Dementia Centred

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By Mark Butler

July 25th, 2014

Downsizing dementia?

This month one dementia story grabbed the headlines – the Cambridge public health study which suggested a third of Alzheimer's disease cases worldwide can be prevented.  To be fair the actual report by Professor Carol Brayne’s team of researchers, who have been around in this territory for some time now, has more to say than this.  However I want to look more at that media coverage rather than the content of the report.  It says a lot about the status of dementia in the media.

Put bluntly, in media terms, dementia may have had its day. Only the routine “imminent cure” stories still make it onto the front pages.  The ongoing circus of the rather unfortunately-named Prime Minister’s Dementia Challenge has settled into a routine cycle of low-impact publicity.  The documentaries have largely disappeared from the screens.  The footprint of dementia in the Arts (which often lags behind news) has declined (if the forthcoming Edinburgh Festivals are any indication of trends). No fresh documentary material is being commissioned any longer.

But some things never change.  The Cambridge Report itself, and the media following, went for some nice, juicy, unimaginable figures on possible impact.  If only x people do what is right, then y million will be saved.  Is 9.6 million “cases” big enough for you? But does the fact that this “new research” story broke into the Big Headlines tell us anything new?   

It may be a little early to say this, but is there an early sign of a change in the way media/policy is shaping up here?  Is there a move from a paradigm of “impending apocalypse and a battle ahead” into classic media territory of “blame”?  

If the disease is truly avoidable, by doing all the right things and changing your life against a handful of key life indicators (public health’s “lifestyle modifications”), aren’t some of those who develop disease to blame for NOT preventing it themselves (with prodding and support from the state and state-aligned charities like Alzheimer’s Society)?

Even worse is this not the next generation we are talking about here  - not those who served in the Wars, but those who lived life to the full after the War, took advantage of all that free, pre-austerity University education, retiring early on pensions funded by the public purse?  This new phalanx of old people is now set to become an undeserving burden on society.  Unless they have looked after themselves they only have themselves to blame. And we/you will have to pay.

So the flipside of a perfectly sensible, slightly righteous set of Public Health messages, is a more subtle repositioning of the standard “old people are a burden on society” message.  Some old people can be accused of not having done enough to head off the disease as they should have done.  It fits nicely alongside similar media blaming around “obesity Britain”.  Avoidable, blameworthy and a burden.

If the state has bought into the idea of a tidal wave of demand at a time when state money just won’t be there to deal with the consequences, what better way to deflect from actual responsibility than to seed the implication that some of those succumbing to this dread disease are in some way themselves culpable. So other people, and their families, are obliged to take a greater share of the consequences.  Responsibility shifts.  And why would the younger generation, full of anger that their lives are not as free or easily financed as their lucky post-war grandparents and parents, disagree?   

This negative implication is not the fault of Professor Brayne.  It is where the story is going and why it got so much coverage.  It’s overall message is hardly new or newsworthy otherwise.

The positive note struck by the Report itself, however, is also open to question. "Simply tackling physical inactivity, for example, will reduce levels of obesity, hypertension and diabetes, and prevent some people from developing dementia as well as allowing a healthier old age in general - it's a win-win situation."  This is highly dubious logic. There is no evidence that reducing levels of the three diseases mentioned actually does anything more than defer the onset of dementia.  It may do absolutely nothing to reduce the quantum of demand. It might just have a one-off delaying impact. And a judgement would need to be made about just how effective such “tackling” would be.  This makes a claim for a win-win somewhat shaky -  a step beyond the research itself.  It would have been interesting to have seen the Report challenged on this conclusion.  Sadly it looks like we are instead at the start of a pernicious, long-term “blame” story.   Let’s hope I am wrong.