Which innovations can improve measurement, technology, investment, and public policy surrounding brain health?
The brain story is a story about how experiences shape our brains. We argue that societal brain capital—which has been long neglected and unexpectedly severely impacted by the COVID-19 pandemic—is declining. Innovations are offered to improve measurement, technology, investment, and public policy.
The brain story, created by the Albert Family Wellness Initiative,1 describes how early life experiences shape brain development and impact lifelong physical and mental health outcomes. For the purposes of this article, we are considering the brain story across the lifespan.
Brain capital integrates brain health and brain skills, which are the cornerstone of the modern economy.2 Human brains are our greatest asset. This understanding provides a unified framework to define elements of brain health, disorder, and skills; quantify them; and track them in order to develop new ways to enhance them.3 Brain capital can help tell the global human story.
Brain Capital in Decline
Our brain health is under threat. Nearly 1 billion individuals worldwide have a mental disorder.4 Access to affordable, quality care is poor in high-income settings and is nearly nonexistent in many low- and middle-income settings. Diagnostic approaches are largely subjective. Treatments of these conditions try to reduce and better manage patients’ symptoms, usually with therapy and medications to help maintain functioning and quality of life.
Preventive strategies are still in their infancy. Stigma surrounding mental disorders remains high in many areas of the world. For decades, health policy and insurance systems have offered minimal coverage of these conditions. This has further restricted access and diminished investment in diagnostics and treatments.
Compounding these challenges, it is estimated that around 23% of individuals infected with COVID-19 will become “long-haulers,” with neurological and psychiatric manifestations.5 The underlying disease mechanisms and treatment strategies are still being researched. An estimate of economic loss caused by the COVID-19 pandemic in the United States suggests that mental health impairment will account for $1.58 trillion lost from a total of $16 trillion of GDP.6
Additionally, according to a recent report by the International Labour Organization,65% of youth report having learned less since the beginning of the pandemic, and 38% report that they are uncertain of their future career prospects.7 If these education and training issues are left unaddressed, this will perpetuate the skilled labor shortage and negatively impact brain capital for years to come. Indeed, it could lead to “a generation lost” to COVID-19-related educational disruptions,8 which could result in this generation losing$17 trillion in lifetime wages, thereby significantly impacting the future economy.9
Whether youth are enrolled in school, receiving training, or working has important implications for future economic growth, development, and stability. If overlooked, youth unemployment has the potential to have significant and serious social repercussions; it can lead to social exclusion and unrest. Investing in job creation, as well as in education and training opportunities, will help youth find their place and contribute to more prosperous and stable societies.
COVID-19 has also had a major impact on early childhood development. Research on infant language development suggests that babies born during the pandemic have delayed milestones, falling approximately 15% to 20% below the well-established norms of development.10 Although the reasons for these delays are complex and multifaceted, the fact remains that a much larger percentage of infants are not meeting previously established developmental norms.
The Resilience Scale Metaphor,11 first created by the Harvard Center on the Developing Child and further developed by the Alberta Family Wellness Initiative, is a unique tool that can help us begin to understand how these adverse experiences affect individuals differently. Resilience refers to our ability to remain healthy in the face of negative experiences, and the Resilience Scale Metaphor depicts how our positive and negative experiences exist in a delicate balance todetermine developmental and physical and mental health outcomes (Figure 1).
Figure 1. The Resilience Scale Metaphor11
The fulcrum of the scale is shifted by thepresence or absence of core life skills, which changes the amount of leverage given to our positive and negative experiences.
Notable Policy Movements
We applaud recent policy activity in this area. As part ofPresident Joe Biden’s first State of the Union Address,12 he announced a strategy to address the national mental health crisis. This critically includes an expanded focus on youth mental health. This may help to develop sustainable efforts to reallocate health care resources from dis-economically overpriced procedures, as well as specialty pharmacy/infusion and complex diagnostics for cancer, cardiovascular, musculoskeletal, and rare diseases, to mental health and substance use care and discovery.
Delegates at the 75th World Health Assemblyapproveda new intersectoral global action plan on epilepsy and other brain disorders (including stroke, migraine, dementia, and meningitis) that aims to improve access to care and preventative measures.13 This extends prior work from the World Health Organization, including its 2019 guidelines on how to reduce risk of dementia and cognitive decline.14
Both the WHO Brain Health Unit15 and Lundbeck,16 a central nervous system-focused pharmaceutical company, recently released new brain health position statements, noting brain capital of critical importance. This demonstrates traction in public policy and in the private sector, respectively. Brain capital has provided a framework for the consultancy firm PwC Nigeria17 to translate the export of skills into an economic argument. These global partnerships were highlighted in the Science Summit at the 77th United Nations General Assembly in a meeting hosted by the European Brain Council and Cohen Veterans Bioscience.18
New Workforce Training Approaches
In Alberta, Canada, the Alberta Family Wellness Initiative has been successfully influencing policy to reflect the most current understanding of brain science across sectors and disciplines. The Brain Story Certification19 is a free online course featuring presentations by leading scientific minds blended with simple metaphors.
The course communicates complex scientific concepts including brain development, epigenetics, executive function, mental health, and addiction to audiences of policy makers, practitioners, and the public who seek a deeper understanding of brain science and its consequences for lifelong health. More than 100,000 individuals have enrolled in this course globally, with more than 55,000 enrolled in Alberta alone.
The course teaches us that just as a house needs a strong foundation, a brain requires a strong base to support all future development. The significant uptake of the Brain Story Certification in the province has contributed to a common language and competency across service sectors including health, education, justice, and children’s services, which has been key to effective systems change.
Fostering a common and easily accessible understanding of brain science, as exemplified in the Brain Story Certification (Figure 2), builds workforce competency, which is what enables both horizontal and vertical integration of the knowledge and will ultimately lead to improved outcomes not only for individuals accessing those services, but for the general population as well.
Figure 2. Overview of the Brain Story Certification
In accordance with the Alberta Family Wellness Initiative theory of philanthropy, the brain story improves practice and future outcomes by focusing on professional development and training. This focus further leads to organizational change and the potential to influence policy.
For example, within the Ministry of Children’s Services of Alberta, alignment with the brain story is reflected in the language of the current guiding framework of the ministry and in contract allocation. Recently, the government of Alberta allocated $5.2 million (CAD) for early childhood educators to become certified in the brain story and to participate in 10 hours of theory to practice sessions exploring practical application of this knowledge.20
The Global Brain Health Institute (GBHI),21 based at the University of California San Francisco and Trinity College Dublin, is an organization established to improve brain health worldwide and reduce the global impact of dementia. More than 150 fellows from more than 40 countries have participated in the unique fellowship program offered by GBHI since its inception just 7 years ago. The multinational, cross-disciplinary approach to maintaining and improving global brain health seeks to drive innovative approaches to equity in care, treatment, advocacy, and policy.
New Technology and Investment Activities
Investments in innovations promise to continue and to expand if the field is managed responsibly. Although the digital health investment sector iscooling off,22 mental health is once again a top clinical funding area. A recentreport from Telosity Ventures23 noted that the youth wellness and mental health space is a $26 billion industry with investment growth of over 15 times during the past 4 years.
There are now at least10 mental health startup “unicorns,” or companies valued at more than $1 billion USD.24 However, there are significant challenges in this space. For example, Cerebral, once valued at$4.8 billion USD,25 is now under a US Department of Justiceinvestigationfor possible violations of controlled substances law.26 There is also a widespread criticism that current mental health startups arenot providing equitable access to those most in need (minorities and those of low socioeconomic status).27
iShares, powered by BlackRock, a large asset manager, recently announced that it will launch a Neuroscience and Healthcare Exchange Traded Fund (ETF). This ETF will “offer the investment community access to equity securities that are involved in the research, development, or manufacturing of neurology biopharmaceuticals or neurological devices.”28 We applaud this move, but also recognize that it is currently limited to pharmaceutical and biotechnology company stocks. Notwithstanding, now is the time to invest in improving the brain health of the global population, while these emergent trends can be addressed.29
As schools increasingly return to in-person learning, investment in education technology “ed tech” venture capital continues to increase.30 There are new novel approaches to deliver personalized education and approaches to upskilling and reskilling adults. There are also promising neuroscience advances spanning brain imaging, digital biomarkers, and brain stimulation techniques.31 These foreshadow opportunities to personalize care and therapy to patients.
Brain capital technologies are neuroscience-inspired innovations that touch upon 1 or more of the fields of neurology, mental health, early childhood brain development, late-life wellbeing, women’s equality, sleep health, education, and workforce. Here are some examples:
Such novel solutions may bring precision solutions to individuals in need.
The Way Forward
We are working to ensure brain capital is no longer overlooked. It is a foundational socioeconomic asset and thus will only reach its full potential when utilized in appropriate settings. It is key to telling the humanity-wide brain story.
The first step will be to continue to build on key concepts, ensuring that brain capital is considered across a range of challenging settings, from the devastating impact of misinformation on democracy to building socioecological resilient systems that can withstand future pandemic-level events. These key concepts are then attached to specific metrics to demonstrate the effect that poor brain health conveys on the population, such as the burden of the growing prevalence of addiction and substance use, and of the failure to address climate change.
Building crucial experience in working with brain capital as a framework will provide the necessary foundation to drive the development of public policy. Showcasing the need for evidence-based policy development in key areas like early childhood education will require significant transdisciplinary engagement and alignment of both horizontal and vertical systems to achieve necessary systems change.
The early work in policy will also require involvement with companies and, as a concept and metric, will guide investment in companies as a brain capital-led marker of benefit and social responsibility.
Our Brain Capital Alliance is developing a dashboard35 to measure and track brain capital across all the aforementioned domains. This will bring together our partners; will be based on global health, education, and workforce datasets; and will be made available to the public.
Resources like the Alberta Family Wellness Initiative’s Brain Story Certification offer both professionals and the public at large the opportunity to develop a deeper understanding of brain science, as well as to foster both a common language regarding this complex science and a common competency across systems. Engagement with the brain story is continuing to grow, fostered by global partnerships across Canada, Australia, Bangladesh, the United States, and the United Kingdom.
We are also developing a brain capital policy innovation handbook for politicians to offer them novel approaches for boosting the brain capital of their constituents. Let us all explore novel approaches to end the brain capital decline and neglect in order to achieve a brighter future.
Acknowledgements and Disclosures
The authors would like to thank the following individuals for their generous review and feedback: Gary Gottlieb, MD; Geoffrey F. L. Ling, MD, PhD; Antonella Santuccione Chadha, MD; and Ernestine Fu, PhD. Co-author Michael Berk is supported by a NHMRC Senior Principal Research Fellowship and a Leadership 3 Investigator grant (1156072 and 2017131).
Dr Eyre is lead of the Brain Capital Alliance and co-lead of the OECD Neuroscience-inspired Policy Initiative . He is Senior Fellow for the Meadows Mental Health Policy Institute and Fellow for the Baker Institute for Public Policy. He is an advisor to the Euro-Mediterranean Economists Association. Dr Lundin is a psychiatry registrar with Barwon Health and an affiliate lecturer with Deakin University. Ms Chen is a venture capitalist focused on the future of work and a lecturer at Berkeley and Singularity University. Shuo is also a California State Mental Health Commissioner. Dr Abbott is a professor of law and health sciences at University of Surrey and an adjunct assistant professor of medicine at the David Geffen School of Medicine at UCLA. Dr Saxena is a professor of the practice of global mental health, global health and population at the Harvard T H Chan School of Public Health. He is the former head of the WHO Department for Mental Health and Substance Abuse. Dr Wong is the John S. Dunn Sr. Presidential Distinguished Chair and director of T.T. and W.F. Chao Center for BRAIN at Houston Methodist and a professor of neurosciences, radiology, pathology, and laboratory medicine at Weill Cornell Medical College. Mr Hackett is a senior business executive and board director. He is co-founder of The Hackett Center for Mental Health Policy and a trustee with Rice University and Baylor College of Medicine. Dr Hynes is an associate fellow at the Johns Hopkins School of Advanced International Studies. Dr Schiller is a professor of psychiatry and neuroscience at the Icahn School of Medicine and Mount Sinai, New York City, New York. Ms Mannix is founder of the Palix Foundation. Dr Jenkins is a scientific associate with the Palix Foundation. Ms Neihaus is a scientific associate with the Palix Foundation. Dr Dawson is an assistant professor at the Oregon Health & Science University School of Medicine and Portland State University, Institute on Aging in Portland, Oregon. Dr Berk is a NHMRC Senior Principal Research Fellow and is Alfred Deakin Professor of Psychiatry, School of Medicine, Deakin University and Barwon Health and Director, IMPACT, the Institute for Mental and Physical Health and Clinical Translation.
1. The brain story. Alberta Family Wellness Initiative. Accessed December 15, 2022. https://www.albertafamilywellness.org/what-we-know/the-brain-story/
2. Smith E, Ali D, Wilkerson B, et al. A brain capital grand strategy: toward economic reimagination. Pol Psychiatry. 2021;26:3-22.
3. Eyre HA, Ayadi R, Ellsworth W, et al. Building brain capital. Neuron. 2021;109(9):1430-1432.
4. Nearly one billion people have a mental disorder: WHO. United Nations. June 17, 2022. Accessed December 15, 2022. https://news.un.org/en/story/2022/06/1120682
5. Wu Q, Ailshire JA, Crimmins EM. Long COVID and symptom trajectory in a representative sample of Americans in the first year of the pandemic. Sci Rep. 2022;12:11647.
6. Cutler DM, Summers LH. The COVID-19 pandemic and the $16 trillion virus. JAMA. 2020;324(15):1495-1496.
7. Youth & COVID-19: impacts on jobs, education, rights, and mental well-being. International Labour Organization. 2020. Accessed December 15, 2022. https://www.ilo.org/wcmsp5/groups/public/---ed_emp/documents/publication/wcms_753026.pdf
8. Gill I, Saavedra J. We are losing a generation. The Brookings Institution. February 8, 2022. Accessed December 15, 2022. https://www.brookings.edu/blog/future-development/2022/01/28/we-are-losing-a-generation/
9. Learning losses from COVID-19 could cost this generation of students close to $17 trillion in lifetime earnings. The World Bank. News release. December 6, 2021. Accessed December 15, 2022. https://www.worldbank.org/en/news/press-release/2021/12/06/learning-losses-from-covid-19-could-cost-this-generation-of-students-close-to-17-trillion-in-lifetime-earnings
10. Deoni SC, Beauchemin J, Volpe A, et al. The COVID-19 pandemic and early child cognitive development: a comparison of development in children born during the pandemic and historical references. Preprint. medRxiv. 2022;2021.08.10.21261846.
11. McCann C, Cook J, Loiseau E. Early learnings about uses for the Resilience Scale Metaphor in practice. Alberta Family Wellness Initiative. January 8, 2021. Accessed December 15, 2022. https://www.albertafamilywellness.org/assets/Resources/Early-Learnings-about-the-Resilience-Scale-Metaphor-in-Practice2.pdf
12. Remarks of President Joe Biden—State of the Union Address as prepared for delivery. The White House. March 1, 2022. Accessed December 15, 2022. https://www.whitehouse.gov/briefing-room/speeches-remarks/2022/03/01/remarks-of-president-joe-biden-state-of-the-union-address-as-delivered/
13. World Health Assembly passes neurological conditions action plan. Alzheimer Europe. News release. May 27, 2022. Accessed December 15, 2022. https://www.alzheimer-europe.org/news/world-health-assembly-passes-neurological-conditions-action-plan
14. Risk reduction of cognitive decline and dementia: WHO guidelines. World Health Organization. 2019. Accessed December 15, 2022. https://apps.who.int/iris/bitstream/handle/10665/312180/9789241550543-eng.pdf
15. Launch of first WHO position paper on optimizing brain health across life. World Health Organization. News release. August 9, 2022. Accessed December 15, 2022. https://www.who.int/news/item/09-08-2022-launch-of-first-who-position-paper-on-optimizing-brain-health-across-life#:~:text=The%20new%20WHO%20position%20paper,brain%20health%20optimization%20for%20all.
16. Brain health—a global priority. Lundbeck. Accessed December 15, 2022. https://www.lundbeck.com/global/about-us/our-commitment/our-position-on-brain-health
17. Brain exports: growing the Nigerian economy. PwC Nigeria. Accessed December 15, 2022. https://www.pwc.com/ng/en/publications/brain-exports-growing-the-nigerian-economy.html
18. Global Partnerships in Brain Research. European Brain Council. Accessed December 15, 2022. https://www.braincouncil.eu/event/global-partnerships-in-brain-research-event-at-science-summit-unga77/
19. Brain Story Certification. Alberta Family Wellness Initiative. Accessed December 15, 2022. https://www.albertafamilywellness.org/training-2
20. More support for early childhood educators in Alberta. Education News Canada. News release. December 7, 2022. Accessed December 15, 2022. https://educationnewscanada.com/article/education/level/k12/3/993672/more-support-for-early-childhood-educators-in-alberta.html#:~:text=The%20governments%20of%20Canada%20and%20Alberta%20are%20also%20providing%3A,brain%20science%20and%20development%20training.
21. Improving brain health and reducing the scale and impact of dementia worldwide. Global Brain Health Institute. Accessed December 15, 2022. https://www.gbhi.org/
22. Pifer R. Digital health funding is cooling down. Industry Drive. July 12, 2022. Accessed December 15, 2022. https://www.healthcaredive.com/news/digital-health-funding-bubble-correction-2022/627029/#:~:text=Mental%20health%20was%20once%20again,staff%20burnout%2C%20Rock%20Health%20said
23. Youth wellness & mental health: a $26 billion opportunity. Telosity Ventures. Accessed December 15, 2022. https://www.telosity.co/mkt-guide
24. Yedinak J. The 10 mental health tech unicorns with the highest valuations in 2021. Behavioral Health Business. February 28, 2022. Accessed December 15, 2022. https://bhbusiness.com/2022/02/28/the-10-mental-health-tech-unicorns-with-the-highest-valuations-in-2021/
25. Reuter E. SoftBank backs mental health app Cerebral, giving it $4.8B valuation. MedCityNews. December 8, 2021. Accessed December 15, 2022. https://medcitynews.com/2021/12/softbank-backs-mental-health-app-cerebral-giving-it-4-8b-valuation/
26. Landi H. Cerebral under federal investigation for possible violations of controlled substances law. Fierce Healthcare. May 7, 2022. Accessed December 15, 2022. https://www.fiercehealthcare.com/health-tech/cerebral-under-federal-investigation-possible-violation-controlled-substances-law
27. Hall C. Access to mental health: startups tackle sector’s complexities as investors go all-in. Crunchbase News. February 22, 2021. Accessed December 15, 2022. https://news.crunchbase.com/health-wellness-biotech/access-to-mental-health-startups-tackle-sectors-complexities-as-investors-go-all-in/
28. iShares Neuroscience and Healthcare ETF. iShares by BlackRock. Accessed December 15, 2022. https://www.ishares.com/us/products/329137/ishares-neuroscience-and-healthcare-etf/
29. Spiegel J. Why now could be the time to consider neuroscience investments. iShares by BlackRock. August 26, 2022. Accessed December 15, 2022. https://www.ishares.com/us/insights/neuro
30. Kunthara S. Edtech investment continues to soar even as schools return to in-person learning. Crunchbase News. March 24, 2022. Accessed December 15, 2022. https://news.crunchbase.com/edtech/edtech-startup-vc-funding-2022-owl-ventures/
31. Bzdok D, Meyer-Lindenberg A. Machine learning for precision psychiatry: opportunities and challenges. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018;3(3):223-230.
32. The only doctor prescribed video game treatment for kids with ADHD. EndeavorRx. Accessed December 15, 2022. https://www.endeavorrx.com/
33. Project: AttentivU. MIT Media Lab. Accessed December 15, 2022. https://www.media.mit.edu/projects/attentivu/overview/
34. Early speech therapy that turns playtime into progress. Babbly. Accessed December 15, 2022. https://www.babbly.co/
35. EMEA President Prof. Rym Ayadi presents the Brain Capital Dashboard at the launch event of the Brain Capital Alliance at CEPS. Euro-Mediterranean Economists Association. July 4, 2022. Accessed December 15, 2022. https://euromed-economists.org/emea-president-prof-rym-ayadi-presents-the-brain-capital-dashboard-at-the-launch-event-of-the-brain-capital-alliance-at-ceps/