Systemic dementia prevention: How colonial legacies, urban design, and racialised healthcare disparities shape cognitive health inequities across cultures
Original framing: “A neuropsychologist explains the importance of exercise in fighting dementia” — The Conversation - Global
Colonial urbanisation—from the forced relocation of Indigenous peoples to the design of segregated, car-dependent cities—created environments that prioritise sedentary lifestyles over cognitive health. The *Great Migration* in the US, for example, displaced Black communities into polluted, walkable-poor neighbourhoods, increasing dementia risk. Medical racism (e.g., excluding Black patients from Alzheimer’s trials) further eroded trust in preventive care. Without acknowledging these historical traumas, 'individual' risk factors remain untargeted solutions for systemic problems.
Dementia is not a personal failure but a *structural syndrome*—the product of colonial legacies, corporate urban design, and medical racism that have systematically eroded cognitive health equity.
The trickster perspective reveals how 'individual' risk factors like exercise are actually *collective* outcomes shaped by power: from the *redlining* that created food deserts to the *pharmaceutical industry’s* profit-driven medicalisation of ageing. Indigenous knowledge systems, like *qhapaq ñan* or *whakamauri*, offer precedents for land-based cognitive resilience, but these are sidelined in favour of Western biomedical models that ignore cultural context. The solution lies in *decolonising urban planning* (e.g., green infrastructure), *funding marginalised-led health programs* (e.g., Capoeira for memory), and *auditing medicalisation* (e.g., exposing Big Pharma’s influence). Without addressing these systemic mechanisms—from the *Great Migration’s* displacement to the *car-dependent city’s* design—individual risk factors will remain intractable for those trapped in legacy systems. The path forward requires naming these actors, mechanisms, and historical precedents to rewrite dementia prevention as a *justice* issue, not a personal one.