"Brain disorders are responsible for at least 27 percent of all years lived with disability in developing countries," the authors wrote. "When disability is taken into consideration along with death, brain disorders comprise nearly 15 percent of the burden of disease in developing countries."
Epilepsy, depression, bipolar disease, schizophrenia, developmental disorders and stroke "are currently estimated to affect as many as 1.5 billion people worldwide -- a number that is expected to grow as life expectancy increases. Since most disorders affecting the brain and its neural connections result in long-term disability and many have an early age of onset, measures of prevalence and mortality vastly understate the disability they cause."
The report, Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenge in the Developing World, was published by the IOM in May 2001 and examines the medical, sociological and economic implications of brain disorders in parts of the world where "diagnoses of mental disorders, including depression, have no conceptual equivalent in many languages."
In describing the scope of the problem, the authors pointed out that health policy has long been limited by the following misperceptions about brain disorders: they are a problem in the developed but not the developing world, they do not cause mortality, they are not amenable to treatment, and they are too expensive to manage.
But, the authors said, such policies ignore the magnitude of the problem. Brain disorders already represent the leading cause of a "large proportion of the burden of disease in developing countries." As a result of demographic shifts, brain disorders are projected to increase. By 2020, stroke and depression will rank first and second as the leading causes of disability worldwide.
Furthermore, the stigma associated with many brain disorders, such as epilepsy, schizophrenia and mental retardation, prevents people in developing countries from seeking and receiving appropriate treatment. In addition, it may result in the loss of social and educational opportunities for both the sufferers and their families.
Poverty can also be both a cause and a result of ill health and may contribute to brain disorders through poor nutrition, unhygienic living conditions and inadequate access to health care. According to the report, research indicates that in many countries "poverty and several psychiatric disorders, such as depression, exacerbate each other."
In addition, the report noted that many countries do not have adequately trained medical and nursing professionals to deal with brain disorders. "In India, for example, there are about 3,000 psychiatrists and 565 neurologists to serve a billion people, while in Zimbabwe there are 10 psychiatrists and 29 neurologists to serve 11 million people," the authors wrote.