National Dementia Strategies in OECD Countries: A Focus on Inequities

Context: In response to increasing global dementia prevalence, several countries have developed national strategies to address dementia as a public health priority. These strategies aim to improve dementia care, supports, and resources for persons living with dementia, care partners, and communities. Inequities in dementia care have been described as impacting access to primary care, specialist services, and hospital care, however it is unclear whether dementia plans adequately address these inequities.

Objectives: This study aimed to (1) describe the trends in economic and demographic factors that may be associated with the development of national dementia strategies to understand why some countries have or do not have dementia strategies, and (2) describe if and how national dementia strategies consider inequities as a target of concern.

Study Design: An environmental scan was conducted. Strategies were screened for eligibility and searched for key terms, and included strategies were synthesized by thematic analysis.

Population Studied: Included strategies had to be accessible in English or French, and address dementia at the national level in countries that are part of the Organization for Economic Cooperation and Development (OECD). Sub-national or provincial plans were excluded on the basis of comparability.

Results: As of 2021, 27 of 38 OECD countries had national dementia strategies, the development of which may have been impacted by economic factors like Gross Domestic Product and Health Spending. Of the 15 included dementia strategies, 13 mentioned one of the following inequities: Race/Ethnicity; Religion; Age; Disability; Sexual Orientation/Gender Identity; Social Class; or Rurality. Of the strategies that mentioned at least one inequity, 11 had general inequity-focused objectives, while only 5 had specific inequity-focused objectives in the form of tangible percentage goals, deadlines, or allocated budgets for achieving the goals of their dementia strategies.

Conclusions: Improving care for all persons living with dementia is a public health priority. Understanding if and how countries consider inequities in their dementia strategies may allow for the development of future strategies that adequately target inequities of concern. When developing future strategies, countries must not only consider inequities at a surface-level, but rather put forth actionable objectives that intend to lessen the impact of inequities in dementia care.