Bridging the Gaps: Addressing Inequities in Neurological Care for Underserved Populations

Abstract

With over 3 billion individuals affected globally, disorders of the nervous system are now a major contributor to both economic burden and morbidity. The global burden of neurological disorders is estimated to be 43% according to the most recent Global Burden of Disease Study. Neurological disorders are the main drivers of disability-adjusted life-years and mortality in the non-communicable disease category. In addition, according to the systematic review by Lanza et al. disparities in the management of neurological disorders exist, disproportionately affecting underprivileged groups [1-3] With the majority of research concentrating within high-income countries (HICs) when compared to their counterpart low- and middle-income countries (LMICs), this study elucidates glaring discrepancies based on socioeconomic position, geographic location, and structural impediment.

This oversight is conspicuously evident in Africa, where healthcare systems often contend with the dualistic burden of communicable and non-communicable diseases [2]. Inequities circumventing healthcare surrounding neurological disorders, compounded by limited access and availability of resources, a dearth in primary clinical and research infrastructure, and a lack of trained medical and nursing personnel, remain a pressing but underexplored issue [3, 4]. The time to act is now. Addressing these inequities is not merely a public health imperative but a moral one, requiring dynamic global collaboration and context-sensitive solutions. (See Figure 1).

While Lanza and colleagues (2024) meticulously documented inequities evident in the healthcare of neurological disorders worldwide [1], the study inadvertently mirrors the ever-growing fissure in research it so critiques: the absence of robust data from LMICs. Of the 49 studies reviewed, only one was conducted in Africa [1]. This disparity is a testament to the systemic absence of LMICs from the global research agenda, perpetuating a vicious cycle of neglect.

In LMICs, neurological care inequities are exacerbated by structural deficiencies. For example, patients living with epilepsy in rural Africa often rely on traditional healers due to sticking to traditional values and beliefs and, in addition, to the lack of neurologists and allied healthcare professionals, resulting in delayed or inadequate therapy [5]. In Guinea, a study found that 79% of epilepsy patients had consulted traditional healers, with 71% seeking their services before approaching medical providers, leading to delays in receiving appropriate treatment. Stroke survivors, disproportionately affected by comorbidities pertaining to hypertension and diabetes mellitus [3, 4, 6], face limited access to rehabilitation services [7]. These disparities affect not just access to care but also healthcare advocacy, data, and knowledge (See Figure 2).

The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (WHO iGAP) offers a promising standardized framework to address these issues [2]. However, its global recommendations must be tailored to the specific realities of LMICs [11-13].

For instance, WHO iGAP advocates for capacity building through subsequent provision of education and training initiatives [2]. In Africa, this may translate to incentivizing local medical graduates to specialize in neurology through scholarships and programs adopting loan forgiveness [6]. Telemedicine, one of many WHO iGAP recommendations stipulated, may bridge the growing hiatus between rural patients and urban specialists [9], provided that governments invest in digital infrastructure and increased internet accessibility.

Furthermore, LMICs must be given priority in international financial arrangements. Strategies that have been effective in raising funds for communicable diseases, such as those of the Global Fund or Gavi, may be modified to assist with neurological care.

To bridge said gaps highlighted by Lanza et al. [1] we propose the following actions (See Table 1):

Neurological care inequities represent a microcosm of broader health disparities, reflecting systemic failures in access, funding, and prioritization. The findings of Lanza et al. provide a crucial starting point for dialog but must be complemented by action, particularly in LMICs like those in Africa.

Global collaboration is key. Academic journals, policymakers, and healthcare organizations must work together to amplify the voices of underserved populations. By prioritizing equity in neurological care, we may not only improve health outcomes but also uphold the fundamental principle of health as a human right.

The challenge is formidable, but the opportunity to transform lives is immeasurable. Bridging these gaps is not just an act of healthcare—it is an act of justice.

Olivier Uwishema: conceptualization, writing – original draft, investigation, methodology, visualization, writing – review and editing, formal analysis, project administration, resources, data curation. Table 1 and Figures were created by Olivier Uwishema. Paul Boon: writing – original draft, writing – review and editing, supervision, resources, formal analysis, methodology, data curation.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.