Introduction by Croakey: Australians who turned 50 during the year from July 2025 subsequently received a letter from the Federal Government with tips for reducing their dementia risk.
“Turning 50 is a good time to think about your future, and how you can stay healthier for longer,” the letter says. “This includes your brain health and reducing your risk of dementia.”
However, prevention campaigns focused on individual behaviour like this can have unintended, negative consequences, while neglecting the wider factors shaping peoples’ capacity to be healthy, according to Curtin University researchers Dr Jennifer Dunne and Professor Blossom Stephan.
“Australia’s growing dementia case numbers will not be addressed through individual behaviour change alone,” they write below. “Protecting brain health should be a shared national responsibility, supported not only by the choices people make, but by the choices governments and institutions make on their behalf.”
Jennifer Dunne and Blossom Stephan write:
More than 446,000 Australians are estimated to be living with dementia in 2026. Without effective prevention, that number is projected to exceed one million by 2066.
In July, the Australian Government sent a letter about dementia risk to people who had turned 50 during the previous financial year. It encouraged them to stay active, eat well, have their hearing and vision checked, look after their heart and mental health, manage diabetes, avoid smoking, limit alcohol, remain socially connected and keep their brains active.
The letter represents an important shift. It tells Australians that dementia is not necessarily an inevitable consequence of ageing and that opportunities to protect brain health begin well before old age.
But how much responsibility for dementia prevention should rest with individuals?
Providing information is important. It is not, by itself, a national prevention strategy.
New research
In research recently published in The Lancet Public Health, we mapped potentially modifiable factors associated with dementia across a socio-ecological framework, from individual characteristics and behaviours to relationships, communities and wider societal conditions.
We identified 61 potentially modifiable risk and protective factors. Around 80 percent were positioned at the individual level. Far fewer concerned people’s relationships, communities or broader social and policy environments.
Much more is known about individual behaviours and clinical characteristics associated with dementia risk than the conditions that shape exposure to those risks or people’s ability to reduce them.
Telling someone to be physically active is sound advice. Acting on it is easier when neighbourhoods are safe and walkable and people have the time, mobility and resources to participate.
Encouraging social connection matters. But connection can depend on affordable transport, inclusive community spaces and opportunities for participation, particularly for people living alone, with disability or mobility limitations, those who have stopped driving, or those in rural and remote areas.
Managing hypertension, high cholesterol, diabetes, depression, hearing loss or vision problems depends on affordable and timely access to healthcare and services.
A risk factor may be “modifiable” in principle, but that does not mean everyone has an equal opportunity to act on it.
Equity matters
Income, education, housing, employment, geography, culture, access to services and air pollution all influence dementia risk and the capacity to respond.
A personalised risk score may identify areas for action, but it cannot provide an affordable hearing aid, create a bulk-billing appointment, bring healthcare closer to a remote community, ensure clean air or build safe places to exercise.
Prevention campaigns focused primarily on individual behaviour can unintentionally widen health inequities. People with greater resources are often better positioned to act on health advice.
There is also a risk of blame. Dementia is not caused simply by poor choices. Age, genetics and other non-modifiable factors remain important, and a person may do everything recommended and still develop dementia.
Prevention messages should offer hope without implying personal responsibility for the disease.
Australia already has a framework for broader action. The National Dementia Action Plan 2024–2034 commits governments to empowering “individuals and communities” to minimise risk where they can and delay the onset and progression of dementia.
Those words, “where they can”, acknowledge that individual agency operates within social, economic and environmental constraints.
The challenge is to ensure implementation gives as much attention to communities and systems as it does to individuals.
Many existing initiatives already influence brain health. Policies that improve cardiovascular health, reduce smoking and harmful alcohol consumption, increase access to hearing and vision care, reduce air pollution, support education and create walkable and socially connected communities may also reduce dementia risk.
Primary care also has a central role. Much of dementia prevention is already embedded in good general practice: managing vascular risk, supporting smoking cessation, treating depression, addressing sensory impairment and helping patients remain physically and socially active.
But health professionals cannot overcome inaccessible or unaffordable systems through advice alone. Governments must ensure the services required to act on prevention messages are available.
Better evidence needed
Broadening prevention does not mean making claims the evidence cannot yet support.
There is substantial epidemiological evidence linking social, behavioural, clinical and environmental factors with dementia risk. Evidence that modifying these factors changes cognitive or dementia outcomes is less developed, while evidence for upstream population-level interventions is particularly limited.
Governments and researchers should build cognitive and brain-health measures into evaluations of relevant health and social policies. Transport, urban-planning and social isolation initiatives could generate valuable evidence if appropriate outcomes are included from the outset.
This would help establish which changes to systems and environments produce measurable benefits, for whom and under what circumstances.
It will also require better Australian evidence. Global estimates suggest that addressing 14 potentially modifiable risk factors could prevent or delay up to 45 percent of dementia cases.
However, the Australian Institute of Health and Welfare cautions that this estimate may not reflect the distribution of risk factors across Australian populations, including First Nations peoples and culturally and linguistically diverse communities.
National and local data are needed to identify where the greatest opportunities lie and design responses appropriate for different communities.
Shared responsbility
The Government’s letter to Australians turning 50 is a welcome invitation to think about brain health earlier in life. Its recommendations are important, and individuals should be supported to act on them.
But the letter should be the beginning of the Government’s responsibility, not the end of it.
Policymakers must create conditions that make healthy choices realistic. Health services must provide timely, affordable and culturally appropriate preventive care. Public health approaches should reduce rather than reinforce inequities, while researchers strengthen the evidence for interventions beyond the individual.
Australia’s growing dementia case numbers will not be addressed through individual behaviour change alone.
Protecting brain health should be a shared national responsibility, supported not only by the choices people make, but by the choices governments and institutions make on their behalf.
Author details
Dr Jennifer Dunne is an epidemiologist and Research Fellow at Curtin University’s Dementia Centre of Excellence. Her research focuses on dementia prevention and risk prediction, with a particular interest in women’s health and the factors that shape dementia risk across the life course. Her work combines epidemiological and advanced statistical methods with large longitudinal cohort and linked health data to investigate modifiable risk factors and improve approaches to dementia risk prediction.
Professor Blossom Stephan is a neuroepidemiologist and Director of the Dementia Centre of Excellence at Curtin University. She holds the inaugural Chair in Dementia, a joint appointment between Curtin University and Dementia Australia. Her research is centred on dementia risk prediction and reduction, with a particular focus on the relationship between cardiovascular and brain health in ageing.
See Croakey’s archive of articles on prevention, and on dementia
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