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Click here or press enter for the accessibility optimised versionDriving digestivehealthTechnology and personalisationlead purchasing prioritiesClick here or press enter for the accessibility optimised versionIntroductionAn unconventionalrevolution in howconsumers manage theirdigestive wellness is quietlygrowing in Europe.With guthealth a growing concernacross the region,thisreport will explore theemerging trendsadvancing the digestivehealth market andinvestigate wayscompanies can respond tothis shift in consumerpatterns.Click here or press enter for the accessibility optimised versionGut health driversThe heightened focus on guthealth is driven by a growingconsumer interest in themicrobiome and the associatedapplications for self-managing gut-relatedissues.Traditional functional and clinicalmanagement approaches,like takingdietary supplements or acid-blocking,over-the-counter medicines,are stillover-the-counter medicines,are stillcommon applications for managingconditions like irritable bowel syndrome(IBS)and functional bloating.However,yesterdays methodologies arebeing usurped by todays technologicaladvances and consumers increaseddesire for personalised products.In 2023,market research firm Grand View Researchestimated the European digestive healthproduct market including probiotics,product market including probiotics,prebiotics,and other digestive healthingredients at around 12.7 billion.The market research and consulting firmexpects the segment to grow at acompound annual growth rate(CAGR)of7.3%from 2024 to 2030.1The gut health category has seen strongprogress across western Europe in recentyears,growing by 14%in 2023,said Connoryears,growing by 14%in 2023,said ConnorSpicer,research consultant at dataanalytics firm Euromonitor International.One of the primary drivers in Europe,hesaid,is a shift in consumer attitudes.Instead of being reactive to conditions andproblems,and seeking out gastrointestinalaids when an issue arises,consumers aretaking a proactive stance and looking forpreventative measures and sustainablesolutions.This approach,Spicer said,“has beenaided by growing availability of gut healthproducts such as probiotics across retailchannels,and further aided by theexpansion of retail e-commerce during theCovid-19 pandemic”.In addition,Spicer said that todaysconsumers are simply more open totalking about their symptoms,increasinglyfrequently using terms like“gut health”and“the microbiome”,which refers to themicroorganisms that live in the humandigestive tract and are responsible fordigestive tract and are responsible forsystemic processes like digestion.Whenthe gut microbiome is unbalanced,digestive issues like IBS,gas,and bloatingcan occur.Scientific advances for gut healthProbiotics,well known for their beneficialeffects on gut health,have recently beenjoined by sibling ingredients,prebiotics,joined by sibling ingredients,prebiotics,postbiotics,and synbiotics,in theconsumer lexicon.Probiotics are the live microorganisms thatimprove an individuals health when takenin the right amounts.Possible healthbenefits can include improving digestion,boosting the immune system,andsupporting overall health.According to the definition established bythe International Scientific Association forProbiotics and Prebiotics(ISAPP),to qualifyas a probiotic,the amount and types ofthe live microorganisms must be known,and they must be scientifically tested toprovide a benefit.Probiotics can be found in a variety of foodproducts,such as yoghurt,infant formula,and dietary supplements.However,ISAPPstates that the live microorganisms foundin fermented foods such as kimchi andmiso are generally not consideredprobiotics because they are“a wild mixtureof microorganisms at an unknown dose”,of microorganisms at an unknown dose”,although it recognises that they alsocontribute to a healthy diet.2The scientific definition of a prebiotic citedby ISAPP is“a substrate that is selectivelyby ISAPP is“a substrate that is selectivelyutilised by host microorganisms conferringa health benefit”.Often,prebiotics take theform of certain types of soluble fibre thatform of certain types of soluble fibre thathumans cannot digest and that insteadserve as food for beneficial microbes thatalready live the colon or elsewhere in thebody.3In other words,prebiotics feed probioticsand help probiotics populate thecolon.Prebiotic foods include greenbananas,onions,chicory root,oats,acaciagum,garlic,and asparagus.According to ISAPP,the health benefits ofspecific prebiotic substances includeimproving calcium absorption,regulatingblood sugar,and enhancing colonicbacterial fermentation to reduce guttransit time.Brands must formulatecarefully if adding high amounts ofprebiotic fibres to a product in order toimpart digestive health benefits,however,as some people experience increaseddigestive discomfort,such as gas andbloating,with a high intake of prebiotics.Synbiotics,meanwhile,are a combinationof probiotics and prebiotics that workof probiotics and prebiotics that worktogether in the digestive tract to helpbalance gut bacteria.They are calledsynbiotics because of their synergisticeffects,whereby the probiotics andprebiotics work together positively.For example,a randomised controlled trialinvestigated the effects of synbiotic intakeon gut microbiome diversity in individualswith a low dietary fibre intake of less than25 g a day.The study found that synbioticsformulated with dietary fibre may improvethe gut microbiome of people with lowfibre intake.4However,ISAPP cautions that moreresearch is needed in this field.“Although,in theory,a probiotic could bematched with a prebiotic that will improvethe probiotics function,few studies havedemonstrated this synergy,”it said.“The specific combination of prebiotic andprobiotic has to be carefully researched ifthe goal is to consume health-benefitingthe goal is to consume health-benefitinglive microorganisms along with the exactsubstrate that they need to grow.”5Postbiotics are a lesser-known bioticwhose definition is still being discussed byindustry stakeholders.In 2021,ISAPPindustry stakeholders.In 2021,ISAPPproposed that postbiotics are“apreparation of inanimate microorganismsand/or their components that confers ahealth benefit on the host”and althoughthis is widely cited,there is not industry-wide consensus.A 2024 article,published in Frontiers inMicrobiology and funded by ISAPP,notesthat some scientists have suggested thatpostbiotics are metabolites produced afterthe beneficial gut bacteria metaboliseprebiotics or probiotic components,whileothers have proposed that postbiotics arethe metabolites generated by themicrobiota.6In the article,entitled“Frequently askedquestions about the ISAPP postbioticdefinition”,the authors highlighted some ofthe problems relating to definingpostbiotics;it is not clear which specificcomponents within a postbiotic areresponsible for the health benefit haveresponsible for the health benefit havebeen expressed,for example,and similarambiguity exists with multi-strain probioticproducts.Although a given product may have beenshown to confer a health benefit,exactlywhich mechanisms in which strains lead toit may be unknown,they write.“Inevitably,questions will and shouldcontinue to be asked in this rapidlyevolving field and we welcome this fruitfuland stimulating ongoing debate,”theauthors conclude.Rise of the health at homee-commerce approachLike at-home Covid-19 tests,a growingnumber of consumers have grownaccustomed to testing in private and ontheir own time.Gut microbiome home test kits offer thatsame level of convenience and privacy.These fall into what global managementfirm McKinsey&Company calls the“healthat home”trend in its Future of Wellness:The Trends Defining the$1.8 Trillion GlobalWellness Market in 2024 report.7At-home microbiome test kits allowcustomers to privately take a stool sampleand send the package back to a lab foranalysis.From there,experts develop apersonalised plan,including dietaryrecommendations for maintainingbalance in the microbiome,that is sharedwith the user.McKinseys research highlights additionalsteps companies could take to bolsterAlthough,in theory,a probioticcould be matched with a prebioticthat will improve the probioticsfunction,few studies havedemonstrated this synergy.”The International Scientific Association forProbiotics and Prebiotics(ISAPP)steps companies could take to bolsterconsumer acceptance of the health athome trend and increase test kit sales.These include creating consumerfeedback loops and encouraging users totake action based on their test results,before testing again to assess the impactof those interventions.8Lastly,McKinseys data suggests thatartificial intelligence(AI)could be agamechanger,pushing the boundaries ofproduct development within the healthand wellness sector.Companies seeking a competitiveadvantage might use generative AI tools tohelp analyse and deliver personalisedresults,or create partnerships with medicaltelehealth services to do the same.9Next-generation tests that avoid invasive andunpleasant testing methods such as stoolanalysis will also be a gamechanger foruser-friendly personalisation in thedigestive health category.10Click here or press enter for the accessibility optimised versionPersonalisednutrition,next-gendiagnostics,andwellness plansTechnology,combined with the riseof first-party user data skimmedfrom or shared from a mobiledevice or app,is making productpersonalisation appealing to consumers.Factors such as genetics,lifestyle,metabolism,microbiome,and overallhealth history can also be considered aspart of a customised nutrition plan,basedon a users unique characteristics.McKinsey data reveals that approximately20%of consumers in the UK and the US and30%of Chinese consumers look forpersonalised products and services thatuse biometric data such as fingerprints,facial images,and voiceprints to providerecommendations.11Euromonitor food and beverage consultantMargaux Laine agreed that this categoryhas potential.“Personalised nutrition is a great support inunderstanding dietary recommendationsand interventions when helping consumersand interventions when helping consumerswith their individual needs.We have seengenetic companies that have tried tounderstand genetic informationbiomarkers but also understand thedifferent lifestyles and the preferences ofconsumers,”she said.Dr Sabina Bruehlmann,chief executiveofficer of Canadian microbiome analysisstartup Nimble Science,noted thatadvances in research on the impact of ahealthy gut hold promise for scientificallyhealthy gut hold promise for scientificallybacked personalised nutrition.“ForEuropeans,who have historically placedgreat emphasis on nutritional awarenessand education,product personalisationhas provided them with the opportunity totake a front seat in gut self-care,”she said.Nimble Science has developed a service tocapture data from the small intestine rather than stool samples using its SmallIntestine Microbiome Aspiration(SIMBA)capsule,an ingestible,single-use capsulecapsule,an ingestible,single-use capsulethat takes a passive sample ofendoscopic-quality luminal fluid from thesmall intestine.Users receive a testing kit athome by mail,which includes the SIMBAcapsule,a retrieval kit,and a postal kit toreturn the sample.According to Bruehlmann,the smallintestine,which is responsible for 90%offood absorption,can be home to manygut-associated diseases and contains awealth of information that cannot becollected from a stool sample.The SIMBA capsule is not yet available as adirect-to-consumer product but Nimble ispartnering with brands to help them betterunderstand their products influence on thegut and provide actionable data viaclinical studies.“By timing the sample collection with theintake of certain foods we are able todirectly assess the impact these foods arehaving on an individuals system,”saidBruehlmann.Another startup operating in this space isUK-based nutrition science company ZOE,which boasts more than 120,000subscribers to its personalised gut healthservices.ZOEs at-home test kit gathers andsynthesises results from the gutmicrobiome as well as from fat and bloodsugar tests.Based on the results,the ZOEapp gives subscribers personalised advicefor maintaining a healthier gut.According to Laine,consumers are open tosharing health data from theirsmartwatches and mobile devices inexchange for the possibility of betterhealth.She also pointed to 2023 Euromonitor datathat found,after surveying over 20,000individuals,that nearly 40%of Europeansfeel extremely or very comfortable usingonline or app-based services forpersonalised nutrition recommendations.12However,consumers need to understandwhy there is a need for data-gathering.“ZOE has been able to explain to theirusers that its by collecting data frommultiple samples,that they will be able tocompare this result and give more precisefeedback,”Laine said.“So,they need to collect as manysamples as possible.That might be a keyfactor to make people understand thatits valuable for them to share their data.”Click here or press enter for the accessibility optimised versionFrom the gut-brainaxis to biohackingThe gut-brain axis refers to abidirectional communicationpathway between the central andthe enteric nervous system that links theemotional and cognitive parts of the brainwith intestinal functions.13Although much research remains to bedone to better understand themechanisms of the gut-brain axis,brandsare already tapping into the science tocreate products and services forconsumers.Mindset Health is an Australian digitalhealth company that has developed amobile app called Nerva to helpconsumers to manage and improvechronic health conditions such as IBS athome.Based on the latest IBS research from DrSimone Peters,founder of the Mind GutClinic and head of clinical content atMindset Health,Nerva uses evidence-based hypnotherapy techniques to helpbased hypnotherapy techniques to helpusers learn behavioural coping skills thatcan help address the miscommunicationbetween the gut and brain.Peters ran a clinical trial with MonashUniversity that found the Nerva approachwas as effective in helping people live wellwith IBS as a low-FODMAP diet.This is atemporary but restrictive diet that limits thenumber of fermentable oligosaccharides,disaccharides,monosaccharides andpolyols(FODMAPs).High-FODMAP foods that should beavoided while on the diet include dairy-based milk,yoghurt and ice cream;wheat-based products such as cereal and bread;beans,lentils,and pulses;somevegetables,such as artichokes,asparagus,onions and garlic;and some fruits,such asapples,cherries,pears,and peaches.14Research has found that the low-FODMAPdiet reduces symptoms in up to 86%ofpeople but adherence can be difficult dueto its highly restrictive nature.Alternatives that offer results that are aseffective such as cognitive-basedbehavioural coping skills could well provepopular with consumers.Taking gut health to the next levelwith biohackingProduct personalisation is also showing upin epigenetic testing,which focuses onlearning how environmental factors caninfluence individual gene activation forbetter a gut microbiota.Some consumers are exploring biohacking,although this do-it-yourself approach tohealth management is considered to bepseudo-scientific.Using this semi-scientific approach,usersinterpret health data gleaned,for example,from their smart watch or other wearableto make physiological changes with theaim of modifying and improving theirgut biology.Changes might be as simpleas adding certain vitamins and minerals tothe diet.A common thread in this technology-based approach to personalising digestivewellness is a growing understanding ofscientific data a consumer desire,Lanesaid,that brands can work to fulfil.These emerging approaches likemicrobiome analysis,epigenetic testingand biohacking,Laine said,are part of a“next generation of approaches to takepersonalised nutrition and a consumersapproach to gut health to the next level”.Click here or press enter for the accessibility optimised versionChallenges tothe productpersonalisationtrendFor all the promises technologyoffers in helping to managedigestive wellness,EuromonitorsLaine sees two challenges hinderingadvances:cost and trust.“It is costly,”she said,of the testing kits.“Weare still in a cost-of-a-living crisis.So,consumers might wait or find otheralternatives to getting this test done andhaving targeted results.”The second impediment centres aroundboosting consumer willingness to sharehealth data,such as information aboutDNA,at scale with profit-driven companies.According to Laines Euromonitor data,onlyabout 13%of European respondents saidthey feel extremely or very comfortablesharing DNA with companies to growproduct offerings and recommendations.15Nimble founder Bruehlmann seesadditional challenges.“It seems as thoughwe are experiencing a first level of fatigueby consumers who feel overwhelmed byby consumers who feel overwhelmed bythe opportunity and underserved by thesolutions,”she said.Many gut health tools have been launchedwithout a true and completeunderstanding of the underlying science orsufficient governance from regulatorybodies,she said.However,as the sciencebodies,she said.However,as the sciencecatches up and the tools gain acceptancethrough more clinical routes,doctors willbe more comfortable making productrecommendations and insurers may bewilling to help cover the costs,she added.“I believe the future holds great promise forpersonalised nutrition,”she said.Read more Multifunctional products set to dominate microbiome marketClick here or press enter for the accessibility optimised versionCharting the rise offunctional foodsThere is a growing demand forfunctional foods that support guthealth for digestive wellness.These include foods that naturally containbeneficial bacteria,such as fermentedproducts like kefir,kombucha,kimchi,andother lactofermented vegetables,andfibre-rich foods fortified with prebiotics thatpromote a healthy gut microbiome byfeeding the beneficial microorganisms.According to market research firm InnovaMarket Insights:“The supplement industry isresponding to the growing demand fornatural gut health solutions with a widerange of innovative products.“This includes probiotics in various formats(capsules,powders,gummies),prebioticsto support gut bacteria,and otherproducts that combine probiotics withother beneficial ingredients for digestiveand overall health.”Whats more,consumers are increasinglyseeking out these products even if they feelseeking out these products even if they feelhealthy;the aim is not always to managedigestive symptoms such as bloating orwind but to support their wellbeing.Innovanotes that many consumers are focusedon preventing health issues before theyarise,with more than one in four claimingto be proactive in preventing healthissues.16Certain geographies also displaypreferences for specific product formats.According to McKinseys data,probioticsupplements are the most frequently usedgut health product in China and the US,while UK consumers are opting for wholefoods such as kimchi,kombucha,andyoghurt,as well as over-the-countermedications.17However,new product development thatfocuses on functional food and drink is richaround the world.In China,ilium and YUIhave developed a powdered milk thatfeatures 40 billion probiotics targetingdigestion,as well as a range of otherhealth benefits.US brands like Olipop andPoppi are shaking up the carbonated softdrink aisle with tasty,low-calorie,low-sugarfizzy pop with added prebiotics such asagave and inulin to support gut health.Appealing to consumers need statesEuromonitor consultant Laine said brandsmust appeal to consumers“need state”orthe psychological impulse that drives themthe psychological impulse that drives themto buy functional foods that supportdigestive wellness.To do that,companiesshould connect food as medicine and offerlabel claims with ingredients that target aspecific health function,she said.According to Laine,consumers,spurred bythe industry,have traditionally connectedhealthy digestion with one ingredient probiotics.But today we know there aremany more ingredients that can supportthe gut.“Slowly,the industry is educating theconsumer.And its working.Consumersnow understand the gut-brain axis.This issomething that they can focus on.So,consumers just need to be educated andto be driven to improving their diet withdiverse products,”she said.According to Innovas research,the desirefor functional foods that improve guthealth is apparent among Europeans one in five consumers says that healthyeating equates to positive nutritioneating equates to positive nutritionalthough the cost of goods remains abarrier to entry for many.18Indeed,Innovas data has found that threeIndeed,Innovas data has found that threeout of five Europeans have a high interestin fibre and another two out of five areinterested in prebiotics as functionalingredients.19Read more Surprisingly diverse range of gut bacteria responsive to inulin,study suggestsSpanish company Mim(MicrobiomeImmunity)Habits has launched a range offour bread loaves in the UK containing theMIM COMPLEX formula a patentedpostbiotic complex created through thesynthesis of 10 different microorganisms tobalance the gut microbiome(Bifidobacterium animalis subsp.lactis;Lactobacillus acidophilus;Lactobacillusfermentum;Lactobacillus delbrueckiisubsp.bulgaricus;Lacticaseibacillus casei;Lactobacillus plantarum;Limosilactobacillus reuteri;Lacticaseibacillus rhamnosus,Saccharomyces cerevisiae yStreptococcus thermophilus).According to the brand,postbiotics act asimmunomodulators on our organism,andits postbiotic complex affects more than270 metabolic functions.20“I would say its quite specific,and the useof postbiotics in food is quite rare,”addedLaine.“The knowledge around it is growing,but its still niche.”US-based BCD Bioscience is anotherstartup targeting digestive wellness via itsfunctional“precision prebiotics”that breakdown polysaccharides into bioactiveoligosaccharides.21Its first product is abarley beta-glucan that targets animproved glycaemic response and theassociated cardiometabolic effects.Despite the growing popularity offunctional food and drink products,supplements still have great potential.Euromonitors Spicer said:“The forecastoutlook for probiotic supplements remainsvery positive across western Europebetween 2024-2029,with a projected CAGRof 6%.The space remains largelyundeveloped compared to other vitaminsand dietary supplement categories.”Brands therefore have an opportunity toeducate consumers on the effectivenessof the longstanding tradition of takingsupplements for preventing and reducingsymptoms,as regular use amongconsumers is still inadequate.Read more BCD Bioscience reinvents thecategory with precision prebioticsClick here or press enter for the accessibility optimised versionKey takeaways Turning to food for solutions for digestive healthproblems is intuitive for many consumers,and thefunctional food and drink space is booming.Functional products range from established formatssuch as yoghurt with live cultures and probiotics toemerging ones like postbiotic-enriched bread orprebiotic-fortified soda drinks.The probiotic supplement market in Europe remainsmuch smaller compared with other vitamin andsupplement spaces,and has ample room to grow.A growing body of science into the gut-brain axis iscreating opportunities for brands to create productsand services that improve digestive problems bytargeting cognitive wellbeing and vice versa,althoughmore research is needed.Many personalised nutrition products in the digestivehealth space still rely on stool sample analysis,which isa significant hurdle for many consumers.More user-friendly analytical methods and lower costswill be pivotal in mainstreaming personalised nutritionfor gut health.Click here or press enter for the accessibility optimised versionVitafoods Insights Webinar SeriesThe future of digestive health4 November 2025Sports nutrition 2.025 March 2025Ageing well:Expanding thehealthspan|29 April 2025Rethinking womens health24 June 2025CLICK HERE TO LEARN MORE AND REGISTER YOUR INTEREST NOW!Advancements in cognitivehealth|2 September 2025Designing next-generationnutraceuticals|7 October 2025Click here or press enter for the accessibility optimised versionR al.“Beneficial Effects of Synbiotics on the GutMicrobiome in Individuals with Low Fiber Intake:SecondaryAnalysis of a Double-Blind,Randomized Controlled Trial.”Nutrients.2024 Jun 29;16(13):2082.doi:10.3390/nu16132082.PMID:38999830;PMCID:PMC11243043.5.https:/isappscience.org/for-consumers/learn/prebiotics/6.https:/www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1324565/ of the Consumer:Health and NutritionSurvey.13.https:/pmc.ncbi.nlm.nih.gov/articles/PMC4367209/14.www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-know15.Euromonitor.Voice of the Consumer:Health and NutritionSurvey.16.Innova.Trends Survey 2024;Lifestyle&Attitudes Survey Survey 2023;Trends Survey 2023.19.Innova.Trends Survey 2024;Lifestyle&Attitudes Survey 2023.20.https:/ creditsPage 1 AdobeStock/RudzhanPage 2 AdobeStock/Page 3 iStock/Tashi-DelekPage 3i AdobeStock/C Design StudioPage 3ii AdobeStock/vaaseenaaPage 3iii AdobeStock/MrPreechaPage 3iv iStock/Sweet fleurPage 3v AdobeStock/MingPage 3vi iStock/BlueastroPage 4 AdobeStock/Stock 4 YouPage 4i AdobeStock/Anatomy InsiderPage 4ii AdobeStock/Pixel-ShotPage 5 AdobeStock/VectorMinePage 5i AdobeStock/Rene La/Page 5ii AdobeStock/Alina.AlinaPage 6 AdobeStock/wladimir1804Page 6i iStock/RealPeopleGroupPage 7 AdobeStock/MeganBetteridgePage 7i AdobeStock/komokvmPage 7ii iStock/Liudmila ChernetskaPage 7iii iStock/ISD90Page 8 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2Healthcare Industry ReportExecutive SummaryKey Report HighlightsMarket OverviewGenerative AI and Digital TransformationRegulatory LandscapeEmerging Healthcare Trends-Surge in Healthcare Consolidation-Increased Outsourcing and Offshoring to Tackle Labor Shortages-Increased Investment in Outpatient Services-Rising Demand for Weight-loss Drugs-Transition from Fee-for-Service Model to Value-based ModelFunding and Investment Landscape-Funding Outlook-Healthcare Sector Market Performance-Healthcare Deals in 2024CONTENTS010203040506073Healthcare Industry ReportThe US healthcare industry is on the cusp of significant growth,driven by a burgeoning and aging population of over 340 million,alongside regulatory tailwinds and technological advancements.In 2023,the industry grappled with various challenges,including workforce shortages,inflationary pressures,tight profit margins,disruptions in supply chains,and diminishing consumer trust within the intricate web of relationships between providers,payers,and patients.However,as we look to 2024,optimism surrounds emerging trends and investor interest in the industrys future.Generative AI(GenAI)is poised to play a pivotal role in addressing evolving consumer demands and the global scarcity of healthcare professionals.Its widespread adoption in clinical settings necessitates substantial investments in infrastructure,which is in its nascent stages,presenting lucrative opportunities for investors.Amidst a financially challenging landscape,the healthcare sector seeks strategies such as consolidation,outsourcing,and emphasizing outpatient care to enhance cost-effectiveness and operational efficiency a trend likely to persist in the coming years.Additionally,the market dynamics are influenced by the introduction of new weight-loss drugs and a transition towards value-based care Medicare models.These shifts,along with the industrys resilience,sustained growth prospects,and avenues for innovation,have positioned healthcare as a focal point for PE and VC strategies.Executive SummaryWhat is driving the US healthcare industry?1.4X11.5%increase in Americans aged 65 and above is projected from 2022 to 2050,per Population Reference Bureau of the US GDP will be social security and medicare expenditures in 2035,up from 9.1%in 2023014Healthcare Industry ReportKey Report HighlightsThe healthcare industry in the US is positioned for significant expansion,driven by factors such as a growing and aging population,changes in disease prevalence,regulatory tailwinds,and the introduction of innovative and specialized technologies.Healthcare has taken center stage in regulatory agendas,focusing on critical areas such as accessibility,affordability,transparency,Medicare,and engagement of the private sector.Outpatient care,outsourcing,and offshoring have emerged as preferred strategies for cost reduction.Centers for Medicare and Medicaid Services(CMS)has set a goal to establish a value-based care relationship for every traditional Medicare beneficiary by the year 2030.GenAI is primed to emerge as a transformative solution to bridge the gap between evolving consumer expectations and a global shortage of healthcare providers.Healthcare providers are increasingly considering consolidation,recognizing the operational advantages of unified management.The global weight-loss drug market achieved an annualized value of$6 billion in 2023 and is anticipated to expand over 16 times to reach$100 billion by 2030.Fundraising activity in healthcare specialist PE reached a record high in 2023,totaling$18.3 billion,and US VC funds focused on health raised$19 billion,marking the third-highest year.5Healthcare Industry ReportThe US has one of the most complex healthcare systems globally,marked by intricate relationships among providers,payers,and patients.This complexity is influenced by various factors,including consumer preferences,regulatory changes,and technological advancements.The US leads the world in healthcare spending,with 16.6%of its GDP allocated to healthcare in 2022,according to the OECD.Projections from the CMS suggest that healthcare spending will continue to rise at an average rate of 5.4%annually,surpassing GDP growth rates with healthcare likely to account for 19.6%of the GDP by 2031.This growth is driven by factors such as a growing and aging population,shifts in disease prevalence,and the adoption of innovative technologies.The healthcare landscape in the US is characterized by intricate interdependencies between providers,payers,and patients,making it one of the most complex systems in the world.The industry is driven by factors such as a growing and aging population,shifts in disease prevalence,and the adoption of innovative technologies.However,it also faces significant challenges,including labor shortages,inflationary pressures,slim profit margins,supply chain disruptions,and dwindling consumer trust.Market Overview 02Chart 1:GDP per capita and health consumption spending per capita,U.S.dollars,2022(current prices and PPP adjusted)Source:OECD,Peterson-KFF$15K$10K$5K$10K$20K$30K$40K$50K$60K$70K$80K$90K$100K110K$120K$130K$140K$150K0Health Spending PerCapitaGDP Per Capita6Healthcare Industry ReportIn the past year,the healthcare industry has grappled with numerous challenges,including labor shortages,inflationary pressures,slim profit margins,supply chain disruptions,and dwindling consumer trust.The labor shortage is the most pressing issue of all.A McKinsey study shows a significant increase in resignations among healthcare professionals,jumping from about 400,000 per month in 2020 to 600,000 by May 2023.The American Hospital Association(AMA)anticipates a shortage of up to 3.2 million healthcare workers by 2026.One key factor behind this shortage is the gap between rising wages and insufficient funding from healthcare providers.Despite a slower growth rate of 4.7%in average hourly earnings in 2023 compared to the pandemic peak,this figure still surpasses the 2.4%average increase seen from 2010 to 2019,according to Fitch.However,organizations are making cost-saving efforts such as HCA Healthcare reducing contract labor costs by 20%year-over-year,Tenet Healthcare lowering contract labor costs to 4.3%of total compensation,and CHS Healthcare aiming for a 50%reduction in contract labor spending compared to 2022.Other factors contributing to the shortages include burnout,shifting demographics,a limited talent pool,and the demanding nature of the medical profession.Chart 2:US Healthcare Spending Projection$7,175$4,255$2,677$1,483$786$294$821971198119912001201120212031PUnited States,1971 to 2021,Selected Years,and 10-Year ProjectionIN BILLONSRecent Detail20172018201920202021$3,446$3,604$3,757$4,144$4,255Source:CALIFORNIA Health Care Almanac7Healthcare Industry ReportFigure 1:US Healthcare Market OverviewHealthcareSpending$7 trillion by2031 Pharmaceuticalsand DrugDiscovery Healthcare ITHealthcareEquipment PharmaceuticalDistribution Hospital andHealthcareCentres BiotechnologyEli Lilly andCompanyVeeva SystemsIncAbbottLaboratoriesMcKessonCorporationHCA Healthcare,Inc.AbbVie Inc.Johnson&JohnsonMultiPlanCorporationStrykerCorporationCencora,IncTenetHealthcareCorporationAmgen Inc.Merck&Co.,Inc.Evolent Health,IncIntuitive SurgicalInc.Cardinal Health,Inc.Universal HealthServices,Inc.Gilead Sciences,Inc.Pfizer Inc.,Teladoc Health,Inc.Boston ScientificCorporationHenry Schein,Inc.CommunityHealth Systems,Inc.VertexPharmaceuticalsIncorporatedBristol-MyersSquibbCompanyCertara Inc.Becton,Dickinson andCompanyPattersonCompanies,IncEncompassHealthCorporationRegeneronPharmaceuticals,Inc.8Healthcare Industry ReportGenerative AI and Digital TransformationVarious applications of GenAI are already transforming healthcare delivery:Personalized Treatment:By leveraging patient-specific data,including genetic information,AI models can predict individual responses to various treatments and medications.CueZen,an AI-powered personalization engine for health,has been recently selected for the Microsoft for Startups Pegasus Program.Enhanced Diagnostic Accuracy:Generative Adversarial Networks(GANs)and Variational Autoencoder technologies have demonstrated remarkable results in medical imaging.A study published by Nature Medicine revealed that GANs improved diagnostic accuracy in breast cancer mammography by over 5.7%.Streamlining Administrative Operations:Beyond patient care,GenAI algorithms optimize hospital workflows,manage patient data,and predict patient admission rates,among other tasks.Health systems like HCA Healthcare are exploring partnerships with Google to leverage GenAI,potentially reducing administrative burdens and addressing clinician burnout.GenAI solutions can help manage labor costs in this services-heavy industry and support the sustainability of healthcare organizations.By leveraging advanced algorithms and vast amounts of data,AI systems generate new insights,predict outcomes,and create solutions to complex medical challenges.03GenAI has emerged as a transformative solution as health systems struggle to meet evolving consumer expectations while facing a global shortage of healthcare providers.Studies,such as one conducted by Humana and the University of Pittsburgh School of Medicine,highlight the potential of GenAI to address inefficiencies in healthcare spending,potentially eliminating a significant portion of the$1 trillion wasted annually.The global market for GenAI in healthcare reflects this promise,with a valuation of$1.6 billion in 2022,projected to soar to$30.4 billion by 2032,according to Allied Market Research.Notably,75%of leading healthcare companies are already exploring or implementing GenAI solutions,as reported by Deloitte.9Healthcare Industry ReportFigure 2:The Impact of GenAI Based on Task and ValueAbility for GenAI to execute tasks in health care rolesCost and complexitity to realize value using GenAIHighData entryClassificationSummeri-zationContentgenerationVisualizationCalculationPredictionInterpretation OptimizationDecisionInnovationEmpathyHighLowLowHospitaladmissionsclerkMedicalrecords clerkMedicalScribeMedicalreceptionistClinical dataspecialistRegulatoryaffairsMedicalrecordstechnicianAudiologistTelehealthnurseQualityassuranceClinical datamanagerClaimsreviewerLaboratoryTechnicianMedicalcoderMedicalbillingspecialistResearchassociateMedicalwriterPatientServices rep.HealthInformationmanagerMarketingspecialistHealth coachMarktingdesignerIT technicianPharmacytechnicianClinicalresearchCoordinatorBio-statisticianBio-InformaticianDosimetristData ScientistEpidemiologistAcutaryUnderwriterData analystRadiologytechnicianRadiologyDermatologyClinicaloperationsmanagerProcessengineerSupply chainanalystPatientaccesscoordinatorSchedulerCharge nursePhysicaltherapistGeneralPractitionerPharmacistHospitaladminSpecialistphysicianResearchscientistBiomedicalengineerBusinessstrategistResearchassociateMarketinganaystHome healthaideMedicalassistantCounselorAccountmanagerSales repPsychologistPrimary carephysicianMedicaldirectorSurgeonsRespiratorytherapistOptometryPathologyHealth careeconomistPublic healtheducatorPatientaccessCoordinatorMedicalImagingSpecialistSource:DeloitteWhile the potential of GenAI in healthcare is immense,its adoption is not without challenges.Data privacy concerns,the need for robust regulatory frameworks,and ensuring algorithmic transparency and fairness are critical issues that need addressing.Additionally,the integration of GenAI into clinical practice requires significant investment in infrastructure and training for healthcare professionals which is still at its nascent stages.Recently there have been a host of strategic partnerships of prominent healthcare organizations with technology firms to leverage GenAI tools.For example,Microsoft has joined forces with Epic Systems,a healthcare software company,and Cognizant to streamline clinician operations.Googles partnerships with Bayer,HCA,and Meditech are directed at improving clinical trial,documentation,and recording processes.VC and PE funds are also actively investing in companies specializing in GenAI.Abridge,a Gen AI-powered clinical documentation tool,recently raised a$150 million series C round led by Lightspeed Venture Partners and Redpoint Ventures.Genesis Therapeutics,a platform utilizing gen AI for drug discovery,secured a$200 million series B round,with support from Andreessen Horowitz,Fidelity,and BlackRock.Syneos Health,acquired by Elliott,Patient Square,and Veritas,inked a multiyear agreement with Microsoft to utilize OpenAIs ChatGPT in clinical trials and commercial initiatives.Similarly,Iodine Software,backed by Advent,has partnered with OpenAI to integrate LLMs into its product suite.Biomedical Research and Drug Development:GenAI is accelerating innovation in drug discovery,exemplified by the strategic collaboration between Sanofi and BioMap.Sanofi aims to optimize the drug discovery process using BioMaps AI platform.Health Education Assistance:With a significant portion of adults in the US seeking health information online,GenAI offers a promising solution to deliver reliable and accessible health information.Companies like Ada Health provide curated and clinically vetted knowledge bases to empower healthcare consumers and caregivers.300%budget expansion for generative AI initiatives is projected by various technical leaders in the healthcare and life sciences industries,according to a survey by John Snow Labs10Healthcare Industry ReportRegulatory LandscapeRegulation in healthcare has placed significant emphasis on several key areas,including accessibility,cost,transparency,Medicare,and private sector involvement.04In December 2023,Congress passed the Lower Costs,More Transparency Act,aimed at enhancing price transparency across the healthcare system and addressing the affordability of prescription drugs.By providing patients with better information on costs prior to procedures,the act aims to empower them to make informed decisions and potentially save on their healthcare expenses.Furthermore,the act includes a provision to reduce Medicare payments to hospitals for specific services also offered in outpatient facilities and physician offices.Recently,the Department of Justice,Federal Trade Commission,and Department of Health and Human Services jointly announced a cross-government public inquiry into the growing involvement of PE and corporations in healthcare.Primarily an antitrust initiative,this inquiry reflects government concerns that PE transactions in healthcare may prioritize profit maximization over quality care.The focus on Medicare reforms is expected to intensify in 2024 as significant deadlines approach,including those affecting telehealth coverage,payment policies,and alternative payment models.Congress is anticipated to take action before 2025 to preserve telehealth flexibilities introduced during the COVID-19 pandemic,including relaxed geographic and originating site requirements,and a temporary halt to restrictions on telehealth reimbursement rates,as per the Common Wealth Fund.Addressing the shortage in the behavioral health workforce,combating the opioid epidemic,and reducing the escalating rates of negative mental health and substance use outcomes,especially among children,remain bipartisan priorities.Lawmakers aim to enhance their capacity to respond to the opioid overdose crisis through the reauthorization of the SUPPORT Act.Additionally,the Senate Finance Committee is pursuing policies to improve timely access to behavioral health services for beneficiaries of Medicare,Medicaid,and the Childrens Health Insurance Program.$7 trillionis projected to be paid by the US Department of Health and Human Services to Medicare Advantage health insurance companies over the next 10 years11Healthcare Industry ReportEmerging Healthcare Trends 05Surge in Healthcare ConsolidationAs economic pressures persist,healthcare providers are increasingly considering consolidation,recognizing the operational advantages of unified management.In 2023,financial challenges played a significant role in driving M&A activities,with financial distress cited as a factor in 28%of announced transactions,a notable increase from the 15%reported in 2022,per Kaufman Hall.Despite regulatory changes implementing stricter standards for assessing whether proposed deals could result in excessive market concentration,M&A activity is anticipated to steadily rise.A recent report from KPMG predicts a surge in megadeals and cross-market transactions,allowing for new economies of scale without triggering antitrust concerns.The industry headwinds have restrained investor interests,making strategic acquisitions the predominant choice.According to Pitchbook,firms that have traditionally focused on healthcare providers are now pivoting toward healthcare IT and pharma services.The Health Assurance Transformation Corporation,a subsidiary of the venture capital firm General Catalyst,recently announced its intention to acquire Summa Health,a hospital system in Ohio.Penn Medicine plans to acquire Doylestown Health.In New Jersey,Hudson Regional Hospital and CarePoint Health System have declared a merger,forming a new system encompassing both for-profit and nonprofit hospitals.Healthcare providers are grappling with nationwide labor shortages,inflation challenges,and depleted COVID-19 relief funds,resulting in negative operating margins.In 2022,over half of U.S.hospitals reported negative margins.While there was a slight improvement in 2023,the ratio of hospital downgrades to upgrades remained 3:1,according to Fitch Ratings.Consolidation has enabled providers to operate more efficiently and is helping struggling providers keep their doors open in underserved areas.Chart 3:Percentage of Announced Transactions Involving a Financially Distressed Party,2019 2023Source:Kaufman Hall18.6.7.2.0.7.0.0.0.0&.00.0 19202020212022202312Healthcare Industry ReportIncreased Outsourcing and Offshoring to Tackle Labor ShortagesHealthcare organizations have faced financial challenges due to escalating labor costs and high interest rates,prompting hospitals to adopt outsourcing as a strategic measure.This shift,fueled by staffing shortages,aims to optimize operations,improve patient care,and achieve financial sustainability.The US Hospital Outsourcing market is estimated to grow at a CAGR of 10.8%,reaching$351.64 billion in 2032 from$126.67 billion in 2022,according to Precedence Research.Administrative and IT functions like revenue cycle,billing,claims,finance,human resources,clinical administration,and supply chain are key areas for complete or partial outsourcing.North America currently holds the largest share,49%,in healthcare BPO,according to MarketsandMarkets.A study by Deloitte projects cost reductions of up to 50%by offshoring,for large health systems spending over$50 million.According to the Manila Bulletin,the Philippines has recently established itself as the worlds leading destination for healthcare BPO.In 2022,the countrys outsourced medical billing companies alone are estimated to have generated revenues surpassing$15 billion.IT functions outsourcing is widely recognized to save approximately 30-40%in costs,and by 2021,around 90%of U.S.hospitals had outsourced at least one IT service to enhance their operational efficiency.The healthcare outsourcing sector has witnessed notable acquisitions in recent years.Omega Healthcare acquired the medical coding company Himagine Solutions,AGS Health acquired a patient access BPO unit based in India,and Warburg Pincus and Brookfield invested$1 billion in Everise,a healthcare services outsourcing firm.Increased Investment in Outpatient Services Outpatient care has evolved as another strategic cost-reduction effort by healthcare providers.Outpatient care enables the expansion of providers geographic presence at relatively low costs while catering to evolving patient preferences.Establishing facilities in convenient locations,capable of embracing emerging technological trends,holds the potential to attract recurring patients and is often less capital-intensive than traditionally large infrastructural setups.According to Kaufman Hall,revenue from outpatient services has experienced significant growth,increasing by more than 40%compared to 2020.Additionally,the CMS projects a substantial 16.9%growth in the demand for outpatient services among individuals aged 55 and above by 2025,offering a transformative opportunity for the healthcare industry.The shift to adopt increased outpatient services is anticipated to be coupled with the divestiture of more costly lines of service.Hospitals are likely to experience closures in departments such as maternity services,inpatient rehabilitation services,or behavioral units,particularly in rural facilities.Beckers Hospital Review noted that over 70 hospitals undertook department closures or service terminations in 2023.ACEP Now reported that 640 hospitals,predominantly in rural areas,recently did not pass financial stress tests,indicating they are at immediate risk of closure,prompting a reduction in expensive yet essential services.49.9%market share in held by North America in the healthcare BPO marketgrowth in the demand for outpatient services among individuals aged 55 and above by 2025,per CMS.13Healthcare Industry ReportRising Demand for Weight-loss Drugs The global weight-loss drug market achieved an annualized value of$6 billion in 2023 and is anticipated to expand over 16 times to reach$100 billion by 2030,according to Goldman Sachs.Leading the market transformation in diabetes and obesity treatment are key players like Novo Nordisks Ozempic and Wegovy,along with Eli Lillys Zepbound and Mounjaro.The potential market for these drugs is substantial,with approximately 11.6%of the American population,according to the Centre for Disease Control and Prevention,and 60 million European adults,according to the World Health Organization(WHO),estimated to have diabetes.Simultaneously,the global prevalence of obesity is estimated to impact one in eight people,per WHO.Consequently,the emergence of new weight-loss drugs,specifically glucagon-like peptide-1(GLP-1)agonists,is positioned to become a key industry driver.According to GlobalData,the global GLP-1 market is projected to grow from$36.6 billion in 2023 to$105 billion by 2029,achieving a CAGR of 19.2%.Novo Nordisk and Eli Lilly are anticipated to lead this growth.Eli Lilly,in particular,reported a substantial surge in sales for its Mounjaro drug,reaching$980 million in 2Q23 compared to$16 million in the drugs initial launch quarter,2Q22.Chart 4:Global Projections of GLP-1 Drug SalesSource:MorningstarNovo NordiskEli LillyAmgenRocheOther70,00052,50035,00017,50020222023E2024E2025E2026E2027E2028E2029E2030E2031E2032E0$Mil11.6%American population to be the potential market for Weight-loss Drugs14Healthcare Industry ReportTransition from Fee-for-Service Model to Value-based Model Fee-for-service represents a traditional healthcare payment model where providers receive compensation based on the number of visits and services they offer.In contrast,value-based care(VBC)is a more contemporary approach that ties compensation to patient outcomes,encouraging providers to prioritize quality over the volume of services provided.According to Humana,patients under the care of VBC physicians exhibited significantly lower acute care usage and experienced fewer potentially avoidable events.Over the past decade,the number of patients receiving healthcare through VBC arrangements increased by 2.3 million.Further,VBC arrangements led to a 30.1%reduction in in-patient admissions and generated 23.2%more savings in medical costs compared to Original Medicare beneficiaries in 2022.The CMS has set a goal to establish a VBC relationship for every traditional Medicare beneficiary by the year 2030.According to McKinsey,private capital investments in VBC companies witnessed a fourfold increase between 2019 and 2021.The growth of VBC across all health plans is expected to continue accelerating to potentially reach an enterprise value of$1 trillion.23.2%more savings in medical costs with Value-based Model in comparison to Original Medicare beneficiaries in 202215Healthcare Industry ReportFunding and Investment Landscape06Healthcare has become a focal point for PE and VC strategies,driven by its reputation for acyclicity,sustained tailwinds,and innovation opportunities.Factors contributing to this interest include an aging population,the imperative for improvements in patient experience,and the potential for advancements in AI and personalized medicine.A survey conducted by Coller Capital found that 87%of LPs consider healthcare and pharmaceuticals attractive sectors for PE investment over the next two years.According to Pitchbook,fundraising activity in healthcare specialist PE reached a record high in 2023,totaling$18.3 billion.Notably,this surge was concentrated on larger funds.In terms of performance,healthcare PE specialists in North America and Europe outperformed their peers across all PE managers in the same geographic regions for the 2012 to 2014 vintage,maintaining competitive performance levels with other managers for more recent vintages.Additionally,North America hosts the highest value of healthcare deals at$29 billion,with biopharma accounting for 25%of deal activity and 54%of deal value,according to Bain&Company.Healthcare has become a focal point for PE and VC strategies,driven by its reputation for acyclicity,sustained tailwinds,and innovation opportunities.Factors contributing to this interest include an aging population,the imperative for improvements in patient experience,and the potential for advancements in AI and personalized medicine.Chart 5:Healthcare PE Fundraising ActivitySource:Pitchbook$2$4$5$3$6$6$8$10$10$17$16$18916191418222629364843210102030405060$0$2$4$6$8$10$12$14$16$18$20201220132014201520162017201820192020202120222023*Capital raised($B)Fund count16Healthcare Industry ReportChart 6:North America Hosts the Highest Value of Healthcare DealsSource:Bain&CompanyHealthcare buyout value,2018-22,$billions(Excluding add-on deals)Healthcare buyout value,2023E,$billions(Excluding add-on deals)Provider and related servicesBiopharama and related servicesMedtech and related servicesPayer and related servicesLife sciences tools and related services$263North AmericaEuropeAsia-PacificRest of world103791North AmericaEuropeAsia-PacificRest of world$2914142PlayerNumber of Investments in Healthcare Since 2022Exits in HealthcareAUM*Dry Powder*Shore Capital Partners14666,0001,231.6Webster Equity Partners8317,035.41,835.2Linden Capital Partners7517,979.61,584.8Kohlberg Kravis Roberts(KKR)6510553,00099,000Audax Private Equity63519,0009,271.6Waud Capital Partners5244,639.5502.2Quad-C Management4713,033.61,184.9The Invus Group45910,000HarbourVest Partners437117,00033,741.8TPG 4212222,00045,942.7Table 1:Most Active PE Players in Healthcare Since 2022Source:Pitchbook,Alternatives WatchIn 2023,US VC funds focused on health raised$19 billion,marking the third-highest year,according to Silicon Valley Bank.However,the number of deals declined by approximately 30%from 54,801 in 2022 to 36,477.This indicates a stabilization compared to the peak in 2021 and a return to previous levels.Additionally,there is optimism that deployment will rise as inflation eases and the Federal Reserve halts rate hikes.SVB notes that VC investors,who previously favored later-stage deals,have undergone a decisive shift towards earlier-stage deals that are sheltered from public market volatility and may have cleaner cap tables without the complications of down rounds or inflated valuations.Consequently,this shift has resulted in smaller investment amounts being spread across a growing number of companies.17Healthcare Industry ReportFigure 3:Most Active VC Investors Source:Silicon Valley BankOverallBiopharmaHealthtechDx/ToolsDevice553636101254333491047222677442125774217187640171866371614653414126518Healthcare Industry ReportFunding Outlook The industry is optimistic,given the favorable outlook of demand and supply dynamics.Increased healthcare spending and a growing aging population are key factors driving up demand.According to the CMS,the proportion of GDP spent on healthcare in the U.S.is predicted to reach nearly 19.6%by 2031.The demand for healthcare technology,in particular,is experiencing rapid growth,with the market expected to expand at a CAGR of 15.6%from 2023 to 2028,according to MarketsandMarkets.On the supply side,there has been a significant increase in investments in research and development(R&D),leading to an accelerated rate of new drug approvals.20 years ago,companies allocated approximately 15%of their sales to R&D,and now that number has surpassed 20%,according to data from the FDA and Empirical Research Partners.Simultaneously,there has been a gradual alignment of expectations between sellers and buyers.Private investors are driven by a growing pressure to divest assets and deliver returns to their LPs who are facing prolonged holding periods,reaching a 20-year high of 7.1 years for North American PE funds in November 2023 per S&P Global.This trend has led to an upsurge in assets entering the market.Concurrently,PE investors globally are holding an unprecedented dry powder,reaching a record high of approximately$2.6 trillion,per S&P Global,with the leading healthcare players holding approximately$195 billion(see fig.8).According to a BCG survey,40%of investors express a bullish sentiment regarding prospects for 2024,and 65%report an optimistic outlook over the next three years.Confidence going forward is expected to increase with improvements in macroeconomic conditions.Further,industry trends,including the expansion of AI,the emergence of a new category of weight-loss drugs,increased adoption of outsourcing and outpatient care,coupled with the positive impacts of the Inflation Reduction Act beginning to materialize,are positioning healthcare deals as a focal point in coming years.65%investors express an optimistic outlook over the next three yearsThe industry is optimistic,given the favorable outlook of demand and supply dynamics.Increased healthcare spending and a growing aging population are key factors driving up demand.Chart 7:Impact of Several Trends of Multiple Healthcare SegmentsSource:Boston Consulting GroupBusinessChallengesContinued labor shortageRA ImplementationEvolving regulatory landscapeMargin pressuresShifting sites of careGrowth of GLP-1sDeployment of traditionaland generative AIDegree of end market impact:HighMediumLowOngoingstrategic shiftsHealth careinnovationHealth care segmentTrendBiopharmaMedtechLST/IVDProviderPayerHCIT119Healthcare Industry ReportHealthcare Sector Market Performance Healthcare,comprising approximately 13%of the S&P 500,experienced a lackluster performance in 2023,with only a 0.3%increase compared to the S&P 500s robust 24%surge.This was a consequence of investors favoring a select group of large tech and growth stocks,which drove up overall market indices.Among the healthcare sector,pharmaceuticals,drug development,and pharmaceutical distribution outperformed over the past three years,with gains of 71.82%and 73.05%respectively,according to the indices defined below.Firms involved in the development of new-age drugs as well as those on the cutting edge of integrating big tech and AI into production processes received significant investor interest.However,this interest did not extend broadly across the healthcare sector,with many traditional healthcare IT firms not experiencing the same level of investor enthusiasm.As a result,Healthcare IT has trailed behind,declining by 33.22%over the same period.Chart 8:Healthcare Segment Stock Price Movement02040608010012014016018020004/01/2105/01/2106/01/2107/01/2108/01/2109/01/2110/01/2111/01/2112/01/2101/01/2202/01/2203/01/2204/01/2205/01/2206/01/2207/01/2208/01/2209/01/2210/01/2211/01/2212/01/2201/01/2302/01/2303/01/2304/01/2305/01/2306/01/2307/01/2308/01/2309/01/2310/01/2311/01/2312/01/2301/01/2402/01/2403/01/24Pharmaceuticals and Drug DevelopmentHealthcare ITHealthcare EquipmentPharmaceutical DistributionHospitals and Healthcare CentersBiotechnologyTable 2:Healthcare Segment Percentage ChangesPharmaceutical Distribution:McKesson Corporation,Cencora,Inc.,Cardinal Health,Inc.,Henry Schein,Inc.,Patterson Companies,Inc.Healthcare Equipment:Abbott Laboratories,Stryker Corporation,Intuitive Surgical,Inc.,Boston Scientific Corporation,Becton,Dickinson and CompanyHospitals and Healthcare Centres:HCA Healthcare,Inc.,Tenet Healthcare Corporation,Universal Health Services,Inc.,Community Health Systems,Inc.,Encompass Health Corporation,Pharmaceuticals and Drug Development:Eli Lilly and Company,Johnson&Johnson,Merck&Co.,Inc.,Pfizer Inc.,Bristol-Myers Squibb CompanyHealthcare IT:Veeva Systems Inc.,MultiPlan Corporation,Evolent Health,Inc.,Teladoc Health,Inc.,Certara Inc.Biotechnology:AbbVie Inc.,Amgen Inc.,Gilead Sciences,Inc.,Vertex Pharmaceuticals Incorporated,Regeneron Pharmaceuticals,Inc.PlayerQTD 1Q24YTD 2024YR/YR 2024Pharmaceuticals and Drug Development16.47.470.50%Healthcare IT0.12%0.12%3.99%Healthcare Equipment14.04.04.15%Pharmaceutical Distribution9.38%9.382.05%Hospitals and Healthcare Centers24.79$.79C.27%Biotechnology2.02%2.02.04s%gains in pharmaceutical distribution over the past three years20Healthcare Industry ReportHealthcare Deals in 202433%increase in$100-$500 million deals between March and April 2024Chart 9:Healthcare Deals in 2024*Data as of May 21,2024Source:S&P Capital IQ$1B$500M-$1B$100M-$500M$100MUndisclosedDeal Value($B)94241866182618107838642186162.53160828818.131.96.20.005.0010.0015.0020.0025.0030.0035.00020406080100120140160JanuaryFebruaryMarchTable 3:Healthcare Deals Summary in 2024*Source:S&P Capital IQ*Data as of May 21,2024Valuation SummaryTotal Deal Value($B):88 Average Deal Value:526.08 Average TEV/Revenue:11.99Average TEV/EBITDA:18.68Average Day Prior Premium:63.54%Average Week Prior Premium:64.87%Average Month Prior Premium:81.81!Healthcare Industry Report Ashler Capital acquired CarePartners Pharmacy,an Illinois-based national provider of pharmacy products and services,on January 4.Novo Holdings acquired Catalent,a New Jersey-based pharmaceuticals company through a$16.5 billion public-to-private LBO,on February 5.Stonepeak acquired Akumin,a Canadian provider of outpatient diagnostic imaging services,through a$600 million public-to-private LBO,on February 6.MedRisk,via its financial sponsors CVC Capital Partners and The Carlyle Group,acquired Medata,a California-based medical bill review software,on January 9.General Catalyst acquired Summa Health,an Ohio-based nonprofit integrated healthcare delivery system,on January 17.New Habor Capital acquired Specialty Infusion Center,a Michigan-based infusion company that provides IV medication,nutrition,and hydration in the home,on January 30.Nautic Partners acquired Angels of Care Pediatric Home Health,a Texas-based Provider of home health services for children and young adults,on February 9.KKR acquired Cotiviti,a Utah-based healthcare analytics company specializing in payment accuracy solutions for healthcare payers,on February 14.Calyx,via its financial sponsor CapVest Partners,acquired Invicro,a Massachusetts-based imaging and analytics software company,for$115 million on March 6.Frazier Healthcare Partners acquired RevSpring,a Tennessee-based provider of patient and consumer engagement and payment solutions on March 12.M&A activity deal value experienced a year-on-year decline from 130 billion to 88 billionThe Healthcare sector has seen 581 deals in 2024 so far,marking a 17%year-on-year decline from 708 deals recorded during the same period in 2023The most active buyers by deal volume include The Ensign Group,Standard Bearer Healthcare,Ginkgo Bioworks Holdings,The Pennant Group,and Acadia Healthcare CompanyKey Private Equity Deals22Healthcare Industry ReportTable 4:Key M&A Deals and Multiples Source:Capital IQTransaction DateTarget/IssuerTotal Transaction Value($mil)Buyers/InvestorsTotal Enterprise ValueTEV/LTM Total Revenues Target/Issuer02-05-2024Catalent,Inc.16,704.29 Novo Holdings A/S14,781.9 3.59 04-05-2024Shockwave Medical,Inc.13,948.28 Johnson&Johnson 12,131.3 15.4 02-26-2024R1 RCM Inc.5,817.31 New Mountain Capital,L.L.C.;New Mountain Investments V,L.L.C.7,358.4 3.22 04-10-2024Alpine Immune Sciences,Inc.4,955.56 Vertex Pharmaceuticals Incorporated 4,160.8 73.6 02-12-2024CymaBay Therapeutics,Inc.4,428.92 Gilead Sciences,Inc.-01-08-2024Axonics,Inc.3,700.59 Boston Scientific Corporation 3,144.6 8.12 01-31-2024Medicare Advantage,Cigna Supplemental Benefits and CareAllies Businesses3,300.0 Health Care Service Corporation,a Mutual Legal Reserve Company-03-25-2024ILC Dover LP2,400.0 Ingersoll Rand Inc.-04-29-2024Deciphera Pharmaceuticals,Inc.2,220.07 Ono Pharmaceutical Co.,Ltd.1,928.3 11.0 01-31-2024Globalink Investment Inc.2,122.72 ALPS Global Holding Berhad69.4-01-23-2024Inhibrx,Inc.1,945.55 Aventis Inc.1,764.2-02-13-202499 Acquisition Group Inc.340.71 Nava Health MD,LLC104.8-01-16-2024Vision Sensing Acquisition Corp.277.25 Medi Forum Co.,Ltd.54.2-04-03-2024ARCA biopharma,Inc.175.0 Oruka Therapeutics,Inc.11.4-04-03-2024Asensus Surgical,Inc.105.19 KARL STORZ SE&Co.KG65.5 7.82 Key M&A Deals and MultiplesDisclaimer Pune|Hyderabad|Bengaluru|London|Zurich|New York|San Francisco|Amsterdam|Toronto|WroclawThis document makes descriptive reference to trademarks that may be owned by others.The use of such 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World Alzheimer Report 2024Global changes in attitudes to dementiaWorld Alzheimer Report 2024Global changes in attitudes to dementia4 ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024AuthorsAlzheimers Disease InternationalAttitudes to dementia survey:Dr Sara Evans-Lacko,Elisa Aguzzoli,Dr Sanna Read,Adelina Comas-Herrera,Dr Nicolas FarinaContributors:Cristiano S.Aguzzoli,Professor Kaarin J.Anstey,Dr Alireza Atri,Paola Barbarino,Chlo Benoist,Professor Bianca Brijnath,Dr Martin A.Bruno,Lucas Cose,Beniam Daniel Darge,Will Dean,Dr Emmanuel Epenge,Patrick Ettenes,Faraneh Farin,Dr Nicolas Farina,James Rupert Fletcher,Carolina Godoy,Esra Hassan,Natalie Ive,Dr Sarang Kim,Dr Christopher Lind,Professor Gill Livingston,Professor Lee-Fay Low,Dr Mataa Mataa,Dr Bruce L.Miller,Dr Moyra E.Mortby,Dr Manka Nkimbeng,Laura Noguera,Dr Primrose Nyamayaro,Dr Dborah Oliveira,Lee-Ann Olwage,Dr JB Orange,Brother John-Richard Pagan,Kago G.Paledi,Manuel Rico,Dr Pamela Roach,Dr Annemarie Schumacher Dimech,Iryna Shevchenko,Dr Shana D.Stites,Dr Aida Surez-Gonzlez,Luciana Vita,Dr Jennifer D.Walker,Noriyo Washizu,Wendy Weidner,Ingrid Wellington,Dr Charles Windon,Jessica Young,Mariana ZaninoSurvey translators:Diego Aguilar,Fernando Aguzzoli Peres,Hamed al-Sinawi,Fathiya Andara,Chlo Benoist,Bulga Bulganchimeg,Elaine Chan,Hendrawan Chandra Kusuma,Debbie Chen,Gan Chong Shyan,Josep Comas i Caussa,Thu Ha Dang,Faraneh Farin,Konstantinos Gkikas,Lea Goldberger,KP Gopalakrishnan,Adelina Herrera i Corcoll,Stefanija Ilinca,Hanumanthachar Joshi K,Magda Kaczmarska,Nancy Kalaba,Fsun Kocaman,Kevin Kristian,Suresh Kumar,Ken Lestariyani Sulis,Klara Lorenz-Dant,Linda Lundberg,Talent Mabasa,Jane Mahakian,Sujatha Manoharan,Gloria Mantineo,Nilanjana Maulik,Sona Mkhitaryan,Elizabeth Mutunga,Maryam Noroozian,Ieva Petkut,Mario Possenti,Aditya Putra,Thakane Raditapole,Muriel Rason-Andriamaro,Susanna Saxl-Reisen,K Selvaraj,Raluca Sfetcu,Alexandra Shchetkina,Vidya Shenoy,Iryna Shevchenko,Aurelija iurien,LiYu Tang,Zbigniew Tomczak,Yuda Turana,Susanne Van den Buuse,Changiz M.Varzi,Noriyo Washizu,Peach Wattanavitukul,Yared ZewdeAcknowledgementsADI would like to extend its gratitude to the team at the London School of Economics and Political Science(LSE)Care Policy and Evaluation Centre for their work on the survey that forms the backbone of this report.Thanks also go to the thousands of people around the world who took the time to translate,share,and respond to this survey.ADI would also like to give special thanks to The Mary Oakley Foundation,Inc.for its generous support this year.ADI would like to thank our corporate partners and donors:BiogenEisaiEli Lilly and CompanyThe Mary Oakley Foundation,Inc.Novo NordiskOtsuka Pharmaceutical Development&Commercialization,Inc.ParexelDiane and Dan RiccioRocheVan Otterloo FamilyPublished by Alzheimers Disease International.September 2024 Copyright Alzheimers Disease InternationalSuggested citation:Alzheimers Disease International.2024.World Alzheimer Report 2024:Global changes in attitudes to dementia.London,England:Alzheimers Disease International.Cover photo:Lee-Ann Olwage,Ghana 5ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024ContentsForeword 6Executive summary 8Key findings 9Recommendations 11Chapter 1:What is stigma?13Chapter 2:Attitudes to dementia survey results 201.Background212.Comparative analysis:2019 vs.2024233.Anticipated discrimination among people with dementia and carers in 2024 394.Impacts of stigma on life satisfaction,loneliness,and quality of life 465.Perceptions of change since 2019 496.Reducing dementia-related stigma 547.Methodology 558.Appendices 58Chapter 3:Expert essays 97The impact of COVID-19 on people with dementia:discriminated,neglected,isolated 98Challenging dementia stigma in popular culture:why we need media guidelines 101Womens experience of stigma and bias around Alzheimers and related dementias:access to information,diagnosis,treatment,care,and research 105“We need to row in the same direction”:a dialogue on dementia science,policy,and awareness 109Valuable initiatives to understand and address stigma in rarer forms of dementia 113Dementia risk reduction and stigma:a complex relationship with hopeful potential 117Stigma and awareness:some critical questions 119Chapter 4:Case studies of stigma 123Speaking up for change:the long road to a Lewy body diagnosis in the U.S.s veteran healthcare system 124“You dont look like you have dementia!”:what I wish people knew about living with primary progressive aphasia 127Alzheimers stigma:a gamut of social group attitudes affecting healthcare access,diagnosis confidence,and caregivers efforts 129Understanding and reducing dementia stigma in Australia:who holds it and how to mitigate it?132Dementia attitudes in British adolescents 135The Big Forget:perceptions of dementia across Africa 138Canadian Indigenous experiences of and attitudes to dementia 141Stigma in times of crisis:how war compounds the struggle for people living with dementia in Ukraine 144Palliative care access for people living with dementia in the Middle East:navigating cultural barriers 146Chapter 5:Case studies in addressing stigma 149Becoming an advocate and a force for change as an LGBTQ person with early-onset dementia 150Changing terminology to change attitudes:the Japanese experience 153Stigma in dementia:lessons from HIV care in Africa 155Development and feasibility testing of the Changing Attitudes and Reducing Discrimination in Dementia(CARD)intervention with community healthcare workers in Brazil 158Old before our years:a conversation between two sons of younger-onset dementia from across the pond 162New paradigms in dementia:promoting brain health and healthy ageing from childhood 165Awareness in action:dementia education for African immigrants in the United States 168The importance of data in addressing dementia attitudes:lower-and middle-income countries perspectives 171Conclusion 1746 FOREWORDALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Have attitudes to dementia changed in the last five years?Like many others,I have been awaiting the release of this years Attitudes to dementia survey with bated breath.This massive endeavour first came about when Alzheimers Disease Internationals(ADI)board included in my job description that one of my targets for success was to help decrease stigma globally.Back then I thought:“That is a huge goal and even if I managed to do something about it,how exactly I am going to measure that if there is no global benchmark for dementia stigma?”Then my next thought was:“Lets roll up our sleeves and create one!”So I established the inaugural Attitudes to dementia survey in 2019,for which ADI entrusted the London School of Economics and Political Sciences(LSE)with the analysis,with the aim of repeating the survey at regular intervals to measure whether our collective work was having any impact on attitudes to dementia.The 2024 survey marks the first follow-up survey,and this first comparison will require attentive reading to understand all the nuances.The changes,some radical,some subtle,over the past five years will be of great interest to all of those who,like our member organisations,work so hard to raise awareness of dementia and Alzheimers in their countries.Our hope is that these facts and figures will form a solid framework for national advocacy strategies and will help negotiate better outcomes for people living with dementia and their families all over the world.The most important thing the report tells us is that we cannot be complacent.Stigma remains high and can take many forms,including self-stigma.It can creep up on you from many different directions when and where you least expect it.This comment from a person living with dementia who filled out the survey illustrates one facet of it and paints a world of miscomprehension,isolation,and disengagement:“I am not going anywhere so people dont notice I am ashamed”ForewordPaola Barbarino,Chief Executive Officer,Alzheimers Disease InternationalFOREWORD 7ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024In 2019,many countries did not see the critical importance of ADIs survey,as often happens with new initiatives.Whilst we received just under 70,000 answers at the time(for which we can never been grateful enough),many of these were from high-income countries,with only two or three countries dominating the scene.The final results were obviously weighted,but we would have loved to receive more input from lower-and middle-income countries.Our wishes have been fulfilled this time;we received fewer replies still a huge amount at just over 40,000 but from a much broader spectrum of countries(166)and a lot more evenly distributed between regions and income groups.I personally cannot thank participants enough.It was not an easy survey to complete.Some of you will read the report cover to cover and pore over its findings,others will speed-read it.For the latter,here are four things that struck me the most in this report:z In 2019,one of the most incredible findings was that 62%of health and care practitioners(such as doctors and nurses)thought that dementia was a part of normal ageing.This year,that number has grown to 65%.This begs the question:What do we have to do,how long do we have to shout from the rooftops to make sure that medical professionals receive sufficient training to identify dementia as a condition caused by a set of diseases,Alzheimers being the most prevalent?Why does this matter?To people living with dementia and their families all over the world,knowing that their relative has a correct diagnosis could:z open the door to support groups,information,and feeling part of a community;z enable them to receive better care in a timely fashion;z open access to new life-prolonging treatments;z last but not least,educate people about the modifications that can be made to enable the person diagnosed to live in their own home more comfortably for longer.z Underscoring that,the second finding that surprised me was that over a quarter of respondents expressed the belief that moving a family member with dementia to a care home,even against their wishes,would be the best option.Most surprisingly,that belief increased substantially in low-/lower-middle income countries,where there is not a strong care home sector.z It is not all bad.There are plenty of things that give us hope,like the fact that the number of people who believe dementia is caused by an unhealthy lifestyle has broadly increased to 61%in higher-and middle-income countries,indicating that the message on risk reduction and prevention(see the World Alzheimer Report 2023)is getting through to the general public(It has however decreased in lower-income countries,why that is will be the subject of further studies).z Finally,over 80%of the general public believes they can change the support provided to people living with dementia through their vote!This is great news;advocacy can work,and I am sure this will put a spring in our step for all of us trying to persuade governments to do more.I could go on,but instead I will leave you with this quote,which has brought this publication to life for me like nothing else:“Theyre just normal people,they have dementia but theres no,like,theyre not different and people with dementia should be treated the same way,and they should be treated with care because obviously they can forget stuff,and theyre just people so theyre just the same as us,theres nothing different with them.”British adolescent,from the essay by Esra Hassan and Nicolas Farina page 135.This really gives me hope that the message is coming across.As you will read in these pages,stigma is multifaceted and hard to pin down.However,I do believe that by engaging the younger generations,dementia stigma will hopefully disappear in the same way as cancer stigma,and that,in due course,we will no longer need for this global survey to be repeated.Until then,we must continue to work together.Our joint voices will continue to make a difference for all those who live with dementia and their families.London,September 20248 ExEcuTIvE SuMMARy ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Executive summary1“Ageing and Health,”World Health Organization,https:/www.who.int/news-room/fact-sheets/detail/ageing-and-health.For over a decade,Alzheimers Disease International(ADI)has been advocating for increased awareness of dementia across the world.Awareness is a nebulous concept,but an important one.Knowledge of dementia plays a key role in how the condition is understood by various stakeholder groups,and how people living with dementia and their carers are treated.Every three seconds,someone,somewhere,develops dementia.In 2019,some 55 million people were estimated to have dementia across the world,a figure predicted to increase to 139 million by 2050 according to the WHO.1 The annual cost of dementia was estimated to stand at US$1.3 trillion in 2019,a figure set to more than double by 2030 to$2.8 trillion.As the world population ages,dementia is becoming one of the leading causes of death in the world,making it all the more urgent for healthcare practitioners,policymakers,and the wider public to seize the significance of the condition and take action to mitigate its negative effects on individuals living with dementia,their families and carers,and societies as a whole.The concepts of dementia awareness and stigma are intricately related under the umbrella of attitudes to dementia.The report poses the question“what is stigma?”through an essay that seeks to define dementia-related stigma and to better understand its component parts based on power,stereotypes,prejudice,and discrimination.In 2019,Alzheimers Disease International(ADI)commissioned a global survey on attitudes towards dementia conducted by the London School of Economics and Political Science(LSE),seeking to understand what were the prevailing beliefs,knowledge,and attitudes about the condition at that specific point in time.The 2019 survey garnered responses from some 68,000 participants,making it a landmark study on attitudes to dementia with unprecedented outreach and the global baseline from which to measure future change.Five years later,ADI and LSE have conducted a follow-up survey in order to see whether attitudes to dementia have changed since.Like in 2019,LSE developed the survey to target four key groups,(1)people living with dementia,(2)carers,(3)health and care professionals and(4)the general public,with analysis being provided in three categories:knowledge,attitudes,and behaviour.The 2024 survey garnered more than 40,000 responses,which,while less than in 2019,still represents a significant number of respondents from around the world sharing their views on dementia,allowing us to see how perceptions of the condition have changed or not in the past five years.The analysis contained within these pages is non-exhaustive given the extensiveness of the survey,and more insights will undoubtedly be gleaned over time at the global and national levels.The time between 2019 and 2024 has seen major global upheavals:the COVID-19 pandemic that stretched healthcare systems beyond their capacity,large-scale and violent conflicts,and economic turmoil all of which may have influenced social and political attitudes and discourse towards dementia.In times of hardship,marginalised and vulnerable populations are often the first to suffer the consequences,and this report explores some of the ways this has played out for people living with dementia.In addition to the survey,ADI commissioned essays to include in the report and provide complementary reflections and viewpoints on the rich topic of attitudes to dementia.The essays have been divided into three sections:expert essays,case studies of stigma,and case studies addressing stigma.The expert essays look at how attitudes to dementia influence,or are influenced by,broad issues such as gender,COVID-19,popular culture,or access to diagnosis and treatment.Case studies of stigma looked at how dementia stigma might express itself in specific instances,such as in some cultures or age groups,in the context of armed conflict,or the life experiences of people with dementia in their own words.Case studies addressing stigma look at some avenues through which attitudes to dementia have been improved throughout the world whether by changing the terminology used to refer to dementia,providing support to LGBTQI people living with dementia,or outreach to children and young people.This section also includes testimonies from ADI member associations in lower-and middle-income countries about the significance of the 2024 survey for them,in areas often neglected by dementia research.KEy FINDINgS 9ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Key findingsThe data,evidence,and case studies from this 2024 World Alzheimer Report highlight the complex and persistent nature of stigma and dementia worldwide.Our 2019 report provided an unprecedented baseline of global stigma data.Five years on,new data help us reflect on what has changed(or not),but certainly on what needs to change if we are to improve outcomes for people living with dementia worldwide.Here,we distil key findings into three categories:knowledge about dementia,attitudes and beliefs,and behaviours.This framework enables us to describe how knowledge about dementia can influence attitudes and beliefs and ultimately behaviours toward people impacted by dementia.Knowledge z 80%*of the general public think dementia is a normal part of ageing,a dramatic increase compared to 66%in 2019.z 65%*of health and care professionals(HCPs)believe dementia is a normal part of ageing,up from 62%in 2019.z Over 96%of the general public believe in the value of a medical diagnosis.z Over 93%of the general public believe there are things we can do to improve the lives of people with dementia.z Over 58%of the general public believe dementia is caused by an unhealthy lifestyle.This number increased since 2019 across high-income countries(HICs)and upper-middle income countries(UMICs)but decreased dramatically in lower-/lower-middle income countries(LMICs).z Over a quarter of people globally believe there is nothing we can do to prevent dementia,with an increase from 2019 to 37%in LMICs.z Over 43%of the general public believe,at least in part,that dementia is caused by lack of family support,a dramatic increase since 2019,especially in HICs.Our 2024 World Alzheimer Report has revealed the troubling reality that nearly 80%of the general public and,more worryingly,65%of health and care professionals,still believe that dementia is a normal part of ageing.This is a concerning increase from our 2019 survey numbers,as we know that this lack of understanding can delay diagnosis and access to treatment and support.There are also varying degrees of understanding around causal attributions of dementia;with a dramatic increase of people in high-income countries believing that lack of family support can cause dementia and over a quarter believing there is nothing we can do to prevent dementia.The news regarding levels of knowledge is not all bad,however.The number of people who believe that dementia is caused by an unhealthy lifestyle has increased to over 61%,suggesting that messaging around the importance of dementia risk reduction is gaining traction.Finally,an overwhelming majority of the general public believe in the value of a medical diagnosis and that there are things we can do to improve the lives of people living with dementia.Attitudes z Between 29%(HICs)and 32%(LMICs)of the general public felt that people with dementia are dangerous more often than not an increase from 2019.z Over 64%of the general public believe people with dementia are impulsive and unpredictable,a slight increase from 2019,especially in UMICs.z Over a quarter of respondents from the general public expressed a belief that moving a family member with dementia to a care home,even against their wishes,would be the best option.This number increased significantly in LMICs since 2019.z Over 60%of the general public believed it is important to remove family responsibilities from people with dementia to avoid stressing them,an increase from 2019 data,especially in LMICs.z Over 80%of general public respondents indicated a willingness to take a genetic test to determine their risk of developing dementia.z More than 90%of carers and respondents from the general public said they would be encouraged to get a diagnosis if a disease-modifying treatment was available.*This is an average of global data.For breakdowns by World Bank income groups,please see Chapter 2.10 KEy FINDINgS ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024 z Over 85%of health and care professionals said they would be encouraged to give a diagnosis if there was a treatment that could prevent or slow the progression of dementia.z More than 80%of the general public believe that they can change the support provided to people with dementia through their vote.There were some real changes in overall attitudes toward people living with dementia since 2019.There was a general increase in the view that people living with dementia are dangerous and unpredictable in their behaviour,as well as an increased perception that it is important to remove family responsibilities from people with dementia to avoid stressing them.Significantly,more than 27%of respondents from the general public expressed a belief that moving a family member with dementia to a care home,even against their wishes,would be for the best.In contrast,the majority of the general public showed a willingness to be proactive in determining their own health journeys in relation to dementia,with over 80%of respondents indicating a willingness to take a genetic test to determine their risk of developing dementia,and more than 90%of respondents saying they would be encouraged to get a diagnosis if a disease-modifying treatment was available.Equally,over 85%of health and care professionals said they would be encouraged to give a diagnosis if there was a treatment that could prevent or slow the progression of dementia.Behaviours z 88%of people living with dementia indicate experiencing discrimination,up from 83%in 2019.z 36%of the general public in LMICs are willing to keep their dementia a secret,a significant increase from 19%in 2019.z Carers and people living with dementia tended to report higher levels of loneliness than the general population.z Over 50%of people with dementia and their carers experienced anticipated discrimination.For people with dementia:z 36%stopped applying for or continuing work z 29%avoid or discontinue close personal relationships z 24%(nearly a quarter)avoid seeking help,care,or treatment due to concerns about potential treatment by pharmacists or other customers.z 22%avoid visiting banks due to fear of judgement z 31%avoid social situations due to concerns regarding the reactions of othersFor carers:z 43%stopped inviting friends over due to concerns about how they might treat their loved one z 47%stopped accepting invites to visit friends or family z 40%avoided joining social groups or activities due to concerns about reactions to their loved one z 34%avoided going out in public with the person they care for due to fears of perception z 41%of carers avoid travel or taking vacations due to concerns that the person they care for could be treated negativelyNot surprisingly,these findings strike to the heart of the World Alzheimer Report.Behaviour outlines the real-world impact of stigma it stems from public and structural stigma and can often manifest as discrimination.It is important to note that this report outlines experiences of discrimination by others,but also levels of anticipated discrimination,which can hinder and individual from participating fully in life due to fear of rejection.In this report,the experience of anticipated discrimination was most profound in family carers.It is clear that people living with dementia,and those who care for them,are experiencing high levels of discrimination and/or fear of discrimination,which is impacting severely on their quality of life.This is significant.REcOMMENDATIONS 11ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024RecommendationsThe survey data,essays,and case studies included in this report paint a complex picture of global attitudes to dementia.These attitudes are complicated,often interrelated,and,sometimes,entangled.But this interconnectedness can work in our favour.By tackling stigma across multiple fronts,at the public,structural,and individual levels,each can have an impact on the next and like dominoes,gradually knock down barriers to inclusion,to work towards a future in which dignity,respect,and inclusion are no longer a dream for people living with dementia,but a reality.ADI recommends stepping up efforts globally to tackle stigma across three fronts:Public z Awareness-raising campaigns need to change and include behaviour change.We need to make messages clearer.Dementia is not a normal part of ageing.Awareness-raising campaigns must be targeted and direct;with simple facts and easy-to-remember anecdotes about what dementia is and what it is not.We also need to focus on creating environments that encourage positive behaviours towards people with dementia.By changing the way society interacts with people living with dementia,we can foster greater understanding and inclusion,which over time can reduce stigma.z Messaging matters.Increased levels of discrimination underscore the need for messaging that goes beyond awareness raising to ensure that the right information is getting across.People with dementia can still lead meaningful and active lives.We need to break down misconceptions that create fear and feed prejudice,with representation from people living with dementia and their carers to demonstrate the true and human face of dementia,in all of its diversity.z Public perceptions influence policy so how we represent dementia matters.Stigmatising portrayals of people with dementia as frail,elderly,an empty shell perpetuate a hopeless view that contributes to apathy amongst policymakers who must decide where best to invest scant resources.Policies and structural stigma will never improve unless we change this narrative and portray the full and rich diversity and experience of the dementia journey.z Anti-stigma tools and communication must be promoted.The higher levels of fear demonstrated within the survey indicate that the public doesnt always know how to connect or respond to people who have dementia.Public awareness campaigns need to include examples of tools and proactive communication techniques many of which already exist on how to engage with a person living with dementia,how to recognise unmet needs,or how to use simple active listening to connect in a non-threatening manner.Structural z We need to recognise and challenge structural stigma.This report touches upon some of the society-level conditions and institutional practices that exacerbate structural stigma impacting people living with dementia,including racism,social determinants of health,disablism,and sexism.These systemic level practices need to be challenged head-on through equitable policies that promote inclusion and provide equal opportunity and access to support and care for those impacted by dementia.z Equitable and inclusive policies start with national dementia plans.National dementia plans remain the most effective way for governments to develop,legislate,and fund dementia-inclusive policies that promote equitable access to treatment and care as well as dementia-inclusive environments.Dementia plans encourage a whole-systems approach to breaking down stigma through collaborative working across health and care systems,community organisations,and public/private entities.z Access to dementia diagnosis,care,and treatment is a right.One key factor in the persistent stigma and fear surrounding dementia is the belief that nothing can be done to treat or slow down the progression of the condition.While there is still no cure,symptomatic treatments exist,and disease-modifying treatments are available in some countries.More than 90%of respondents said they would seek out a dementia diagnosis if they knew a disease-modifying treatment was available.This overwhelming response should be viewed as a call for governments and international organisations to ensure equitable access to pharmacological,non-pharmacological,and lifestyle treatments and therapies,regardless of age,background,income,or country of residence.12 REcOMMENDATIONS ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024 z vote:dementia is a political issue.With 83%of the general public believing that their vote can influence dementia policy,its clear that dementia is a factor they wish to see addressed in candidates political platforms.The 2024 Attitudes to dementia survey proves that there is a real appetite from constituents for their political leaders to play an active role in creating environments where people living with dementia can be supported,cared for,and thrive for as long as possible.Individual z Include the voice of lived experience.Fundamental to any anti-stigma initiative is to include the input and representation of people living with dementia to ensure their views,experiences,ideas,and desires are front and centre in all the detail and practicalities of our programmes.The voices of people with dementia will break down barriers and this can enhance self-esteem,quality of life,promote social inclusion,and improve overall wellbeing.z Support carers.This survey revealed the true impact of experienced and anticipated discrimination on carers.They experience more loneliness and reported a poorer quality of life than the general population and health and care professionals.Whether due to societal prejudices or internalised stigma,the burden of dementia should not be carried alone.ADI calls on governments to provide solid support networks and person-centred services to create truly dementia-inclusive communities,in which those living with the condition and those who care for them no longer feel isolated and cast aside.Individuals who care about dementia,whether they are directly affected or not,should also be encouraged to take action to change the way dementia is discussed and treated.z Invest in training health and care providers.With 65%of healthcare professionals still believing dementia is a normal part of ageing and 59%thinking members of their own profession tend to ignore the person living with dementia there is a clear and urgent need to improve and expand dementia education,train ing,and professional development for clinicians and other health and long-term care profession als.They are on the frontline and deserve access to all necessary tools to ensure they can break stigma and encourage deeper understanding and expertise of dementia.z Take individual action.While ADI is a strong advocate of governmental and institutional-level responses to address structural issues,every single one of us has the power to make a difference at our own level,as shown in the box below.Every person reading this report can act today to make the world a better place for people living with dementia,in ways big and small.In the words of Noriyo Washizu,one of the contributing authors of this report,“a journey of a thousand miles begins with a single step.”Five things you can do:1Educate yourself.Contact your local Alzheimer or dementia organisation(which can be found on ADIs website)or check out the resource section on ADIs website to learn more about dementia and how you can break the cycle of stigma.2Reach out to someone who has dementia.Do something meaningful for a family impacted by dementia that you know,or volunteer to help at a charity or an Alzheimer or dementia association.Small acts of service add up.3Advocate.Does your home country have a national dementia plan?Is there a clear pathway for accessing timely diagnosis or post-diagnostic care?Write to the policy makers in your country to insist that dementia become a priority.4Reduce your own risk.There is a lot you can do to reduce your own risk of developing dementia and enhance your brain health.Its never too late,or too early,to start!Take a look at the World Alzheimer Report 2023 for an accessible and easy-to-read introduction to the topic.5Post about dementia.Use social media to share the findings of this survey and to challenge others to learn more.13ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Chapter 1:What is stigma?A participant of the annual Kahuna Kupuna surf contest in San Francisco,California in August 2024.Loosely translated from Hawaiian,“Kahuna Kupuna”means“Big Chief Wise Elder,”a fitting name for the only amateur surf contest in the world specifically designed for surfers aged 40 and over.(Alex Kornhuber)14 cHAPTER 1:WHAT IS STIgMA?ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024What is stigma?Jessica Young,1 JB Orange,2 and Christopher Lind31 PhD Candidate,Flinders University,Adelaide,Australia;Western University,London,Canada2 Western University,London,Canada;School of Communication Sciences and Disorders,Faculty of Health Sciences,Western University,London,Canada.3 PhD,Flinders University,Adelaide,Australia“People with dementia look forward to the day when we no longer have to be defined by our disease or our disabilities,and we are all treated equally.”Kate Swaffer,dementia activist1The World Alzheimer Report 2019 presented the largest global survey of attitudes to dementia at the time.Findings outlined in the original report showed that stigma impacts the everyday lives of people with dementia in complex and harmful ways.Five years on,we return to the topic to explore further how we can continue to address the harms associated with dementia-related stigma.In this chapter we revisit:1.What the word stigma means2.The impact stigma can have on people with dementia and people close to them3.What we can do about stigma to reduce its harmful effectsWe summarise briefly five different types of stigma and share some recent advances in strategies to reduce dementia-related stigma.Defining stigmaThe word stigma describes when a person or a group of people is treated unfairly because the person or group is perceived to be different.2 The person or group is not treated in the same way as people who are perceived to be normal.They could be perceived as different in a variety of ways,for example,by their ethnicity,religion,physical abilities,mental health,or sexual orientation.They could also be perceived as different because they have dementia.The word stigma originates from Greek,meaning a mark or brand.Dementia symptoms or a diagnosis is often perceived as a mark or a label that sets a person apart from what is widely considered normal(Figure 1).In this report,we use the word stigma to refer to the ways we treat people with dementia unfairly because of that mark or label.We also use the word stigma to refer to the unfair treatment of people close to a person with dementia because of their relationship with them.One common model for understanding stigma shows that it has three main components:negative stereotypes,prejudice,and discrimination3(see Figure 2).According to the model,stigma occurs when a person:z internalises negative ideas and assumptions about people with dementia(negative stereotypes),z holds negative feelings toward people with dementia because of negative stereotypes(prejudice),and z uses actions that treat a person with dementia unfairly(discrimination).We describe each of the three components in more detail.DEMENTIAFigure 1:A person with a label of dementiacHAPTER 1:WHAT IS STIgMA?15ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Negative stereotypes:ideas and assumptionsStereotypes are common ideas or assumptions about people with the same mark or label.For example,people marked or labelled as women often are stereotyped as more emotional and physically weaker than people marked or labelled as men.However,many do not fit those stereotypes,and there are many diverse experiences of gender beyond those two labels.Stereotypes group together people by the same marks or labels,and permit others to assume that they are all the same.2Negative stereotypes portray people with a certain label as less important,capable,or valuable than people without that label.Negative stereotypes depict dementia as an entirely negative experience(Figure 3).Dementia is depicted as completely devastating,debilitating,frustrating,severe,hopelessly incurable,and leading to a complete loss of abilities.4,5,6,7We can learn,internalise and share these stereotypes,even if we do not believe them.8 For example:1.We share them through words.We could share negative stereotypes by labelling people with dementia as sufferers,demented,or victims.9,10 We could also share them by talking about dementia as a living death or a fate worse than death.5,7,112.We share them through pictures.For example,pictures or images of people with dementia in the media often match the negative stereotypes.9 For example,they might show a person who looks old,weak,sad,and distressed.Prejudice:negative feelingsPrejudice occurs when internalised dementia stereotypes lead to negative feelings toward people with dementia,such as fear,shame,anxiety,embarrassment,or even disgust.5,9,1214 The depth of these feelings can be impacted by a persons age,gender,ethnicity,culture,and their understanding of dementia.15 These negative emotions then can lead to negative or unfair actions toward people with dementia.Negative stereotypesIdeas and assumptionsPrejudiceFeelingsDiscriminationActionsSTIgMAFigure 2:Three components of stigma,adapted from Rsch,Angermeyer and Corrigan(2005)Figure 3:Negative stereotypes of people with dementiaDementia stereotypesPeople with dementia are:za burden on families za danger to themselves zold zweak zincompetent zdistressed zuntrustworthy16 cHAPTER 1:WHAT IS STIgMA?ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Five types of stigmaThere are quite a few different types of dementia-related stigma.Here,we describe five of them:public stigma,self-stigma,courtesy stigma,affiliate stigma,and structural stigma.9,12,23 There may be other similar types,but these are the most common ones.Type 1:Public stigmaPublic stigma is the most common type of dementia-related stigma.9 It occurs when the general public and/or health professionals hold prejudice toward people with dementia and,as a result,discriminate against them(Figure 4).For example,a person may internalise the stereotype that people with dementia are a danger to themselves,this may lead to prejudice in the form of fear,and that could result in social discrimination,where they avoid a person with dementia entirely.Type 2:Self-stigmaSelf-stigma occurs when people with dementia hold negative feelings toward themselves,which then impacts their actions in a way that harms them(Figure 5).A dementia diagnosis or perception of dementia symptoms could make a person with dementia feel ashamed,anxious,embarrassed,vulnerable,invisible,and lead to low self-confidence.5,12,16,24 These feelings can cause people with dementia to withdraw,and in a way self-discriminate.It may cause them to avoid other people,hide their symptoms or diagnosis from others,not ask for help,and/or refuse rehabilitation and treatment.12,14,16,17,20,25 These behaviours further socially isolate people with dementia,and act as a barrier to them being well supported and maintaining their quality of life.DEMENTIAFigure 4 Public stigmaDEMENTIAFigure 5:Self-stigmaDiscrimination:actionsDiscrimination occurs when a person with dementia is treated unfairly because of negative stereotypes and prejudice towards them.3 People with dementia can be discriminated against by a range of different people,for example by members of the general public,family members,health and care professionals,the judicial system,or employers.People with dementia also can be discriminated in a range of different ways.9,12,13,1622For example,people with dementia can be:z avoided socially z kept away from other people z have their dementia diagnosis hidden from them z not be offered rehabilitation or treatment z excluded from making decisions about their own life z made to live somewhere without their consent(i.e.involuntary institutionalisation)cHAPTER 1:WHAT IS STIgMA?17ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Type 3:Courtesy stigmaCourtesy stigma occurs when family,friends,or health and care providers are discriminated against because of their relationship to the person with dementia(Figure 6).26,27 For example,stereotypes of family and carers being neglectful could invoke feelings of disgust toward them.23,28 In turn,those feelings may lead to discrimination against family members,friends or formal caregivers or health professionals.In courtesy stigma,discrimination often manifests socially.For example,people close to the person with dementia could be avoided socially,excluded from or not invited to attend special events,shunned,or talked about behind their backs.17,23,2729Type 4:Affiliate stigmaAffiliate stigma is like self-stigma for people close to the person with dementia.It occurs when family,friends,or health and care providers internalise negative stereotypes of family and carers(see stereotypes described in courtesy stigma section above)(Figure 7).This could make them feel“anger,fear,and shame,”23 possibly leading them to:z hide their relationship with the person with dementia from others z hide the person with dementias diagnosis from others z isolate themselves socially z not ask for helpType 5:Structural stigmaStructural stigma occurs when institutions discriminate against people with dementia through the use of laws,policies,and practices(Figure 8).This sort of discrimination could include:z Limiting eligibility for health services and supports z Residential institutions that confine people with dementia z Hospitals and residential institutions that restrict access by family members,and/or z Healthcare staff receiving limited education about best-practice dementia care30,31DEMENTIAFigure 6:Courtesy stigmaDEMENTIAFigure 8:Structural stigmaDEMENTIAFigure 7:Affiliate stigma18 cHAPTER 1:WHAT IS STIgMA?ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Acknowledging,addressing,and reducingUnderstanding the three components(stereotypes,prejudice,and discrimination)and five different types of stigma(public stigma,self-stigma,courtesy stigma,affiliate stigma,and structural stigma)can help us find effective ways to reduce dementia-related stigma,and to improve the lives of people with dementia and people close to them.8,12There are many different ways we could start to reduce dementia-related stigma.15,32 Here we present just a few of them.For example:1.We can challenge negative stereotypes by:z Media,advocacy organisations,and researchers using words and images that reflect balanced depictions of dementia.For example,using images that depict individuality,a person-centred focus,and family connections.6 For example,using person-centred language such as person with dementia rather than demented person.z Using accurate public health information about dementia33,34 z Providing specific dementia-related stigma education programmes3537 z Paying attention to and following the advice of advocates with dementia,such as members of Dementia Alliance International or ADIs Global Dementia Experts Panel z Sharing the capabilities and diverse experiences of people with dementia.Some recent examples are:yBUDI Orchestra-Musical performances by people with dementia38 yCracked-Theatre and film about relationships with people with dementia39 z#WorldAlzDay-Social media campaigns sharing diverse experiences of dementia402.We can challenge prejudices by:z Understanding how stereotypes shape our feelings about dementia z Recognising when our actions are led by fear,shame,guilt etc.3.We can challenge discrimination by:z Understanding how prejudices shape our actions toward people with dementia z Supporting rehabilitation access z Supporting social connections for people with dementia and families z Challenging discriminatory policies and practices z Supporting people with dementia to inform research,policy development,advocacy,and care services30,33,41,42People with dementia deserve to live meaningful lives that are not constrained by disease,or disability,nor by others perceptions or actions.As dementia advocate Kate Swaffer notes,challenging stigma is one way to work toward equal treatment and non-discrimination of people with dementia.cHAPTER 1:WHAT IS STIgMA?19ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024References1.Alzheimers Disease International,World Alzheimer Report 2019:Attitudes to dementia.2019.2.Goffman,E.,Stigma:Notes on the management of spoiled identity.1963,New York,NY:Simon and Schuster.3.Rsch,N.,M.C.Angermeyer,and P.W.Corrigan,Mental illness stigma:concepts,consequences,and initiatives to reduce stigma.Eur Psychiatry,2005.20(8):p.52939.4.Crichton,P.,H.Carel,and I.J.Kidd,Epistemic injustice in psychiatry.BJPsych Bulletin,2017.41(2):p.6570.5.Low,L.F.and F.Purwaningrum,Negative stereotypes,fear and social distance:a systematic review of depictions of dementia in popular culture in the context of stigma.BMC Geriatr,2020.20(1):p.477.6.Cuadrado,F.,et al.,How to improve attitudes towards dementia?Reframing as a tool to overcome the stigma around Alzheimers disease.Patient Education and Counseling,2023.115.7.Ballenger,J.F.,Framing Confusion:Dementia,Society,and History.AMA Journal of Ethics,2017.19(7):p.713719.8.Young,J.A.,et al.,Expanding current understandings of epistemic injustice and dementia:Learning from stigma theory.J Aging Stud,2019.48:p.7684.9.Werner,P.,et al.,From History to Intervention:A Sociocultural Analysis of Dementia Stigma,in Dementia and Society,E.Schokkaert,M.Vandenbulcke,and R.-M.Dres,Editors.2022,Cambridge University Press:Cambridge.p.2544.10.Swaffer,K.,Dementia:Stigma,Language,and Dementia-friendly.Dementia,2014.13(6):p.709716.11.Werner,P.,C.N.Shpigelman,and L.Raviv Turgeman,Family caregivers and professionals stigmatic experiences with persons with early-onset dementia:a qualitative study.Scand J Caring Sci,2020.34(1):p.5261.12.Nguyen,T.and X.Li,Understanding public-stigma and self-stigma in the context of dementia:A systematic review of the global literature.Dementia(London),2020.19(2):p.148181.13.Philip,G.,et al.,Exploring stigmatizing perceptions of dementia among racialized groups living in the Anglosphere:A scoping review.Aging and Health Research,2024.4(1).14.Lopez,R.P.,et al.,Managing Shame:A Grounded Theory of How Stigma Manifests in Families Living With Dementia.J Am Psychiatr Nurses Assoc,2020.26(2):p.181188.15.Herrmann,L.K.,et al.,A Systematic Review of Alzheimers Disease and Dementia Stigma Research:How Might We Move the Stigma Dial?American Journal of Geriatric Psychiatry,2018.26(3):p.316331.16.Wong,K.L.Y.,G.Johnson,and D.OConnor,Living with dementia:Exploring the intersections of culture,race,and dementia,stigma.Dementia(London),2024:p.14713012241249796.17.Oliveira,D.,et al.,Experiences of stigma and discrimination among people living with dementia and family carers in Brazil:Qualitative study.Ageing and Society,2023.43(2):p.447468.18.Low,L.F.,et al.,Communicating a diagnosis of dementia:A systematic mixed studies review of attitudes and practices of health practitioners.Dementia(London),2019.18(78):p.28562905.19.OConnor,D.,J.Mann,and E.Wiersma,Stigma,discrimination and agency:Diagnostic disclosure as an everyday practice shaping social citizenship.Journal of Aging Studies,2018.44:p.4551.20.Cations,M.,et al.,Health Professional Perspectives on Rehabilitation for People With Dementia.Gerontologist,2020.60(3):p.503512.21.Johnson,R.,et al.,The relative contributions of disease label and disease prognosis to Alzheimers stigma:A vignette-based experiment.Social Science&Medicine,2015.143:p.11727.22.Stites,S.D.,J.D.Rubright,and J.Karlawish,What features of stigma do the public most commonly attribute to Alzheimers disease dementia?Results of a survey of the U.S.general public.Alzheimers Dement,2018.14(7):p.925932.23.Abojabel,H.and P.Werner,Exploring family stigma among caregivers of persons with Alzheimers disease:The experiences of Israeli-Arab caregivers.Dementia(London),2019.18(1):p.391408.24.Maxfield,M.and J.Greenberg,Anticipated Stigma and Dementia-Related Anxiety in Middle-Aged and Older Adults.GeroPsych(Bern),2021.34(1):p.1322.25.Ashworth,R.,Perceptions of stigma among people affected by early-and late-onset Alzheimers disease.Journal of Health Psychology,2020.25(4):p.490510.26.Werner,P.,Stigma and Alzheimers disease:A systematic review of evidence,theory,and methods,in The stigma of disease and disability:Understanding causes and overcoming injustices P.W.Corrigan,Editor.2014,American Psychological Association:Washington,DC.27.Werner,P.and H.AboJabel,Who internalizes courtesy stigma and how?A study among Israeli Arab family caregivers of persons with dementia.Aging Ment Health,2020.24(7):p.11531160.28.Werner,P.and A.Hess,Examining courtesy stigma among foreign health care workers caring for persons with Alzheimers disease:A focus group study.Home Health Care Services Quarterly,2016.35(2):p.6985.29.Greenwood,N.,G.Mezey,and R.Smith,Social exclusion in adult informal carers:A systematic narrative review of the experiences of informal carers of people with dementia and mental illness.Maturitas,2018.112:p.3945.30.Bacsu,J.-D.R.,et al.,Understanding stigma of dementia during COVID-19:a scoping review.Frontiers in Psychiatry,2024.15.31.Jacobs,R.,et al.,Stigma and its implications for dementia in South Africa:a multi-stakeholder exploratory study.Ageing and Society,2022:p.131.32.Bacsu,J.D.,et al.,Stigma Reduction Interventions of Dementia:A Scoping Review.Can J Aging,2022.41(2):p.203213.33.Stites,S.D.,et al.,Identifiable Characteristics and Potentially Malleable Beliefs Predict Stigmatizing Attributions Toward Persons With Alzheimers Disease Dementia:Results of a Survey of the U.S.General Public.Health Commun,2018.33(3):p.264273.34.Lawlor,B.,The local and global imperative to raise public awareness and knowledge about dementia.Arq Neuropsiquiatr,2018.76(11):p.729730.35.Herrmann,L.K.,et al.,A new curriculum to address dementia-related stigma:Preliminary experience with Alzheimers Association staff.Dementia(London),2019.18(78):p.26092619.36.Kim,S.,et al.,Dementia Stigma Reduction(DESeRvE):Study protocol for a randomized controlled trial of an online intervention program to reduce dementia-related public stigma.Contemporary Clinical Trials Communications,2019.14:p.100351.37.Alipour Chermahini,M.,et al.,The Impacts of an Educational Program by Using Group Discussion on Perceived Stigma Among the Family Caregivers of People with Alzheimers Disease.Jundishapur Journal of Chronic Disease Care,2021.10(3).38.Reynolds,L.,et al.,The stigma attached isnt true of real life:Challenging public perception of dementia through a participatory approach involving people with dementia(Innovative Practice).Dementia,2017.16(2):p.219225.39.Kontos,P.,et al.,Projecting a Critique of Stigma Associated With Dementia on Screen:The Impact of a Canadian Film on the Importance of Relational Caring in the Community.Gerontologist,2024.64(2).40.Tenzek,K.E.,et al.,Staying connected:Alzheimers hashtags and opportunities for engagement and overcoming stigma.Journal of Aging Studies,2023.66.41.Phillipson,L.,et al.,Involvement of people with dementia in raising awareness and changing attitudes in a dementia friendly community pilot project.Dementia(London),2019.18(78):p.26792694.42.Hossain,M.Z.and F.Mughal,Dementia and revivalist Islam:New perspectives to understanding dementia and tackling stigma.J Eval Clin Pract,2021.27(2):p.213217.20 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Chapter 2:Attitudes to dementia survey resultsA father and son in the village of Monjolos,in northeastern Brazil in 2015(Domenico Pugliese)cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 21ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Dr Sara Evans-Lacko1,Elisa Aguzzoli1,Dr Sanna Read1,Adelina Comas-Herrera1,Dr Nicolas Farina21Care Policy and Evaluation Centre,London School of Economics and Political Science2Peninsula Medical School,University of Plymouth1 BackgroundAddressing the stigma associated with dementia is a global challenge given its profound impact on individuals,families,and societies around the world.Dementia-related stigma exacerbates the challenges faced by those living with the condition and obstructs efforts to provide care and support.Stigma,manifesting in various forms internalised or self,public,and structural(See Table 1)imposes significant barriers to the wellbeing of people with dementia and their carers.The different aspects of stigma are discussed more in depth in Jess Young et als essay in Chapter 1.At the individual level,stigma undermines life goals,diminishes participation in meaningful activities,and deteriorates quality of life.People with dementia often internalise societal stereotypes,leading to self-stigma,which can manifest as shame,social withdrawal,and secrecy.This internalised stigma can be as debilitating as the symptoms of dementia itself,further isolating individuals and preventing them from seeking help and support.Public stigma can also extend to carers,who may also face stigma by association.Stigma can also influence public policy and the allocation of resources for dementia care.Negative perceptions and widespread misinformation about dementia contribute to a lack of funding for essential services and support systems.This underinvestment exacerbates existing inequalities,leaving individuals with dementia and their carers without the necessary resources to manage the condition effectively.Consequently,societal stigma perpetuates a cycle of neglect and inadequate care,exacerbating the challenges faced by individuals with dementia and their families.Table 1.Definitions and examples of different types of dementia-related stigmaType of stigmaDefinitionExamplePublic stigmaThe reaction that the general public has towards people with dementia,often characterised by negative stereotypes,prejudice,and discrimination.“People with dementia are like children,incapable of making decisions.”“People with dementia are like the living dead.”Internalised or self-stigmaWhen individuals with dementia internalise societal stereotypes and turn them against themselves,resulting in feelings of shame,reduced self-esteem,and social withdrawal.“I have dementia so I can no longer contribute meaningfully to my family or community.”“Because of my dementia,I avoid social events to avoid embarrassment.”Structural stigmaSystemic policies,practices,and regulations that disadvantage people with dementia.This includes institutionalising discrimination and perpetuating inequality.Insurance policies that exclude coverage for dementia care.Nursing homes refusing to admit individuals with dementia due to additional care requirements.Affiliate stigmaThe stigma experienced by carers and family members of individuals with dementia.This occurs when they internalise public stigma and face discrimination or social exclusion due to their association with someone who has dementia.This can lead to feelings of guilt,shame,and social isolation among carers.“People stopped inviting us over to their house after they found out about my family members dementia.”“I feel embarrassed to talk about my spouses dementia with my friends.People avoid inviting us over.”22 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 202411 Changes since the 2019 report and the current landscapeThe 2019 World Alzheimers Report represented the first and largest global survey on dementia stigma.The 2019 survey findings provided a detailed description of the nature of dementia-related stigma,how it is experienced by people living with dementia,and its detrimental impacts across diverse contexts.Much has changed since the publication of the 2019 report.The COVID-19 pandemic,in particular,has amplified existing structural discrimination and highlighted the need for more robust support systems.The pandemic has strained healthcare resources,making it even more challenging for people with dementia to access essential care and support.Geopolitical conflicts,economic crises,and the ongoing impact of climate change have created regional pockets devoid of basic services and patchy access to dementia medications.Despite these challenges,there have been notable advancements.The Global action plan on the public health response to dementia,launched by the World Health Organization in 2017,has inspired a number of countries to devise national dementia plans that enhance the quality of life of individuals living with dementia and their carers by improving access to diagnosis,treatment,and support services.While the Global action plan has so far fallen short of its set ambitions,it remains a powerful tool,which has led ADI to advocate for its extension past its scheduled 2025 end date.The 2024 surveys aim was to capture the current global knowledge,attitudes,and behaviours towards dementia-related stigma,comparing these findings with those from 2019.This report seeks to understand the changes in dementia stigma over the past five years and to explore how these insights can inform effective strategies to reduce stigma globally.Emphasising the theme of change,this report highlights initiatives and progress in combating dementia stigma,including case studies and examples of stigma reduction efforts.These initiatives,together with the findings from our survey,can highlight areas that need more attention and provide examples of tools to enact change.We must collectively seek to create environments where people with dementia and their carers can live meaningful,inclusive,and stigma-free lives.By addressing stigma at multiple levels,we strive to foster a more equitable and supportive society for those affected by dementia.This requires a concerted effort to challenge societal norms,implement inclusive policies,and provide support systems that enable the wellbeing of people with dementia and their carers.Through collaborative efforts,we can dismantle the barriers imposed by stigma and work towards a future where every individual affected by dementia can experience dignity,respect,and inclusion.“We must collectively seek to create environments where people with dementia and their carers can live meaningful,inclusive,and stigma-free lives.”cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 23ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024In the 2019 World Alzheimer Report,we explored the issue of stigma across three key areas that contribute to it:1)knowledge(problems of ignorance and misinformation),2)attitudes(problems of prejudice),and 3)behaviour(problems of discrimination).1 These issues are interlinked and influence one another in complex ways.We repeat the exercise here,but through the lens of how these have changed since 2019.Building on this theme,we first present survey findings regarding stigma-related knowledge.For our comparisons,we group countries according to World Bank income groups,allowing us to capture differences and similarities across countries with similar levels of resources and economic development.Additional comparisons between countries are included in the appendices at the end of this chapter.Detailed information about our sample and the methods we used for comparisons over time are included in Section 7 on methodology.21 Changes in stigma-related knowledge about dementiaThe vast majority of general public respondents(96 to 97pending on World Bank income group)believe in the value of a medical diagnosis(Figure 1)and that there are things we can do to improve the lives of people with dementia,and this is relatively consistent across countries and seemed to remain relatively stable between 2019 and 2024(Figure 2).There is also a high agreement that social support can help improve the lives of people with dementia,though agreement decreased in low-/lower-middle income countries and increased in high-income countries between 2019 and 2024(Figure 3).However,between 24%and 37%of survey respondents still think that there is nothing we can do to prevent dementia(Figure 4).This belief increased across all country income groups between 2019 and 2024,with a particularly significant rise in low-/lower-middle income countries,where it increased from 20%to 37%.This suggests a growing gap in awareness of dementia risk reduction,potentially leading to missed opportunities for prevention in lower-income settings.Figure 1.Percentage of the general public agreeing with the statement Its useful to receive a formal diagnosis by World Bank country income group in 2019 and 202402040608010020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries94%2 Comparative analysis:2019 vs 202424 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 2.Percentage of the general public agreeing with the statement There are things we can do to improve the lives of the people with dementia by World Bank country income group in 2019 and 202402040608010020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries95%Figure 3.Percentage of the general public agreeing with the statement A person with dementias situation is likely to improve with social support by World Bank country income group in 2019 and 202402040608010020242019High-income countriesUpper-middle income countriesLow-/Lower-middleincome countries92%cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 25ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 4.Percentage of the general public agreeing with the statement There is nothing we can do to prevent dementia by World Bank country income group in 2019 and 2024051015202530354020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries20 $7%Public perceptions about the causes of dementiaCausal attributions how people explain the causes of dementia play a crucial role in shaping public attitudes,behaviours,and policy responses.Understanding these perceptions can help us identify areas where misinformation may be influencing the stigma surrounding dementia.In this section,we explore public beliefs about the causes of dementia,including views on whether it is attributed to bad luck(Figure 5),an unhealthy lifestyle(Figure 6),lack of family support(Figure 7),or simply a normal part of ageing(Figure 8 and 9).In terms of a fatalistic view that dementia is caused by bad luck,perceptions remained relatively stable in low-/lower-middle income countries.In high-income countries,however,fewer people agreed that dementia was caused by bad luck in 2024 compared to 2019(27%to 23%).Conversely,in upper-middle income countries,agreement increased from 11%in 2019 to 17%in 2024.In 2024,more people in high-income countries believed that dementia was caused by an unhealthy lifestyle(61%vs 51%),suggesting that messaging around risk reduction is gaining traction.However,this belief remained relatively stable in upper-middle income countries and decreased in low-/lower-middle income countries(78%to 58%).The increase in agreement that dementia is caused by a lack of family support suggests a growing tendency to place responsibility for dementia on the social environment,particularly families.This could reflect a cultural shift towards moral or social attributions,where the family is viewed as failing in their duty of care,or reflect societal norms where the role of the family in caregiving is becoming more pronounced.In relation to stigma,this view can lead to blame and guilt directed at carers and families,contributing to family members internalising feelings of shame(Figure 7).26 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 5.Percentage of the general public agreeing with the statement Dementia is caused due to bad luck by World Bank country income group in 2019 and 2024Figure 6.Percentage of the general public agreeing with the statement Dementia is caused due to unhealthy lifestyle by World Bank country income group in 2019 and 202405101520253020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries26#&02030405060708020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries78YQabX%cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 27ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 7.Percentage of the general public agreeing with the statement Dementia is caused due to lack of family support by World Bank country income group in 2019 and 2024Dementia as a normal part of ageing?The view that dementia is a normal part of ageing can hinder recognition that there is something wrong,discourage people from seeking a diagnosis,and ultimately inhibit the types of support and treatment received.In the 2019 report,we found that this misconception was widespread internationally.In this report,we see that this view has become even more prevalent across most income groups and participant categories(Figure 8).The most notable increase was among people living with dementia in high-income countries(from 63%to 74%)and low-/lower-middle income countries(from 74%to 84%).Perhaps more concerningly,in 2024,the proportion of health and care professionals who agreed with this misconception ranged from 62%to 68%.This compares with a broader range of 53%to 78%in 2019.This misperception is more common in low-/lower-middle income countries compared to upper-middle income and high-income countries.For example,84%of people with dementia in low-/lower-middle income countries felt that it was likely dementia was a normal part of ageing,compared to 74%of those in high-income countries.However,an exception to this trend was observed among health and care professionals in low-/lower-middle income countries,where the belief that dementia is a normal part of ageing decreased from 78%in 2019 to 68%in 2024.Despite this decline,the overall perception remained strong across regions,highlighting ongoing challenges in addressing this misconception.The continued prevalence of this belief among health and care professionals is concerning,as it could significantly impact the diagnosis,treatment,and support provided to people living with dementia.010203040506020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries575 CCF( cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 8.Agreeing with the statement Dementia is a normal part of ageing,%very or somewhat likely by World Bank country income group in 2024Figure 9.Agreeing with the statement Dementia is a normal part of ageing,%very or somewhat likely by World Bank country income group in 201922 Changes in stigma-related attitudesThere were some changes in stigma-related attitudes around perceptions between 2019 and 2024,though the patterns differed by item and according to country income groups(See Figures 10-12).Dementia does not affect everyone in the same way,but it is a progressive condition,which means that the symptoms can be relatively mild at first and people can continue to lead a relatively normal life,but this will change over time.It is important to note that in lower-and middle-income countries,people with dementia are likely to be diagnosed when they are at more advanced stages of dementia and this may affect the perception people have of the capabilities of people with dementia.020406080100High-income countriesUpper-middleincome countriesLow-/lower-middleincome countries84htbyqteyq%General publicHealth and careprofessionalsCaregiversPeople with dementia0102030405060708090100High-income countriesUpper-middleincome countriesLow-/lower-middleincome countries74xydqSracap%General publicHealth and careprofessionalsCaregiversPeople with dementiacHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 29ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Family responsibilities:z In 2024,between 60%and 69%of the general public believed it was important to remove family responsibilities from people with dementia to avoid stressing them.z There was an increase in people who agreed with this statement from 2019 to 2024 in upper-middle income and low-/lower-middle income countries.Figure 10.Percentage of the general public agreeing with the statement It is important to remove family responsibilities from people with dementia so as not to stress them by World Bank country income group in 2019 and 2024Dangerousness:z In 2024,between 29%and 32%of the general public felt that people with dementia were dangerous more often than not.z There was an increase in agreement from 2019 to 2024 in high-income countries from 16%to 29%.Figure 11.Percentage of the general public agreeing with the statement People with dementia are dangerous more often than not by World Bank country income group in 2019 and 20240102030405060708020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries45Uaci10152025303520242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries310)020 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Impulsivity and unpredictability:z In 2024,between 64%and 71%of the general public perceived people with dementia as impulsive and unpredictable.z There was an increase in agreement with this statement from 2019 to 2024 in upper-middle income countries from 63%to 73%.Figure 12.Percentage of the general public agreeing with the statement A person living with dementia is impulsive and unpredictable by World Bank country income group in 2019 and 20242.2.1 General public perceptions of personal risk of developing dementiaHere,we explore public and personal perceptions of the risk of developing dementia,dementia treatment(See Figures 1316),and discuss how these may be linked with hopes for a cure and the reality of treatment limitations across contexts and cultures.z In 2024,the vast majority of respondents across all income groups acknowledged the likelihood of developing dementia and expressed concern about it.Across country income groups,there was also strong interest in genetic profiling,2 with between 8089%of respondents indicating a willingness to take a genetic test,reflecting both a desire for proactive health management and a fear of the unknown.However,it raises important considerations about the publics understanding of the limitations of genetic testing namely,that there isnt a conclusive genetic test to determine whether someone will develop dementia.Additionally,there could be potential implications of such testing,including how insurance companies might use this information to raise premiums.z In 2024,high-income countries showed higher perceived likelihood of developing dementia(89%)compared to lower-income countries(79%).This was a slight decrease since 2019.0102030405060708020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries69ccdsq%cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 31ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 13.Percentage of the general public agreeing with the statement I would take a genetic profiling test to learn whether I am at risk of developing dementia by World Bank country income group in 2019 and 2024Figure 14.Percentage of the general public agreeing with the statement I am concerned about developing dementia at some point in my lifetime by World Bank country income group in 2019 and 202402040608010020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries88t02030405060708020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries78xwxs2 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 15.Percentage of the general public agreeing with the statement I could develop dementia at some point in my lifetime by World Bank country income group in 2019 and 2024In 2024,we introduced an additional item assessing peoples willingness to seek a diagnosis if a treatment that could prevent or slow the progression of dementia was available.z Among carers and the general public,more than 90%of respondents said they would be encouraged to get a diagnosis if such a treatment was available.z Among health and care professionals,91%,89%,and 92%of respondents from high-income,upper-middle income and low-/lower-middle income countries,respectively,expressed a willingness to seek a diagnosis.Figure 16.Agreeing with the statement If I knew there was a medicine or treatment that could prevent or slow the progression of dementia,it would encourage me to get a diagnosis by World Bank country income and respondent group in 202402040608010020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries84y0406080100High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries95%General publicHealth and care professionalsCaregiverscHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 33ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024The second question assessed the willingness of health care professionals to give a diagnosis if there was a treatment that could prevent or slow the progression of dementia.Across all World Bank country income groups,health and care professionals indicated that access to such a treatment would encourage them to provide a diagnosis,with percentages ranging between 85%in low-/lower-middle income countries to 90%in high-income countries.Figure 17.If I knew there was a medicine or treatment that could prevent or slow the progression of dementia,it would encourage me to give a diagnosis(%,agree)2.2.2 Attitudes towards moving a family member with dementia to a care home even if they didnt want to go z In 2024,a larger proportion of respondents across all income groups expressed a belief that moving a family member with dementia to a care home,even against their wishes,would be the best option.z There was a substantial increase among low-/lower-middle income respondents,with the belief that care homes would be the best option,with the percentage rising from 9%in 2019 to 33%in 2024 and this despite the fact that a majority of low-/lower-middle income countries do not have a strong care home sector.Upper-middle income country respondents increased from 15%to 27%and high-income country respondents increased from 25%to 29%.020406080100Healthcare professionals High-income countries Upper-middleincome countriesLow-/lower-middleincome countries 854 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 18.Percentage of the general public agreeing with the statement If I had a family member with dementia it would be best to move them to a care home even if they didnt want to go by World Bank country income group in 2019 and 202423 General public changes in stigma-related behaviourUnderstanding stigma-related behaviour is essential to fully grasp the impact of stigma on the lived experiences of people with dementia and their carers.These behaviours,which stem from public and structural stigma,can manifest as discriminatory actions that undermine the autonomy,dignity,and wellbeing of those affected by dementia.By examining these behaviours,we can gain insight into the real-world impact of stigma and identify strategies to reduce its harmful effects.In this section,we first explore the behaviours of the general public,as they significantly influence societal norms and attitudes.We then examine the actions of health and care professionals,whose professional conduct plays a key role in shaping the care environment for people with dementia.Finally,we focus on the experiences of people with dementia and their carers,highlighting the discrimination they face as a result of stigmatising behaviours and ensuring their voices are at the forefront of our discussion.2.3.1 Secrecy and concealment of dementia among the general public z The vast majority of people would not feel embarrassed when going out with a person with dementia.There were no differences between 2019 and 2024 in terms of the general public reporting feeling embarrassed when going out with a person with dementia.Agreement remained low and stable at between 6%and 10%in 2024.0510152025303520242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries9%)3%cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 35ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 19.Percentage of the general public agreeing with the statement Feel embarrassed going out in public with relative or friend with dementia by World Bank country income group in 2019 and 2024 z Compared to 2019,in high-income countries,there was a decrease in the proportion of general public respondents feeling comfortable spending an afternoon with someone with dementia.In 2019,82%of people were comfortable to spend an afternoon with a person with dementia,compared to 74%in 2024.Figure 20.Percentage of the general public agreeing with the statement Feel comfortable to spend an afternoon with someone who has dementia by World Bank country income group in 2019 and 2024024681020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries9%8%5%6%7040608010020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries71styt6 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024 z Among the general public,in low-/lower-middle income countries,there was also an increase among the general public in willingness to keep their dementia a secret from the doctor,rising from 4%in 2019 to 16%in 2024.While still low,this indicates a growing tendency to conceal dementia when consulting health and care professionals.Figure 21.Percentage of the general public agreeing with the statement I would keep my dementia a secret from the doctor by World Bank country income group in 2019 and 2024 z In low-/lower-middle income countries,the general public was more willing to keep their dementia a secret when meeting people in 2024(36%)compared to 2019(19%).Figure 22.Percentage of the general public agreeing with the statement If I had dementia,I would make an effort to keep my dementia a secret when meeting people by World Bank country income group in 2019 and 20240510152020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries4%3%3%6%71015202530354020242019High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries19 $ 6%cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 37ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 20242.3.2 Secrecy among health and care professionals z Fewer health and care professionals said they would hide their dementia when meeting people compared to the general public.z Among health and care professionals in upper-middle income countries,people were less inclined to hide their dementia compared to 2019.Table 2.Changes in agreement with the statement If I had dementia,I would make an effort to keep my dementia a secret when meeting people among health and care professionals%by World Bank country income group in 2019 and 2024Health and care professionals 20192024AgreeAgreeHigher-income1616Upper-middle income 1910Low-/Lower-middle income 11132.3.3 Changes in experiences of discrimination and unfair treatment due to ones dementiaWe asked people living with dementia to indicate whether they had experienced any form of discrimination across 14 life areas,ranging from making/keeping friends to being avoided or shunned(see Table 3).From 2019 to 2024,there was a significant increase in the percentage of people with dementia reporting discrimination in all 14 life areas.The largest increases were observed in making or keeping friends,dating and intimate relationships,and having rights or responsibilities unfairly taken away.The overall percentage of individuals experiencing discrimination in at least one area also increased significantly from 83%to 88%.38 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Table 3.Changes3 in experienced discriminationa reported by people living with dementia between 2019 and 2024,overall and by life area(%reporting discrimination)2019 2024 Direction of change p-valuebMaking or keeping friends 37.7 53.8*Increased0.001Treatment whilst dating and intimate relationships 24.7 53.7*Increased0.001Housing 9.3 18.0*Increased0.001Treatment by children/family members 28.3 37.7*Increased0.001Rights or responsibilities unfairly taken away 23.9 36.6*Increased0.001Denied a choice to do something 42.5 59.7*Increased0.001Social life 26.7 33.2 Increased0.0140Not taking your opinions seriously 50.2 65.5*Increased0.001Jokes about your dementia symptoms 32.8 44.2*Increased0.001Levels of privacy 13.5 19.9*Increased0.0029Personal safety and security 13.3 18.2 Increased0.0179Treatment by health or medical staff 18.6 24.5 Increased0.0121People doing things for you 51.3 57.7 Increased0.0274Avoided or shunned 29.1 40.7*Increased0.001Experienced discrimination in at least one area 82.8 87.6Increased0.0196a Includes responses A lot/moderately/a littleb p-values indicate the likelihood that the observed changes occurred by chance.Lower p-values indicate stronger evidence that the changes are real and not due to random variation.A p-value of 0.05 is considered statistically significant suggesting there is less than a 5%probability that the result is due to chance.A p-value of 85They make me feel that Im incapable of remembering anything.Female,Bahamas,5665They hardly ever believe what I am telling them.Female,South Africa,5665They sometimes make jokes,I feel belittled.Female,South Africa,5665Experienced discrimination in health and care settingsPeople with dementia also reported some common experiences of discrimination in health and care settings.z People with dementia reported feeling dismissed by doctors and health and care professionals.z People with dementia also feel that their symptoms are dismissed or minimised.44 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Table 7.Examples of experienced discrimination in healthcare settings among people with dementiaThe attending doctor was insensitive to my concerns and brushed it off with a hurting remark I dont see there is a problem with your language.Female,Singapore,5665Does a doctor telling me that I am too young to have dementia count?I have Lewy Body.I have good days and bad days.On good days,medical staff treat me like I am making it up.On bad days,some doctors dont allow me to be part of the conversation,talking at me rather than with me.Male,USA,5665When the doctor talks to my husband about me and I being together,without taking into account my presence.Female,Brazil,7685They may just nod their heads,but really dont believe a word of it.Unless I have a printed official document!Male,New Zealand,7685In the healthcare arena,nurses and doctors speaking to my daughter,not me or,comments like youre too young,you havent got it.Female,UK,5665Some doctors or health and care providers dont know how to interact with people with Alzheimers.Female,Ecuador,5665Anticipated discrimination among caregivers of people living with dementia z Carers want to prevent people living with dementia from being mistreated and experiencing unfair treatment by others z Carers are worried about others making fun of or disrespecting the person living with dementia because of their behaviours z Carers think that lack of understanding from others is a key factor,which drives them to not participate in social activities nor go to public places with people with dementiaExamples of anticipated discrimination among people with dementia z People living with dementia feel that people keep their distance from them,they are talked to differently,and they feel like they are not trusted by others in the way they used to be z People living with dementia express that other family members think less of them and for this reason,they prefer to exclude themselvescHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 45ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Table 8.Examples of anticipated discrimination reported by caregivers and people living with dementiaI dont make her participate because she often says things that make me feel very uncomfortable and I think others do too.Carer,Female,Argentina,6675Above all,I am ashamed in advance.Few people even in my family put up with my mothers possible behaviour.Carer,Female,France,4655I knew they dont understand and dont include my mother so I prefer to not go sometimes.Carer,Male,Zimbabwe,4655I am embarrassed or uncomfortable that my mother is present in social situations.Carer,Female,Argentina,3645There are still many people who do not understand dementia,especially at a young age.My husband does not want to be treated and spoken to as if he were a child.It is quieter to just stay at home.Carer,Female,Netherlands,5665Because my wifes ability to do some things has decreased,I prefer not to participate in these gatherings so that she will not be humiliated.Carer,Male,Iran,5665Im not sure“unfairly”describes my experience.I feel a wariness,a tendency to keep me at arms length.Person living with dementia,Female,USA,7685If we express that we cant remember.Other people will have unusual reactions,so we have to try to say little and conceal that we dont remember.Person living with dementia,Female,Thailand,364546 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 202441 Life satisfaction z Overall,a larger proportion of health and care professionals(68%)and general public(69%)reported being satisfied with life every day or almost every day,compared with people living with dementia(46%)and caregivers(43%).z Importantly,9%of people living with dementia and 11%of caregivers did not feel satisfied with life at any point in the past month,compared with 3%among health and care professionals and 4%of the general public.z Daily or almost daily satisfaction with life was most frequently reported by health and care professionals in upper-middle income countries(76%)and the general public in high-income countries(71%).The lowest proportions of daily or almost-daily life satisfaction were among people living with dementia in upper-middle and low-/lower-middle income countries(30%and 31%,respectively).z Among caregivers,those in upper-middle income countries reported the highest proportion of daily or almost daily life satisfaction(54%),compared with 38%in low-/lower-middle income and 40%in high-income countries.Notably,12%of people with dementia and 18%of carers in low-/lower-middle income countries reported not feeling satisfied with life at any point in the past month.Figure 24.Life satisfaction(%)by participant group.4 Impacts of stigma on life satisfaction,loneliness,and quality of life01020304050NeverOnce or twice a monthAbout once a weekAbout 2 or 3 timesa weekAlmost every dayEvery day12&23(C71!%9%7%5%5%6%7%9%31.53%4%General publicHealth and careprofessionalsCaregiversPeople living withdementiacHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 47ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 25.Satisfied with life every day or almost every day(%)by World Bank country income group.42 Loneliness4 z We found that carers(mean=6,standard deviation=2.02)and people living with dementia(mean=5.1,standard deviation=1.86)tended to report higher levels of loneliness compared to health and care professionals(mean=4.3,standard deviation=1.69)and the general public5(mean=4.1,standard deviation=1.62).z There was some variability between countries in terms of loneliness score,though there did not appear to be a clear pattern(e.g.,loneliness scores were not consistently higher in a given group).z Feelings of loneliness can be explained by a number of factors,outside of population grouping and geographic locale.Females tended to report being lonelier.This was true for females who were living with dementia,carers,and the general public.Among health and care professionals,males tended to report greater loneliness.In addition,individuals with more education(i.e.,attaining a university degree or higher)were less likely to be lonely across groups.01020304050607080Higher incomeUpper-middle incomeLow/Lower-middleincome31VU80viTThq%General publicHealth and careprofessionalsCaregiversPeople living withdementia48 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 26.Loneliness(UCLA Loneliness Scale)by World Bank country income group.43 Quality of life6 z Although overall people living with dementia(mean=3.4,standard deviation=0.81)and carers(mean=3.4,standard deviation=0.76)showed similar levels of quality of life7,carers in low-and middle-income countries reported higher quality of life compared to people living with dementia,whereas in higher-income countries the pattern was opposite.z Quality of life tended to be lower among people with dementia in low-/lower-middle income countries(mean=3.0,standard deviation=0.73),and highest in high-income countries(mean=3.5,standard deviation=0.81).A similar pattern was observed for carers,although the difference between upper-middle and higher-income countries was small.Figure 27.Quality of life in caregivers and people living with dementia by World Bank country income group.0.00.51.01.52.02.53.03.54.0CaregiverPerson living with dementiaHigh-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries33.13.53.43.43.1012345678Higher incomeUpper-middle incomeLow/Lower-middleincome5.45.156.36.24.74.45.54.943.95.4General publicHealth and careprofessionalsCaregiversPeople living withdementiacHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 49ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 202451 Perception that peoples attitude has changed since 2019 by participant group and World Bank country income groupOverall,around half of all respondents,across all the different groups,seemed to think that there was more awareness of dementia and that people were more supportive since 2019,with higher agreement among caregivers and health professionals in higher-income countries.People living with dementiaTable 9.Do you feel that in general peoples attitude towards dementia has changed in the last five years?(%agree by World Bank income groups)Yes,people are more aware and supportive of dementia than before Yes,people have less awareness and more negative attitudes about dementia than before No,peoples attitudes towards dementia have not changed much I dont know or I dont have an opinion Low-/Lower-middle income countries5671521Upper-middle income countries555319High-income countries5171923Total 5372021CaregiversTable 10.Do you feel that in general peoples attitude towards dementia has changed in the last five years?(%agree by World Bank income groups)Yes,people are more aware and supportive of dementia than before Yes,people have less awareness and more negative attitudes about dementia than before No,peoples attitudes towards dementia have not changed much I dont know or I dont have an opinion Low-/Lower-middle income countries45102719Upper-middle income countries5572315High-income countries6542012Total 60521135 Perceptions of change since 201950 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Health and care professionalsTable 11.Do you feel that in general peoples attitude towards dementia has changed in the last five years?(%agree by World Bank income groups)Yes,people are more aware and supportive of dementia than before Yes,people have less awareness and more negative attitudes about dementia than before No,peoples attitudes towards dementia have not changed much I dont know or I dont have an opinion Low-/Lower-middle income countries5152519Upper-middle income countries5510277High-income countries684226Total 645238General publicTable 12.Do you feel that in general peoples attitude towards dementia has changed in the last five years?(%agree by World Bank income groups)Yes,people are more aware and supportive of dementia than before Yes,people have less awareness and more negative attitudes about dementia than before No,peoples attitudes towards dementia have not changed much I dont know or I dont have an opinion Low-/Lower-middle income countries4772323Upper-middle income countries49112020High-income countries5652117Total 537211952 Participation and awareness of dementia related activities z Across all target groups and income levels,a significant proportion of respondents reported seeing dementia-related posts or articles on social media or news platforms.This awareness was relatively consistent in upper-middle and high-income countries,with 40%to 48%of people living with dementia,carers,and the general public reporting such exposure.Levels were lower(34%to 48%)in low-/lower-middle income countries.z Notably,health and care professionals tended to show higher levels of awareness than the other participant groups.The highest awareness was in high-income countries,with 52%of health and care professionals reporting seeing dementia-related posts or articles,compared to 44%of people with dementia,48%of carers,and 42%of the general public.z People living with dementia in high-income countries and carers and health and care professionals in high-income and upper-middle income countries had the highest levels of participation in activities to support or learn about dementia,with around one-third reporting participation.The general public in low-/lower-middle income countries had the lowest levels of participation(8%).z The general public reported the lowest levels of exposure to dementia-related activities.Almost half of those in low-/lower-middle income countries(46%)reported no exposure,followed by upper-middle income countries(35%)and high-income countries(31%).cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 51ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 28.Among people living with dementia are you aware of any dementia-related activities on social media,news,awareness campaigns?(%agree by World Bank income groups)Figure 29.Among carers are you aware of any dementia-related activities on social media,news,awareness campaigns?(%agree by World Bank income groups)01020304050High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries392A%9D2%Yes,I have seen some posts,articles,or events about dementia on social media,news or elsewhereYes,I have participated in some online or ofline activities to support or learn about dementiaNo,I have not seen or participated in any dementia-related activitiesI dont know or I dont remember01020304050High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries445%3H%33H%42%Yes,I have seen some posts,articles,or events about dementia on social media,news or elsewhereYes,I have participated in some online or ofline activities to support or learn about dementiaNo,I have not seen or participated in any dementia-related activitiesI dont know or I dont remember52 cHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTSALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 30.Among health and care professionals are you aware of any dementia-related activities on social media,news,awareness campaigns(%agree by World Bank income groups)Figure 31.Among the general public are you aware of any dementia-related activities on social media,news,awareness campaigns?(%agree by World Bank income groups)53 Confidence to challenge stigma and discrimination z Among the general public group,most respondents feel more confident to challenge stigma and discrimination than they did in 2019,especially in high-income countries(64%).z Health and care professionals living in high-income and upper-middle income countries and people living with dementia in upper-middle income countries tended to feel most confident relative to 2019(8082%),while only 36%of people living with dementia in low-/lower-middle income countries felt more confident.01020304050High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries34F%8A5B1%Yes,I have seen some posts,articles,or events about dementia on social media,news or elsewhereYes,I have participated in some online or ofline activities to support or learn about dementiaNo,I have not seen or participated in any dementia-related activitiesI dont know or I dont remember0102030405060High-income countriesUpper-middleincome countriesLow-/Lower-middleincome countries45%4)E%62R%52%Yes,I have seen some posts,articles,or events about dementia on social media,news or elsewhereYes,I have participated in some online or ofline activities to support or learn about dementiaNo,I have not seen or participated in any dementia-related activitiesI dont know or I dont remembercHAPTER 2:ATTITuDES TO DEMENTIA SuRvEy RESuLTS 53ALZHEIMERS DISEASE INTERNATIONAL|WORLD ALZHEIMER REPORT 2024Figure 32.Compared to five years ago,do you feel more confident now in challenging stigma and discrimination related to dementia when you see it?%responding Yes by World Bank country income group54 Perceptions that ones vote can change support for people living with dementiaAnother new question we introduced in the 2024 survey explored the perceived influence of ones own vote on the support provided to people living with dementia.Here we sought to understand the extent to which respondents believe that their vote can impact dementia care policies in their respective countries.The findings,presented in Figure 33,are analysed across different World Bank income groups to highlight variations in perceived electoral influence on dementia support.Interestingly,across all countries,more than 80%of the general public believes that they can change the support provided to people with dementia through their vote.It is encouraging to see such a high proportion of respondents believe they can influence dementia care through their vote.This suggests there is a strong foundation of civic engagement that can be harnessed to drive meaningful change.Figure 33.I feel that I can change the support provided to people living with dementia in my country through my vote,%responding Yes by World Bank country income group020406080100High-income countriesUpper-middleincome countriesLow-/Lower-m
2024-12-29
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