. doi:10.1001/jamaneurol.2022.1783

Corresponding Author: Nicoline Schiess, MD, MPH, Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, Geneva 1202, Switzerland (schiessn@who.int).

Conflict of Interest Disclosures: Dr Schiess has received grants from Edmond J. Safra Foundation paid to her institution during the conduct of the study. Dr Okun serves as a consultant for the Parkinson’s Foundation; has received research grants from the National Institutes of Health (NR014852, R01NS096008, U01NS119562, UH3 NS18-023, R21NS072897, R25NS108939), the Parkinson’s Foundation, the Michael J. Fox Foundation, the Smallwood Foundation, the Tourette Syndrome Association of America, and the UF Foundation; has received royalties for book publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford, and Cambridge; is an Associate Editor for New England Journal of Medicine Journal Watch Neurology; and has participated in CME and educational activities on movement disorders sponsored by the Academy for Healthcare Learning, PeerView, Prime, WebMD/Medscape, Medicus, MedNet, American Academy of Neurology, Movement Disorders Society, and Vanderbilt University. Dr Dorsey has received personal fees from the American Academy of Neurology, American Neurological Association, Excellus BlueCross BlueShield, International Parkinson’s and Movement Disorders Society, National Multiple Sclerosis Society, Northwestern University, Physicians Education Resource, PRIME Education, Stanford University, Texas Neurological Society, and Weill Cornell Honoraria; consulting fees from Abbott, AbbVie, Acadia, Acorda, Bial-Biotech Investments, Biogen, Boehringer Ingelheim, California Pacific Medical Center, Caraway Therapeutics, Curasen Therapeutics, Denali Therapeutics, Eli Lilly, Genentech/Roche, Grand Rounds, Huntington Study Group, Informa Pharma Consulting, Karger Publications, LifeSciences Consultants, MCM Education, Mediflix, Medopad, Medrhythms, Merck, Michael J. Fox Foundation, North American Center for Continuing Medical Education, Neurocrine, NeuroDerm, National Institutes of Health, Novartis, Origent Data Sciences, Otsuka, Physician’s Education Resource, Praxis, PRIME Education, Roche, Brown, McCarthy & Gruber, Sanofi, Seminal Healthcare, Spark, Springer Healthcare, Sunovion Pharma, Theravance, Voyager, and WebMD; grants from Biogen, Biosensics, Burroughs Wellcome Fund, CuraSen, Greater Rochester Health Foundation, Huntington Study Group, Michael J. Fox Foundation, National Institutes of Health, Patient-Centered Outcomes Research Institute, Pfizer, PhotoPharmics, Safra Foundation, and Wave Life Sciences; has performed editorial services for Karger Publications; owns stock in Included Health and Mediflix; and has ownership interests in SemCap outside the submitted work. Dr Bloem has received grants and personal fees from UCB and Zambon paid to his institution; personal fees from Critical Path Institute, AbbVie, Biogen, Roche, GE Healthcare, Novartis, and Bial paid to his institution during the conduct of the study; grants from the Netherlands Organisation for Scientific Research, Michael J. Fox Foundation, Stichting Woelse Waard, Alkemade Keuls, Maag Lever Darm Stichting, ParkinsonNL, Davis Phinney Foundation, Parkinson’s Foundation, Verily, Horizon 2020, Nothing Impossible, and Parkinson Vereniging outside the submitted work. Dr Bhidayasiri has received grants from Thailand Science Research and Innovation, Thailand Research Fund, and Chulalongkorn University; personal fees from Royal Society of Thailand, Abbott Pharmaceuticals, Lundbeck Pharmaceuticals, Teva Pharmaceuticals, Eisai Pharmaceuticals, and Otsuka Pharmaceuticals outside the submitted work; and has patents for laser-guided walking stick issued to Chulalongkorn University, for laser-guided walking stick issued, for nocturnal monitoring device issued, for tremor analysis device issued, and for a Parkinson cup pending. Dr Chishimba has received personal fees from Northwestern Medicine outside the submitted work. Dr Chowdhary has received grants from Edmond J. Safra Foundation during the conduct of the study. Dr Fung has received grants from AbbVie and nonfinancial support from Merz outside the submitted work. Dr Gifford has received personal fees from Michael J. Fox Foundation, Parkinson Canada, and University of Rochester outside the submitted work; and is president and cofounder of PD Avengers. Dr Kühn has received personal fees from Medtronic, Boston Scientific, Teva, and Abbott outside the submitted work. Dr Lim has reeived personal fees from Medtronic outside the submitted work. Dr Okubadejo has received grants from Michael J. Fox Foundation outside the submitted work. Dr Dua has received grants from Edmond J. Safra Foundation during the conduct of the study. No other disclosures were reported.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the World Health Organization. Dr Okun is Associate Editor of JAMA Neurology, but he was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Additional Contributions: We gratefully acknowledge the contributions of the Edmond J. Safra Foundation for their financial support of the WHO consultation workshop, “Addressing the Public Health Importance of Parkinson Disease.”

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