Neuroscientist and researcher Dr. Indira Turney discusses the urgent need for inclusive research, systemic change, and dismantling harmful biases for true brain health equity.
This article is part of the series Diversity & Dementia, produced by Being Patient with support provided by Eisai.
Caribbean neuroscientist Indira Turney’s research is centered on deepening our understanding of the disparities in brain health, particularly the race-related disparities that impact Black and brown communities. For Turney, her work is about “being able to realize that people in general have unique lifestyle experiences, and that affects their health,” she told Being Patient.
In particular, she is probing the impact of lifestyle factors on the brain, shedding light on a field still in its infancy.
“Everything that affects your health affects your brain, but I think, in general, it is understanding that we need more precise treatment for people’s health,” Turney said. “We should account for their race knowing that, especially within America, but in most societies, people’s race determines their life experience, which will determine how their health manifests.”
In her conversation with dementia activist and filmmaker Rianna Patterson for Being Patient, Turney highlighted the urgent need for inclusive research, systemic change, and dismantling harmful biases. Here’s what she had to say about the necessary steps to address brain health disparities effectively.
A new perspective on race and brain health
Turney’s work is rooted in understanding how lifestyle factors influence brain health, especially among marginalized communities.
Her focus on Black and brown individuals stems from a glaring gap in research: These communities have not received the attention they deserve in studies related to dementia and brain health.
Turney explained, “My work is part of that journey of dismantling these concepts of what it’s like to treat a person and understand a person’s health.” Because black and brown people haven’t been studied in dementia research, medical professionals and researchers need to take different approaches to evaluating symptoms.
“Understand that you have to incorporate, if a black person comes through, and they’re talking about I have memory problems,” she noted, that doctors should “maybe ask a few extra questions and account for different things that you may not throw with the white person and not just be like, ‘Oh, you’re fine, don’t worry about it.'”
Trial administrators, drug developers, and the scientific community have become increasingly vocal about the lack of racial minority representation in clinical trials, particularly for Alzheimer’s drugs. And with predominantly white, male trial enrollment for decades, progress toward understanding how to treat Alzheimer’s — or even what causes it — has been stunted.
Even after decades of research on Alzheimer’s disease, effective treatments or a cure remain elusive, primarily due to the omission of those most affected.
Changes to health care
Inequality in brain health care
This lack of diversity can lead to inadequate healthcare and medication for marginalized groups. One such example that Turney provided is the difference between depression medications for white people and people of color.
“My work is hopefully, over time, just discovering the precise measures for different groups of people so that we don’t have this one-pill-fits-all because we know, especially within medicine, almost nothing works for black and brown people,” she explained, “Like depression medication, you have to try five different ones versus your white counterpart, and they get prescribed today, and in two weeks, they feel better because the drugs work for them.”
Turney also noted that lack of diversity was particularly true just between men and women in studying the signs of a heart attack. Because white men were primarily studied in terms of the signs of a heart attack, for many years, medical professionals were unaware of the different signs in women.
“If that was the case, for just men and women who are included in these studies,” Turney stated, “Imagine what it’s like for black and brown people where they just don’t know what it’s like.”
The need for precise, individualized care
To combat the biases that exist in healthcare that prevent Black and Brown people from getting the treatment they need, Turney argues that doctors and researchers need to think about things on an individual level. Because so many factors impact a person’s overall health, she argues that medical professionals must focus on the complete picture of what can impact someone’s health.
“When I first used to talk about this, I was very naive in thinking like, ‘Oh, I’m gonna develop this thing that’s gonna prevent black and brown people from getting dementia as much as other groups,’” Turney explained, “But now, I think it’s realizing that it’s just exposing the unique lifestyle experiences and structural factors in society that’s affecting people’s brain health, and how we can avoid or prevent or still have to treat everyone equally so that they can have optimal health based on their lifestyle.”
To provide that care, Turney explained that doctors need to start by “just focusing on discovering the things that are unique and that we need to account for when we’re trying to treat people in general.” While she isn’t a doctor herself, she hopes that her research can help inform better care for marginalized populations in the future.
The role of healthcare policies
To address these disparities, Turney emphasizes the importance of healthcare policy changes. “The ultimate change has to happen on a system level and not the individual because there are many people out there trying their best,” she explained, “the system has to change, not just [in] healthcare.”
Until the current system is fundamentally changed, people of color will still not be able to get access to life-saving healthcare. That’s because, to provide the best standard of care, you need to understand the issues that impact health for the most marginalized.
“The system has to change, not just [in] healthcare.”
Turney explained that the history of slavery, inaccessible housing, inability to own property and businesses, and all of the policy decisions along the line have contributed to health issues in Black communities. Trying to approach care without policy changes and a “colorblind” lens doesn’t work “because there are just too many lifestyle differences. That is because of the system around us that people have to live in.”
Ultimately, for Turney, “the system needs to be burned down” so it can start anew to serve people of color better.
Breaking down biases
Turney underlines the significance of dismantling existing biases within the healthcare system. Stereotypes about pain tolerance, stress, or responses to treatment can lead to unequal care. She said these biases must be confronted and eradicated to provide equitable healthcare to all.
In particular, she noted how many more Black women die in childbirth in comparison to white women. “That’s just because these medical professionals are trained to only look for certain symptoms in white women, and they don’t realize [that] this Black woman is in pain.”
Learning to break down these biases and identify the different experiences people of color have through research can give doctors the tools to provide informed and more comprehensive care.
The Importance of supportive work environments
Beyond healthcare, changes should extend to the workplace. Supportive work environments can help marginalized individuals manage the stressors unique to their experiences.
Turney used the example of the decision to move office work remotely. While working remotely might be ideal for white people of a middle-class background, she asserts that you should,
“Understand that for Black or Brown person working at home [that] may not be the best option. Do they have a computer? Do they have a laptop? Do they have a quiet neighborhood? Do they have to figure out childcare? A lot of those things affect that person being able to work from home.”
You should “be aware of those things and [have] the right support for those people.” Recognizing the challenges Turney outlines that Black and brown employees may face and offering support can lead to a more equitable and inclusive workforce.
Reparation and equity
Turney discusses the concept of reparations as a means to address the systemic injustices that have disadvantaged Black communities.
“There’s trauma that has been passed on from generation to generation,” she explained, “and there’s a whole other world of neuroscience-related research that talks about post-traumatic slave syndrome and how that manifests within the body and the brain”
She asserts that “being able to not make up for things that happened 60 years before you were born, and then coming in, living into it, and then having to survive” would be life-changing for many Black people. For that reason, Turney believes in reparations to give people of color the foundation for better health.
Reparations are not limited to financial compensation but can extend to providing resources that empower individuals to access education, housing, and employment opportunities, leveling the playing field. Ultimately, with reparations and an understanding of the generational trauma, Turney believes that “general healthy living could have been afforded to everyone.”
Broader systemic change, better public health
In closing, Turney called for systemic change. This systemic change could improve healthcare for everyone.
“I think a lot of people think when you try to afford more opportunities and equal policies for other people, especially Black people,” Turney explained, “they think it means being taken away from white people, and not realizing that these opportunities have just never been provided to Black people.”
Ultimately, a healthcare system that looks at the individual, as well as the external factors that impact health, doctors, and researchers alike, will be able to treat Alzheimer’s disease and other dementias better.
“They think it means being taken away from white people, and not realizing that these opportunities have just never been provided to Black people”
Turney finds a system that is leaving large portions of the population out of its research is one that needs to be reconstructed. “Unless we dismantle the entire system unless we start over from scratch,” she explained, “there’s just inevitably going to be things that disproportionately affect black and brown people, and we need to account for those things.”
She said that waiting for gradual change while generations continue to face disparities is no longer acceptable.
“I don’t know [that] if, in my lifetime, we will actually have a cure for dementia necessarily, but my hope is that being able to study Black and brown people’s brains and the life factors that affect it, [will] give us more information,” Turney predicted, “so that maybe the next generation can be like, ‘Okay, here’s the time period where we need to intervene, whether it’s like 25 to 35, is that sweet spot.’ or knowing that, like, hypertension is most important for black people, while genetics are more important for white people so that we know how to [approach that.].”
For Turney, the time has come for society to acknowledge these disparities and work collaboratively to create a healthcare system that provides equitable care to all, regardless of race or background.
By including people of color in brain health research and focusing on how doctors can provide better individualized care, we can aim for a future where brain health disparities are a thing of the past and everyone has an equal opportunity to lead a healthy life.
Katy Koop is a writer and theater artist based in Raleigh, NC.