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EDITORIAL BOARD
Aimee Aubeeluck Associate Professor
of Health Psychology and HCPC
registered psychologist, University of
Nottingham
Mark Baker Senior Teaching Fellow,
King’s College London, Florence
Nightingale Faculty of Nursing,
Midwifery and Palliative Care
Mary Braine Senior Lecturer, School
of Health and Society, University of
Salford
Neal Cook Reader/Associate Head of
School, School of Nursing, Ulster
University, Londonderry
Ismália de Sousa Clinical Nurse
Specialist in Stroke, Imperial College
Healthcare NHS Trust, London
Jane Dundas Senior Lecturer, Clinical
Leadership and Management,
Kingston University and St George’s,
University of London
Karen Harrison Dening Head of
Research and Publications,
Dementia UK
Jonathan Hayton Chair, Nightingale
Student Council, Guy’s and St Thomas’
NHS Foundation Trust, London
Daiga Heisters Head of UK
Parkinson’s Excellence Network,
Parkinson’s UK
Stuart Hibbins Senior Lecturer,
London South Bank University
Siobhan McLernon Senior Lecturer
(Neurosciences), London South
Bank University
Alison McLoughlin NIHR Doctoral
Research Fellow, Stroke Research
Team, University of Central Lancashire
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British Journal of Neuroscience Nursing  February/March 2019  Vol 15 No 1
Ann-Marie Mestecky Lecturer,
Florence Nightingale Faculty of Nursing
and Midwifery, King’s College London
Mary O’Brien Professor of Palliative
and Support Care, Faculty of Health
and Social Care, Edge Hill University,
Ormskirk, Lancashire
Anne Preece Head Injury Advanced
Nurse Practitioner, Neurosciences,
Queen Elizabeth Hospital, University
Hospital Birmingham Foundation Trust;
President, BANN
Cathy Queally Epilepsy Clinical Nurse
Specialist, King’s College Hospital,
London
Emily Spence Neurosciences, Stroke
and Neurorehabilitation Practice
Development Nurse, Brighton and
Sussex University Hospitals NHS
Trust; BANN representative for
the BJNN
Lucy Sutton Independent Consultant,
End of Life Care
Colm Treacy Senior Lecturer (Acute
Care), Kingston and St George’s Joint
Faculty Health, Social Care and
Education, Kingston University, London
Catheryne Waterhouse Lecturer/
Practitioner, Royal Hallamshire
Hospital, Sheffield; BANN
Representative, European Association
of Neuroscience Nurses
Sue Woodward Head of Clinical
Education, Florence Nightingale Faculty
of Nursing and Midwifery, King’s
College London; Chair, RCN
Neuroscience Nurses Forum
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ISSN 1747-0307
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Cover photo:
EDITORIAL
Can we really prevent dementia?
What is the role of personal responsibility in sustainable
healthcare provision?
A
midst a backdrop of global growth in an ageing population, the
UK government is advancing an agenda of disease prevention,
with a view to slowing the progression of many lifestyle disorders.
One such target for prevention is dementia. The prevalence of
dementia is increasing, and activities to reduce risk have become
a public health priority, featuring in both academic research and within media
reporting. There are a number of recent studies that demonstrate dementia as
being preventable in around 30% of all cases, through the control of modifiable
risk factors, such as obesity, diabetes, alcohol consumption, high blood pressure
and smoking (e.g. Livingston et al, 2017). Frankish and Horton (2017) estimate
that delaying the onset of dementia by just 1 year could reduce its prevalence
by 11% by 2050. To this end, Irving et al (2019) argue that it is important for us
to consider the broader social impact of risk factors, and understand our wider
social responsibility, in looking after our own cognitive health.
The idea that we are responsible for our own health and wellbeing is not new.
However, in recent years there has been a shift from the focus of responsibility
for health being on society’s obligation to provide healthcare, to one where the
individual is expected to assume personal responsibility. Where there are limited
resources, and an increasing population requiring access to them, the notion
that some are more deserving of healthcare than others can easily be postulated.
Should someone who has a poor diet and smokes have the same access to
dementia care as a non-smoker who has taken regular exercise their whole life?
There is an argument that those of us who take health risks ‘violate’ some form
of social contract. Moreover, it is suggested that when responsibility for one’s
own health is advocated, treatments may be more effective, as the individual
begins treatment in the best health that they can be. However, there is limited
evidence to support the view that better treatment outcomes are achieved where
people have not contributed to their condition through their lifestyle choices.
One problem with the promotion of personal responsibility is that it focuses
on negative health-risk behaviours, placing accountability on individuals who
engage in stigmatised behaviours, such as smoking or alcohol use. It does not,
however, place individuals who play high-risk sports, travel overseas to high-risk
countries or have stressful working lives in this same category of responsibility,
suggesting that some high-risk behaviours are more acceptable than others. And
that individuals can make lifestyle changes, when in reality individual health is
situated within a societal context, and is not just about personal self-control.
The climate of NHS underfunding and limited resources may make personal
responsibility an attractive policy choice to follow in the allocation of healthcare,
and there are certainly some benefits for promoting good health across a person’s
life span. However, I would argue that far more debate is required before health
policies based on the deservedness of care and the exclusion of those deemed
unworthy of our compassion can be incorporated into our present systems. BJNN
Frankish H, Horton R. Prevention and management of dementia: a priority for public health.
Lancet. 2017;390(10113):2614–5
Irving K, Hogervorst E, Oliveira D, Kivipelto M. New developments in dementia prevention
research. London: Routledge; 2019
Livingston G, Sommerlad A, Orgeta V et al. 2017. Dementia prevention, intervention, and care.
Lancet. 2017;390(10113):2673–734
Aimee Aubeeluck, Editorial Board Member
5
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