LAUSR

Brain health, defined as a life‐long dynamic state of cognitive, emotional, and motor domains, is underpinned by physiological processes and influenced by eco‐bio‐psycho‐social determinants, resulting in a continuum of quality of life and wellness. In this context, sex and gender are, among others, principal biological and social determinants of brain health, respectively. Their inequities can impact in a myriad of complex and multi‐layered ways. However, despite the growing interest in brain health, researchers and policymakers often overlook the differences between sexes and genders, which in turn translate into growing inequities. As members of the Sex and Gender differences in Brain Health and Aging interest group of the Global Brain Health Institute (GBHI), our primary goal is to address this gap and to foster global collaborations addressing these disparities. Sex and gender differences can be observed in several areas of brain health. They are noted in epidemiology, pathophysiology, clinical manifestations and progression, response to treatment, as well as in public health, social care and support and in community services. In Peru, the percentage of illiterate adult women (20.3%) is almost 4 times greater than their male counterparts, leading to a higher risk to dementia. We need to develop more customized disease prevention, and care strategies that recognize and address inequities in sex and gender, disadvantage and marginalization of transgender people, to identify and promote lifestyle factors that may protect brain health in these at‐risk populations. In research, the pronounced underrepresentation of women and non‐existent research on trans and non‐binary gendered individuals highlight those inequities. Therefore, it is urgent to identify areas where increased research is needed to better understand the role of sex, gender and gender identity to move towards precision medicine, and to promote overall health and well‐being. Sex and gender shape how brain health and aging are understood and experienced socially and culturally. Currently, prevention and research are rarely tailored to the specific needs due to the diversity in sociodemographic, cultural and environmental characteristics of populations. In Ghana, the task of a physically demanding and time‐consuming activity such as fetching water falls principally upon women. In Latina America, caregivers are mainly women, who often suffer from mood and anxiety disorders and some of them have lost their job. Ignoring these glaring disparities leads to a further failure in identifying and addressing sex‐ and gender‐specific determinants of brain health, an inability to reproduce results and correct conclusions, which may significantly vary between different countries and cultural contexts. Taken together, all these shortcomings impact how brain health is prioritized in policymaking and impede global progress. It is therefore critically important that global policies take a gender‐sensitive and gender‐transformative approach, seeking to identify and dismantle entrenched sex‐ and gender‐related disparities. It is time to create a space for multi‐stakeholder cooperation and joint learning, with local, national and international stakeholders. They would represent sectors of policy, research, education, health care and community services, and include individuals facing brain health challenges and their families, all as part of a Theory of Change (ToC) process. Theory of Change was developed as a theory‐driven evaluation approach that seeks to understand and make explicit how and why a program leads to a specific set of outcomes. Co‐developed with a varied group of participants to ensure that the proposed actions are relevant, feasible, acceptable and scalable, ToC is now considered as a powerful tool for strategy building, monitoring, evaluation and iterative learning. Our goals are (i) to facilitate the development of a cohesive vision for mainstreaming sex and gender‐sensitive approaches in prevention, policy, research, awareness and advocacy, health care, social care and community services, (ii) to define a common set of objectives for promoting equity at a global scale, (iii) to develop a shared understanding of the pathways towards achieving these objectives and a blueprint for tracking progress (Figure 1). In conclusion, the collective success of bridging the pathways of ToC into a global collaboration focused on sex and gender equity could have a key role in address the existing gaps in brain health. This effort will add to other current global initiatives emphasizing the need to generate and promote new areas of research and implement new policies that align with the idea of sex and gender equity in brain health worldwide.