|Year : 2016 | Volume
| Issue : 3 | Page : 185-187
Translating scientific evidence into global health policy: Making mental health count for individuals' and populations' health
Eliot Sorel M.D.
School of Medicine and Health Sciences, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
|Date of Web Publication||3-Nov-2016|
School of Medicine and Health Sciences, Milken Institute School of Public Health, The George Washington University, Washington D.C.
Source of Support: None, Conflict of Interest: None
Scientific evidence in all sciences, inclusive of the brain and neurosciences as well as in assessing health systems’ performance is rapidly evolving in the 21st century. This new evidence is augmenting the understanding of the brain and its functions, its transactions with the human genome, the microbiome,Β the social determinantsΒ of health, and the dominant global burden of diseases presented by non-communicable diseases, inclusive of mental disorders, and their comorbidities. Together they are stimulating new research and innovation in addressing the challenges of primary, secondary and tertiary prevention continuum as well as the current health systems’ fragmentation. The author presents contemporary scientific evidence, its impact on developing Total Health models of integrated health systems, and its translation into global health policy to benefit individuals’ and populations’ health.
Keywords: TOTAL health, scientific evidence, translation, global health policy
|How to cite this article:|
Sorel E. Translating scientific evidence into global health policy: Making mental health count for individuals' and populations' health. Indian J Soc Psychiatry 2016;32:185-7
|How to cite this URL:|
Sorel E. Translating scientific evidence into global health policy: Making mental health count for individuals' and populations' health. Indian J Soc Psychiatry [serial online] 2016 [cited 2019 Aug 24];32:185-7. Available from: http://www.indjsp.org/text.asp?2016/32/3/185/193194
| Introduction|| |
Health is a state of complete physical, mental, and social wellbeing, not just the absence of disease and/or infirmity. Health is determined by multiple factors, biological, genetic, psychosocial, economic, cultural, and environmental. Together, they affect and determine health, illness, and disabilities with significant consequences for individuals’ and populations’ health, as well as economic consequences.The complexity of health, illness, and disabilities requires health systems that would respond on a timely basis with a continuum of primary, secondary, and tertiary prevention. It is also a must that such systems are accessible, of quality, and sustainable.
| Epidemiology, Burden of Disease, and of Disability|| |
More than 500 million people suffer from mental disorders and nearly 1 million commit suicide every year. Mental disorders represent 14% of the global burden of disease, and 30–45% of the global burden of disability. Tens of billions of dollars are lost in productivity yearly. In the countries listed under Organization for Economic Cooperation and Development (OECD) alone, this loss in productivity due to mental illness accounts for approximately 4% of the OECD countries Gross Domestic Product.,
| Translating Scientific Evidence|| |
The United Nations General Assembly, for the first time in its history, included noncommunicable diseases (NCDs) on its agenda in September 2011. Mental disorders, although among the most prevalent of NCDs, were excluded from this agenda. In prior years, the United Nations and its agencies also excluded mental disorders from the Millennium Development Goals (MPGs), either unaware, or ignoring the scientific evidence regarding the high global burden of disease and disability represented by mental disorders and the well-documented evidence that there is no health without mental health.
In addition to the burden of disease and of disability posed by mental disorders, they also pose another challenge, the challenge of comorbidity with other NCDs. A most illustrative comorbidity cluster is that of diabetes, depression, and cardiovascular disorders that is encountered across low-income, middle-income, and high-income countries. Contemporary health systems that are primarily attending to secondary and tertiary prevention through fragmented specialty silos do not respond well to the comorbidity challenge. A TOTAL health systems integration is a sine qua non response to enhance health systems’ performance, individuals’, and populations’ health given the high incidence and prevalence of NCDs and their clusters of comorbidity.
Further more, health systems must be accessible, of quality, and nondiscriminatory vis-à-vis mental disorders. A historic step in preventing the shame, stigma, and discrimination against mental disorders was the passage, in the United States, of the Domenici-Wellstone Parity Law, signed into law by President George W. Bush in December 2008, and began to be implemented in January 2009 by President Barack Obama. Nevertheless, to date the Domenici–Wellstone regulations that would enforce the law’s implementation are not yet fully operational and observed nationwide.
The continued discrimination against mental disorder has an impact not only on the individuals who suffer from such disorders, but also on their families and with significant economic consequences for the nations’ economies.
| Global Health Policy and Advocacy|| |
In the wake of the United Nations General Assembly discrimination against mental disorders or vis-a-vis mental disorders of 2011, advocates around the world mobilized to challenge the United Nations’ unfortunate exclusion of mental disorders from the General Assembly’s agenda of 2011. Among those who advocated for their inclusion were professional leaders from the United States and around the world that contacted directly the Executive Committee of the World Health Organization (WHO) regarding these matters in January 2012. Such letters of advocacy were sent to the Executive Committee of WHO by the World Psychiatric Association, the Black Psychiatrists of America, Columbia University Department of Psychiatry (New York), and professionals from the Satcher Health Leadership Institute, the George Washington University School of Medicine, and School of Public Health. These advocacy letters were accepted onto the WHO Executive Committee agenda in January 2012 and their recommendations were placed on the WHO Assembly agenda of May 2012 and adopted to be included in the subsequent WHO Global Mental health Action Plan of 2013–2020 that predicated, among other things, the integration of mental health and primary care.
| Health Systems’ Integration|| |
The TOTAL Health Model we are developing is based on the integration of primary care, mental health, and public health with an emphasis on a continuum of primary, secondary, and tertiary prevention. TOTAL Health also includes health protection, promotion, and illness prevention throughout life with a special emphasis on the primordial importance of the perinatal period. Such a model is an effective response to non-communicable diseases and their high levels of comorbidity with an emphasis on primary prevention, health promotion and prevention starting very early in life. The TOTAL Health model also enhances access, quality, outcomes, and diminishes costs, shame, stigma, and discrimination. It is a model that in effect integrates brain, body, and mind.Β Its full potential is well-served by a strategic and catalytic use of communication and information technology.
The current Brain Project in the United States and the Human Brain project in Europe are two innovative research initiatives that are likely to open new vistas of understanding of brain functioning and illuminate some of the complexities related not only to neurological disorders, but also related to brain heart interactions, brain immune systems interactions, and brain microbiome transactions. In aggregate, these are most relevant to better understanding NCDs, to enhance primary and secondary prevention strategies and enhance the translation of scientific evidence into global health policy.
| Global Mental Health Action Plan 2013–2020|| |
The WHO Assembly of May 2012 ratified the inclusion of mental health on the global health agenda complementary to the NCDs action taken at the United Nations General Assembly in fall 2011. Consequently, an action plan review was designated for 2012–2013 with an action plan implementation 2013–2020. Some significant highlights of the global mental health action plan include:
- Strengthening effective leadership and governance;
- Provide comprehensive, integrated, responsive, and community based care;
- Implement promotion and prevention for mental health; and
- Strengthen information systems, evidence, and research.
| Economic and Health Consequences|| |
NCDs have a leading role in affecting the worldwide workforce and populations’ health. They contribute significantly to absenteeism, presenteeism, and unemployment, resulting in hundreds of billions of dollars lost in earnings and productivity globally. Such a high impact phenomena is a result of the fact that 50% of mental disorders exist by age 14 and 75% by age 24, but go undetected for many years and subsequently contribute to evolving comorbid conditions to the burden of disease and disability. A special case is constituted by individuals and populations who suffer from severe and recurrent psychiatric disorders who are among the highest populations with severe comorbidities of cardiovascular disorders and diabetes that are not attended to in a timely and effective fashion, consequently, resulting in these individuals dying 20–25 years prior to the rest of the population of the same age.,
| Reflections and Conclusions|| |
Mental disorders are diagnosable and treatable, and we have the ability to return people to productive lives and positive relationships in a majority of cases but our work is not completely done yet. We need better measurements of mental health systems’ performance; scaling up evidence-based treatments through shared responsibilities of care receivers, care givers, payers, and policy makers. We must also enhance health literacy across the life cycle and assure access to care for all in a system that is of quality and sustainable accomplished through primary care, public health, and mental health integration providing appropriate incentives for innovation, integration, and superior outcomes we also need new investments in education, training, services, research, and policy. And last but not the least, we must include mental health in the updated MPGs and global NCD plans making mental health count for individuals’ and populations’ health, and for the countries’ economies.
| Recent, positive developments|| |
The World Bank Group in collaboration with the World Health Organization convened, during the Finance Ministers’ meeting, this spring 2016, in Washington, DC the historic and unprecedented high level dialogue on Making Mental Health a Global Development Priority. An Innovators’ Fair of global mental health innovations, across economies, preceded the meeting. It illustrated well the ingenuity, creativity, and pragmatism of worldwide global mental health initiatives, a concrete reflection of translating scientific evidence into practice and policy.
We were pleased to contribute to our TOTAL Health screening for integrated care innovation with a focus on Depression and Comorbidity in Primary Care in China, India, Iran and Romania recently completed and published in the International Medical Journal.
Specific commitments and action plans were identified that are to be carried out in the years to come and in tandem with the WHO Global Mental Health Action Plan 2013-2020.
Additionally, the United Nations just adopted the Mental Health and Human Rights Resolution co-signed by sixty one member states that is naturally complementary to the intended initiatives identified by the World Bank and WHO in their recent, high level Washington meeting.
We would follow closely the World Bank/WHO initiative and the U.N. Mental Health and Human Rights Resolution. We will monitor and assess their transformation from the aspirational to the operational, enhancing TOTAL Health and in this process making mental health count for individuals’ and populations’ health.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
| References|| |
Kessler RC, Ustun TB. The WHO Mental Health Surveys. Geneva: Cambridge University Press, 2008.
Organization for Economic Cooperation and Development (OECD). Making Mental health Count: The Social and Economic Costs of Neglecting Mental Health Care. OECD Health Policy Studies. Paris: OECD Publishing, doi: 10.1787/978964208445-en.
WHO. The WHO Global Mental Health Action Plan.
Geneva: WHO, 2013.
Sorel E, Dima C, Balanescu P, Botezat-Antonescu I, Oana C, Depression and Comorbidity in Primary Care in China, India, Iran and Romania. Int Med J 2016;;23:118-131.