Dementia prevention requires systemic change beyond individual lifestyle choices

Fifty-seven million people around the world are living with dementia right now. By 2050, that number is expected to nearly triple to 139 million. Those figures sit at the center of a growing argument among researchers about how we actually prevent the disease—and the argument hinges on a fundamental question: whose responsibility is it?

Curtin University researchers have just published findings in The Lancet Public Health that challenge the dominant framing of dementia prevention. For years, the public health conversation has centered on what individuals can do—exercise more, eat better, stay mentally active, maintain social ties. These things matter. But the research examined 61 potentially modifiable risk and protective factors for dementia and found that prevention strategies built almost entirely around personal behavior miss something crucial: many of the conditions that shape whether someone develops dementia are not actually within an individual's control.

Consider the landscape. A person's education level influences their cognitive reserve and their lifetime risk of dementia. So does where they live—whether their neighbourhood is safe enough to walk in, whether it has parks and community spaces, whether the air is clean. Access to healthcare, the quality of that healthcare, the presence of meaningful social connections, housing stability—all of these affect brain health across a lifetime. These are not lifestyle choices in the way we typically use that phrase. They are circumstances, often determined by economics, geography, policy, and accident of birth.

The researchers found that prevention efforts have historically concentrated on individual motivation and behaviour change. Public health campaigns tell people what they should do. But this approach carries an implicit burden: if you develop dementia, it suggests you did not do enough. It places the weight of prevention on the person, even when the actual determinants of their risk lie in systems and structures far beyond their reach.

The scale of the problem makes this reframing urgent. Fifty-seven million people living with dementia today represents an enormous human and economic cost. The projected rise to 139 million within the next quarter-century means the question of prevention strategy is not academic—it will shape policy, funding, and the lived experience of hundreds of millions of people and their families.

What the Curtin research is calling for is a shift in how we think about prevention altogether. Instead of asking individuals to optimize their behaviour within whatever circumstances they find themselves in, the research suggests asking what systemic changes would actually reduce dementia risk across populations. That means looking at education policy, urban planning, environmental regulation, healthcare access, and the social infrastructure that allows people to build and maintain connection. It means recognizing that brain health is not primarily a personal achievement but a public health outcome shaped by the conditions in which people live.

This is not an argument against individual action. It is an argument that individual action alone cannot solve a problem that is fundamentally structural. The research opens a door to a different kind of conversation—one where dementia prevention becomes a question not just for individuals and their doctors, but for policymakers, urban planners, and anyone involved in shaping the conditions of daily life.