WHO Mental Health Forum
14-15 October 2019
WHO headquarters Geneva – Executive Board Room
WHO’s Integrated Approach to Brain Health
Professor Raad Shakir FRCP
Imperial College, London UK
Member European Affairs committee EAN]
Chair Neurosciences Topic Advisory Group ICD11 WHO
The annual WHO meeting of the mental health forum was held on the 14-15 October 2019. This is the first time that Neurology was invited to attend and present in two separate sessions. I represented the EAN and presented the case for global Neurosciences in the two sessions.
Fig 1. Developing an integrated approach to brain health
The first presentation included the enormous burden to neurological diseases and the preference of the term Brain Health rather than mental health in all the WHO organisations. The clear point is that the division of mental health and substance abuse in the WHO is outdated and does not represent the disciplines of Neurology and Neurosurgery appropriately as the most common cause of DALYs and the second commonest cause of death. The discipline of Neurology does not figure in the WHO statistics, as this was not included as the commonest lethal group of conditions affecting humanity as it was misclassified. It was pointed out that Stroke kills more than AIDS, Malaria and TB put together.
The WHO emphasis was on rehabilitation and there is scant mention of causation, diagnosis, management, or training of Neurologists and Neurosurgeons (FIG2). This glaring deficiency has to be rectified especially now as 194 countries just approved the WHO/UN declaration on Universal Health Coverage (UHC).
The lack of medical and nursing personal as well as the lack of availability of drugs used for headaches, stroke, epilepsy, Parkinson’s and neuromuscular diseases were outlined. The Neurology Atlas 2017 which was jointly produced by the WHO and WFN was freely available during the meeting and the facts are quite startling. Specifically in Europe that statistics of the WHO European region when last published failed to show specific data on neurological Morbidity and Mortality
Fig2. WHO’s Integrated Approach to Brain Health.
The second presentation was related to the implications of ICD11 on Neurological practice.
The presentation was limited to 10 minutes and the most new cardinal features of the Nervous System Diseases (NSD) chapter were listed. It was clearly stated that the agreement of the WHO to move Stroke from the vascular diseases chapter to the NSD chapter was a huge step forward and it has made a marked difference to funding and allocation of resource for neurological services.
Other new features included the expansion of the major headings from 14 to 25, which include circa 5,500 items at all levels. It is of note that the whole of ICD10 had 15,000 items and now ICD11 has around 55,000 (10%) of which are in the NSD chapter. More over separate chapters include migraine, epilepsy and stroke. Other new chapters include Prion diseases, which were termed “slow viral infections’ in ICD10. Stroke was in three chapters’ vascular diseases, episodic syndromes with migraine and epilepsy as well as imaging findings for silent infarcts. All this is now moved over to the NSD chapter. Emphasis on neuroimmunology, paraneoplastic disorders, neurogenetics, disorders of consciousness, autonomic disorders, disease of CSF pressure and flow as well as the vexing issue of the placement of Dementia. The agreement reached with colleagues responsible for the mental health chapter was to keep the item dementia where it was in ICD10 under the disorders of mental health and create new entities in the NSD chapter under the title of “Disorders with Neurocognitive impairment as a major feature”. This compromise should satisfy both the aetiological and the practical care components of the huge issue of Dementia (Fig3).
Fig3. The causes of Dementia as they appear in the NSD chapter ICD11.
The new ICD comes a generation following the old one, which was conceived in the 1980s. It has definitions and will reflect current scientific thinking and practice. It will also help as an educational tool for young trainees with its definitions and ontology to know how nervous system diseases are placed.
The neurological community is now on the WHO’s map as major player in the shaping of health care across the world in view of its prominence in dealing with the major disorders causing death and disability. Our place is now secure and we should demand the rightful placement of our specialty in all aspects of health care provision including Universal Health Coverage.