PROTECTING THE PLANET AND OUR BRAINS: A Photographic Exploration Executive Summary Can you spot the pale blue dot on the left page? This tiny speck is our planet – our home in the vastness of space. Captured by the Voyager 1 space probe in 1990 from a distance of six billion kilometres, the “Pale Blue Dot” image serves as a powerful reminder of Earth’s fragility and the interconnectedness of all life. It underscores the urgent need to protect our planet’s health, as it directly impacts human well-being. So far, human life on Earth has steadily improved, enabling us to live much longer lives. However, with this privilege comes new challenges, one of the most pressing being the rapid rise of dementia globally. For Aotearoa New Zealand, with the number of people with dementia projected to triple by 2050, the implications are profound – not just for individuals and their families, but for society as a whole. Currently, over 70,000 New Zealanders live with dementia, and as our population ages, this figure is set to soar to over 200,000, placing an enormous strain on the healthcare system, social services, and families. The annual cost of dementia is already staggering, at NZD 2.5 billion, and is expected to climb to NZD 6 billion by mid-century. Notably, dementia does not impact all communities equally. Māori and Pacific populations face significantly higher risks. Māori experience nearly double the rate of dementia compared to non-Māori, often at much younger ages. These disparities are deeply linked with the social determinants of health – factors like income, education, access to appropriate healthcare, and housing – that have a disproportionate impact on these communities. Addressing the disparities is critical to reducing dementia and ensuring that all New Zealanders have the opportunity to age well. As we grapple with the rise of dementia, another urgent challenge has emerged: climate change. While it might seem unrelated to dementia at first glance, the connections are becoming increasingly clear. Climate change is not just about rising sea levels or extreme weather; it also affects our health, including the health of our brains. Environmental factors exacerbated by climate change, such as air pollution and extreme heat, have been linked to cognitive decline and increased dementia risk. Fine particulate matter from air pollution is a significant contributor, and as urbanisation and industrialisation continue, these risks are expected to grow. Additionally, extreme heat poses a serious threat, especially to older adults, worsening existing health conditions that can accelerate cognitive decline. The mental health impacts of climate change further compound the problem. Climate- related events, such as Cyclone Gabrielle and subsequent flooding, can trigger stress, anxiety, depression, and social isolation – all risk factors for dementia. The displacement of communities due to climate change, particularly in the South Pacific islands to which many New Zealanders have close ties, threatens the social determinants of health that are essential for maintaining brain health. Yet, this convergence of challenges presents a unique opportunity: by addressing climate change, we can simultaneously reduce the risk of dementia. Adopting sustainable practices not only helps mitigate climate change but also promotes brain health. For instance, urban planning that incorporates more green spaces can enhance physical and mental well-being, providing protective factors against cognitive decline. Policy actions such as reducing air pollution and promoting renewable energy can have dual benefits, improving both environmental and public health outcomes. In this context, the research project “Co-exploring Dementia Risk Reduction from a Planetary Health Perspective,” funded by the Health Research Council (HRC) of New Zealand, unites science and art to highlight the shared benefits of sustainable living and dementia prevention. The project uses photovoice, a participatory research method, to explore through photographs the intricate connections between our environments, lifestyle, and brain health. The resulting exhibition, “Protecting the Planet and Our Brains: A Photographic Exploration”, displayed in this brochure, features the works of 14 Auckland residents, whose dedication and creativity brought this project to life. Much like the ‘Pale Blue Dot’ image prompts us to reflect on the fragility of our unique habitat by offering a different perspective, I invite you to view our planet and our actions through a fresh lens – recognising that the steps we take today can secure a healthier future for both our planet and our brains. What actions are you taking? Associate Professor Susanne Röhr Project Lead Background Reflecting global trends, dementia is on the rise in Aotearoa New Zealand, with the number of people with dementia expected to rise sharply in the coming decades. Currently, over 70,000 New Zealanders are living with dementia, representing about 1.4% of the total population. By 2050, this number is projected to reach over 200,000, which means more than 3% of the population will have dementia. This increase is largely due to our ageing population, as the number of people aged 65 and over is expected to double by 2050 – and the higher the age, the higher the risk of developing dementia. As we continue to age as a population, understanding dementia – what it is, who is at risk, how to care for people with dementia, and notably, what we can do to prevent it – becomes increasingly important. The socioeconomic impact of dementia is substantial, creating costs estimated at NZD 2.5 billion each year, a figure that includes healthcare costs, social services, and lost productivity. By 2050, the economic burden is projected to rise to NZD 6 billion annually. The financial impact also extends to families, with an estimated 40,000 people providing unpaid care to their loved ones with dementia – totalling one million hours of informal care every week. Disparities in dementia Dementia does not occur equally across ethnic groups in Aotearoa New Zealand. Māori, Pacific, and Asian communities face unique challenges when it comes to dementia. For Māori, the prevalence of dementia is nearly twice as high as in the non-Māori population, and it often occurs at younger ages. Approximately 10% of Māori aged 65 and over are living with dementia, compared to around 6% of non-Māori in the same age group. Pacific peoples also experience higher rates of dementia compared to the general population. It is estimated that around 8% of Pacific people aged 65 and over are living with dementia, and like Māori, Pacific peoples often face dementia earlier in life. The differences are linked to a range of factors, including higher rates of diabetes, cardiovascular disease, obesity, and other conditions that increase dementia risk, rooted in socioeconomic disparities caused by systemic discrimination and racism. The social determinants of health – the conditions in which people are born, grow, live, work, and age – play a critical role in the risk and prevalence of dementia. Factors such as education, income, access to healthcare, housing, and social inclusion significantly impact brain health across the lifespan. Inequities in these areas contribute to the higher prevalence and earlier onset of dementia. Addressing these social determinants is essential for effective dementia prevention and care. Cultural differences in understanding and managing dementia, coupled with language barriers, can further contribute to the inequitable burden of dementia. For Asian communities, dementia is often stigmatised, leading to delays in seeking help. The Asian population is growing rapidly, currently representing over 15% of the total population, and it is expected to continue growing. As a result, the need for culturally appropriate dementia services tailored to these communities is becoming increasingly urgent. Policies that promote health equity, such as improving access to quality education, affordable healthcare, and stable housing, can reduce the risk factors associated with dementia. Moreover, public health initiatives that focus on reducing health disparities, increasing awareness, and providing culturally appropriate care are crucial. For instance, implementing policies that ensure all communities have access to early dementia diagnosis, treatment, and support services can help mitigate the inequities seen in dementia outcomes. Governments, healthcare providers, and communities must work together to develop and implement policies that address these social determinants and promote brain health equity, ultimately reducing the impact of dementia across all populations. Types and trajectories of dementia Notably, dementia is not a single disease but rather a term that describes a group of symptoms impacting memory, thinking, and social abilities severely enough to interfere with daily life. It is the consequence of damage to or loss of nerve cells and their connections in the brain, due to causes that researchers are still trying to understand. With population ageing being a global phenomenon, dementia is an increasing public health challenge worldwide. Approximately 55 million people are living with dementia globally, with nearly 10 million new cases diagnosed each year. There are several types of dementia, with Alzheimer’s disease being the most common, accounting for 60-70% of all cases. Alzheimer’s typically presents with symptoms such as memory loss, orientation difficulties, and changes in behaviour. Vascular dementia, the second most common type, often occurs after a stroke or other events that reduce blood Dementia: a growing public health challenge Potential for dementia prevention according to 12 modifiable risk factors in Aotearoa New Zealand’s main ethnic populations. Figure adopted from Ma’u, E., Cullum, S., Cheung, G., Livingston, G., & Mukadam, N. (2021). Differences in the potential for dementia prevention between major ethnic groups within one country: A cross sectional analysis of population attributable fraction of potentially modifiable risk factors in New Zealand. The Lancet Regional Health. Western Pacific, 13, 100191. Less education 6 6.6 8.9 5.5 3.6 0.3 5.6 4.1 3 2.8 2.4 2 Obesity Hearing Loss Hypertension TBI Alcohol Physical inactivity Diabetes Social isolation Smoking Air pollution Depression Potentially modifiable 50.8% Pacific peoples E a r l y - L i f e ( < 4 5 y r s ) M i d - L i f e ( 4 5 - 6 5 y r s ) L a t e r - L i f e ( > 6 5 y r s ) Less education 5.6 6.5 7.3 5 3.5 0.7 5.1 5 4.3 4.2 2.4 1.8 Obesity Hearing Loss Hypertension TBI Alcohol Physical inactivity Diabetes Social isolation Smoking Air pollution Depression Potentially modifiable 51.4% M ā ori E a r l y - L i f e ( < 4 5 y r s ) M i d - L i f e ( 4 5 - 6 5 y r s ) L a t e r - L i f e ( > 6 5 y r s ) Less education 4.5 5.3 8 4.9 3.7 0.6 5.7 5.2 4.7 1.9 1.9 1.2 Obesity Hearing Loss Hypertension TBI Alcohol Physical inactivity Diabetes Social isolation Smoking Air pollution Depression Potentially modifiable 47.6% European E a r l y - L i f e ( < 4 5 y r s ) M i d - L i f e ( 4 5 - 6 5 y r s ) L a t e r - L i f e ( > 6 5 y r s ) Less education 3.8 4.9 7.3 3.9 2.9 0.3 5.5 3.1 2.8 2.6 2.6 1.1 Obesity Hearing Loss Hypertension TBI Alcohol Physical inactivity Diabetes Social isolation Smoking Air pollution Depression Potentially modifiable 40.8% Asian E a r l y - L i f e ( < 4 5 y r s ) M i d - L i f e ( 4 5 - 6 5 y r s ) L a t e r - L i f e ( > 6 5 y r s ) flow to the brain and accounts for about 15-20% of cases. Other types include Lewy body dementia and frontotemporal dementia, each with its unique set of symptoms and progression patterns. Often, dementia can present as a mix of types. The trajectory of dementia varies from person to person. In the early stages, individuals may notice mild memory loss or difficulty with complex tasks in everyday life, such as handling finances or medication intake. As the condition progresses, memory problems become more pronounced, and individuals may increasingly need help with daily activities. In the later stages, individuals with dementia may need more and more support to care for themselves. Dementia care and services In Aotearoa New Zealand, a range of healthcare services are available to support people with dementia and their families. The public health system provides diagnostic services, treatment, and ongoing care, often coordinated through general practitioners (GPs) and specialists like neurologists or geriatricians. However, the availability of services can vary depending on where you live. Support for carers is another critical aspect of dementia care. An estimated 60% of people with dementia live at home, relying heavily on family members for care. Various organisations, including Dementia New Zealand and Alzheimers New Zealand, offer resources, support groups, and respite care services to help alleviate some of these burdens. A list of dementia resources and services can be found at the end of this chapter. There are also emerging opportunities in dementia care, driven by advances in research and technology. Innovations such as telehealth services, dementia-friendly communities, and personalised care plans, including the consideration of cultural aspects, are helping to improve the quality of life for people with dementia and their families. The development of dementia-friendly communities is particularly promising, with several initiatives underway across Aotearoa New Zealand to create more supportive environments for those living with dementia. Opportunities for risk reduction While there is currently no cure for dementia and treatment options are limited, research has identified several risk factors that can increase the likelihood of developing the condition. Some of these risk factors, like age and genetics, cannot be changed. However, there are many modifiable risk factors that we can address to help reduce the risk of dementia. The latest Lancet Commission report on dementia prevention, intervention, and care highlights that up to 45% of dementia cases could potentially be prevented or delayed by addressing 14 modifiable risk factors throughout the life course. Considering 12 factors, the dementia prevention potential in Aotearoa New Zealand is estimated to be even higher with approximately 48%. For a detailed overview, see the infographic on left page. One crucial area in dementia prevention is the role of lifestyle factors. Regular physical activity, a healthy diet, and maintaining a healthy weight are all associated with a lower risk of dementia. Physical activity, in particular, has been shown to benefit brain health by improving blood flow and reducing inflammation. Studies suggest that regular exercise can reduce the risk of developing dementia by up to 30%. A balanced diet, rich in fruits, vegetables, whole grains, and healthy fats, and avoiding ultra-processed and high-sugar foods, supports overall health and can reduce the risk of conditions like diabetes and heart disease, which are linked to dementia. The Mediterranean diet, which emphasises plant-based foods, lean proteins, and healthy fats, is associated with a 35% lower risk of cognitive decline. Keeping your brain active is another important factor in reducing dementia risk. Engaging in mentally stimulating activities, such as reading, puzzles, learning new skills, or maintaining social connections, can help build cognitive reserve. Cognitive reserve is the brain’s ability to withstand age-related losses and to improvise and find alternate ways of getting a job done, which can help delay the onset of dementia. Research indicates that individuals with higher levels of education and those who engage in lifelong learning activities have a 20-30% reduced risk of dementia. Managing chronic health conditions effectively is crucial in reducing dementia risk. Conditions like hypertension, obesity, diabetes, and high cholesterol can damage blood vessels in the brain, leading to conditions like vascular dementia. For example, people with diabetes are 50% more likely to develop dementia. Regular check-ups and following doctor’s advice on managing these conditions can significantly reduce dementia risk. Sleep plays a vital role in brain health. Poor sleep, especially in midlife, has been linked to an increased risk of dementia. Studies have shown that people who regularly sleep less than six hours per night in midlife are 30% more likely to develop dementia later in life. Ensuring you get enough quality sleep—typically 7 to 8 hours a night for most adults— can help protect the brain. Social engagement and mental well-being are also key factors in dementia prevention. Loneliness and depression are associated with an increased risk of dementia, with some studies suggesting that social isolation increases dementia risk by 50%. Staying connected with family, friends, and the community can help reduce this risk. If struggling with mental health issues, seeking help from a professional can make a significant difference. Limiting or entirely avoiding alcohol consumption and not smoking are other important steps in reducing dementia risk. Excessive alcohol intake can lead to brain damage and increase the risk of dementia, while smoking is linked to vascular problems that can harm brain health. Smokers are estimated to have a 45% higher risk of developing dementia than non-smokers. Reducing alcohol intake to low levels and quitting smoking can have significant protective effects on brain health. Engaging in creative practices, such as painting, music, writing, or other forms of artistic expression, has been linked to maintaining cognitive function and reducing the risk of dementia. Creative activities stimulate various parts of the brain, encouraging neuroplasticity and cognitive reserve, which can help delay the onset of dementia symptoms. Participating in creative practices has been shown to reduce stress, improve mood, and provide social interaction, all of which are beneficial for brain health. Traumatic brain injury (TBI) is a significant risk factor for dementia, particularly when injuries occur in midlife or involve repeated head trauma, such as in contact sports. People who have experienced a severe TBI are estimated to be 2-4 times more likely to develop dementia later in life. Even mild TBIs, such as concussions, can increase the risk, especially if they occur repeatedly. Preventing head injuries by using protective gear, avoiding high-risk activities, and seeking immediate medical attention after any head trauma is essential in reducing this risk. Hearing and vision loss are important modifiable risk factors for dementia. Studies have shown that untreated hearing loss in midlife can increase the risk of dementia by up to 50%. Hearing loss may lead to social isolation, depression, and reduced cognitive stimulation, all of which can contribute to cognitive decline. Similarly, vision loss can impair a person’s ability to engage with their environment and others, increasing the risk of dementia. Regular hearing and vision check-ups, along with the use of hearing aids and corrective lenses, can help mitigate these risks significantly. Never too early, never too late Education and awareness are crucial in dementia prevention. The more we understand about the condition and its risk factors, the better equipped we are to take action. Public health campaigns and community initiatives play a vital role in spreading this knowledge and encouraging healthier lifestyles. For example, a 10% reduction in exposure to dementia risk factors could prevent up to 3 million cases worldwide by 2050. Dementia is a growing challenge in Aotearoa New Zealand, but it’s one that we can address with the right knowledge, support, and action. It’s never too early and never too late to take steps to reduce dementia risk. Whether it’s making lifestyle changes to protect your brain, educating yourself and others, or advocating for policies that promote brain health equity, every action counts. By working together as individuals and communities, we can help create a future where dementia is less common, and those with dementia receive the care and support they need to live well. Key scientific literature that informed this chapter: Barnes, D. E., & Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer’s disease prevalence. The Lancet Neurology, 10(9), 819-828. Cheung, G., To, E., Rivera-Rodriguez, C., et al. (2022). Dementia prevalence estimation among the main ethnic groups in New Zealand: a population-based descriptive study of routinely collected health data. BMJ Open, 12(9), e062304. Cullum, S., Mullin, K., Zeng, I., et al. (2018). Do community‐dwelling Māori and Pacific peoples present with dementia at a younger age and at a later stage compared with NZ Europeans? International Journal of Geriatric Psychiatry, 33(8), 1098-1104. Dudley, M., Menzies, O., Elder, H., Nathan, L., Garrett, N., & Wilson, D. (2019). Mate wareware: Understanding’dementia’from a Māori perspective. The New Zealand Medical Journal (Online), 132(1503), 66-74. Duron, E., & Hanon, O. (2008). Vascular risk factors, cognitive decline, and dementia. Vascular Health and Risk Management, 4(2), 363-381. Kaup, A. R., Mirzakhanian, H., Jeste, D. V., & Eyler, L. T. (2011). A review of the brain structure correlates of successful cognitive aging. Journal of Neuropsychiatry and Clinical Neurosciences, 23(1), 6-15. Livingston, G., Huntley, J., Sommerlad, A., et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet Commission. The Lancet, 403(10377), 585-624. Long, S., Benoist, C., & Weidner, W. (2023). World Alzheimer Report 2023: Reducing dementia risk: never too early, never too late. London, England: Alzheimer’s Disease International. Ma’u, E., Cullum, S., & Cheung, G. (2024). Navigating ethnic diversity: Rethinking dementia prevention in Aotearoa New Zealand. Australian & New Zealand Journal of Psychiatry, 58(5), 381-384. Ma’u E, Cullum S, Yates S, et al. (2021). Dementia Economic Impact Report 2020. Auckland, New Zealand: University of Auckland. World Health Organization. (2019). Risk reduction of cognitive decline and dementia: WHO guidelines. World Health Organization. Dementia resources: know where to find support Alzheimers New Zealand https://www.alzheimers.org.nz Alzheimers New Zealand provides support, education, and advocacy for people living with dementia, their families, and caregivers. They offer information on dementia symptoms, diagnosis, care options, and connections to local support services across New Zealand. Dementia New Zealand https://www.dementia.nz Dementia New Zealand provides tailored support services, education, and resources to individuals living with dementia and their caregivers. They work with local affiliates to deliver practical assistance, carer support, and community education. Health New Zealand | Te Whatu Ora https://info.health.nz/conditions-treatments/brain-and-nerves/dementia Health New Zealand | Te Whatu Ora provides comprehensive information about dementia mate wareware, including about caring for someone with dementia and dementia services in New Zealand. Brain Research New Zealand (BRNZ) https://www.brainresearch.co.nz Brain Research New Zealand focuses on aging-related brain disorders, including dementia, through research, clinical trials, and public education. They aim to improve understanding, treatment, and prevention of neurological conditions affecting older adults. Health Navigator New Zealand - Dementia https://www.healthnavigator.org.nz/health-a-z/d/dementia/ Health Navigator offers user-friendly information on dementia, including symptoms, diagnosis, and care options. Their platform is designed to help individuals and caregivers make informed health decisions with easy-to-understand content. Age Concern New Zealand https://www.ageconcern.org.nz Age Concern New Zealand advocates for the rights and well-being of older people, providing services such as elder care, social support, and education on health issues, including dementia. They offer a network of local offices to support older adults and their families. Aotearoa Brain Project https://www.aotearoabrainproject.nz The Aotearoa Brain Project is a collaborative research initiative focused on understanding brain health across the lifespan in New Zealand. The project’s website offers a variety of resources designed to enhance understanding and support for brain health. Dementia Friendly Recognition Programme https://alzheimers.org.nz/explore/dementia-friendly-nz/dementia-friendly-recognition- programme/ Dementia Friendly NZ is an initiative aimed at creating supportive, inclusive environments for people living with dementia. They provide resources and guidelines for businesses, organizations, and communities to become more dementia-friendly. New Zealand Dementia Foundation https://www.nzdementia.org The New Zealand Dementia Foundation is dedicated to improving the lives of people affected by dementia through research, education, and community support. The foundation provides resources, training, and advocacy to empower those living with dementia, their caregivers, and healthcare professionals across New Zealand. World Health Organization (WHO) - Dementia https://www.who.int/health-topics/dementia The World Health Organization provides global information on dementia, including facts, figures, prevention strategies, and care guidelines. Their resources are valuable for understanding dementia within a global context and accessing international best practices. Scope Brain health and dementia in a changing climate Dementia is increasingly recognised not only as a medical condition but as a public health challenge influenced by broader environmental factors, including climate change. The intersection of dementia and climate change is rooted in the understanding that the environment significantly shapes brain health. As climate change continues to alter the world’s ecosystems, it brings new risks to human health, including cognitive decline and dementia. Climate change refers to long-term shifts in temperatures and weather patterns, primarily driven by human activities such as burning fossil fuels, deforestation, and industrial processes. These activities increase the concentration of greenhouse gases in the atmosphere, leading to global warming and a cascade of environmental changes. These changes, including extreme weather events, rising sea levels, and shifts in biodiversity, can have direct and indirect effects on human health. The impact of climate change on brain health is an emerging area of research. Environmental factors associated with the causes and consequences of climate change, such as air pollution, extreme heat, and food and water insecurity, are increasingly linked to cognitive decline and a heightened risk of dementia globally. As we face the dual challenges of an ageing population and a rapidly changing climate, understanding and mitigating these risks is crucial. Planetary health: an emerging concept Planetary health is an emerging interdisciplinary field that emphasises the interconnectedness of human health and the health of our planet’s ecosystems. It is based on the understanding that the well-being of humans is inextricably linked to the well-being of natural systems, such as air, water, soil, and biodiversity. The concept of planetary health calls for a shift in how we approach health challenges, recognising that protecting and restoring the environment is essential for sustaining human health. By fostering sustainable practices and stewardship of natural resources, planetary health aims to promote not only the health of individuals and populations but also the resilience and stability of the Earth’s ecosystems, which are vital for future generations. Climate change-associated risk factors for dementia One of the most well-established links between dementia and climate change is air pollution – while these are distinct issues, they are closely connected. Studies have shown that exposure to fine particulate matter (PM2.5) and other pollutants, often exacerbated by industrial activities and traffic, is associated with a higher risk of cognitive decline and dementia. Proximity to major roads, urbanisation, and industrial areas further increase this risk. Extreme heat, another consequence of climate change, poses significant risks to brain health. Older adults are particularly vulnerable to heat stress, which can exacerbate existing health conditions, including those affecting the brain. Prolonged exposure to high temperatures has been shown to impair cognitive function, leading to a greater risk of dementia. Water and food security are at risk due to climate change, affecting nutritional health – a critical factor for maintaining cognitive function. For example, the Western diet predominant in Aotearoa New Zealand, which is high in processed foods and low in essential nutrients, has been linked to an increased risk of obesity, diabetes, and cardiovascular diseases, all of which are risk factors for dementia. Climate change exacerbates food insecurity, reducing the ability to grow and harvest, and access healthy, nutrient-rich foods, particularly in vulnerable populations. Additionally, climate change affects mental health, contributing to stress, anxiety, and depression – conditions that are linked to the risk of cognitive decline. The disruption of social and community networks due to extreme weather events can lead to social isolation, another well-known risk factor for dementia. One of the biggest impacts is the risk of displacement due to climate change, when land becomes uninhabitable due to coastal erosion, sea level rise, or ongoing drought – an urgency already faced by some of our neighbouring South Pacific island states, threatening living conditions and community connections, which are intrinsically foundational for our health, lifestyle, and opportunities to age in place. Mitigating climate change and dementia risk simultaneously Addressing the intertwined challenges of climate change and dementia requires holistic strategies that consider both environmental sustainability and brain health. One approach is promoting lifestyle changes that are beneficial for both the environment and brain health. For instance, adopting a predominantly plant-based diet can reduce the risk of cardiovascular diseases and dementia while also lowering greenhouse gas emissions associated with animal agriculture. Encouraging physical activity, such as walking or cycling instead of driving, not only reduces carbon emissions but also improves cardiovascular health, which is closely linked to brain health. Urban planning that includes green spaces can enhance physical and mental well-being, providing areas for exercise, social interaction, and exposure to nature – all of which are protective factors against cognitive decline. The more powerful approach is policy action. Reducing air pollution through stricter regulations on emissions from industries and vehicles can lower the risk of dementia while also addressing climate change. Promoting renewable energy sources, enhancing public transportation, and implementing policies that reduce the carbon footprint of industries are crucial steps that benefit both the environment and health. Public health initiatives that integrate climate action with dementia prevention can have a dual impact. For example, educating communities about the benefits of sustainable living and its role in reducing dementia risk can empower individuals to make informed choices that support both their health and the planet, allowing them to grow old healthily in a changing climate. Key scientific literature that informed this chapter: Basu, R., & Samet, J. M. (2002). Relation between elevated ambient temperature and mortality: A review of the epidemiologic evidence. Epidemiologic Reviews, 24(2), 190-202. Calderón-Garcidueñas, L., & Torres-Jardón, R. (2012). Air pollution, socioeconomic status, and children’s cognition in megacities: The Mexico City scenario. Frontiers in Psychology, 3, 217. Hales, S., Kovats, R. S., & Woodward, A. (2003). Climate change and human health: Impacts, vulnerability, and public health. The Lancet, 362(9394), 1015-1017. Howden-Chapman, P., & Chapman, R. (2012). Health co-benefits from housing-related policies. Current Opinion in Environmental Sustainability, 4(4), 414-419. Kopp, W. (2019). How Western diet and lifestyle drive the pandemic of obesity and civilization diseases. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 12, 2221-2236. McMichael, A. J., Woodruff, R. E., & Hales, S. (2006). Climate change and human health: Present and future risks. The Lancet, 367(9513), 859-869. Myers, S. S. (2017). Planetary health: protecting human health on a rapidly changing planet. The Lancet, 390(10114), 2860-2868. Paul, L. A., Hystad, P., Burnett, R. T., et al. (2020). Urban green space and the risks of dementia and stroke. Environmental Research, 109520. Pourzand, F., Bolton, A., Salter, C., Hales, S., & Woodward, A. (2023). Health and climate change: adaptation policy in Aotearoa New Zealand. The Lancet Regional Health–Western Pacific, 40. Power, M. C., Adar, S. D., Yanosky, J. D., & Weuve, J. (2016). Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research. Neurotoxicology, 56, 235-253. Röhr, S., Rodriguez, F. S., Siemensmeyer, R., et al. (2022). How can urban environments support dementia risk reduction? A qualitative study. International Journal of Geriatric Psychiatry, 37(5), 627-637. Trezza, B. M., Apolinario, D., de Oliveira, R. S., et al. (2015). Environmental heat exposure and cognitive performance in older adults: A controlled trial. Age, 37, 1-10. Wellenius, G. A., Boyle, L. D., Coull, B. A., et al. (2012). Residential proximity to nearest major roadway and cognitive function in community‐dwelling seniors: results from the MOBILIZE boston study. Journal of the American Geriatrics Society, 60(11), 2075-2080. Whitmee, S., Haines, A., Beyrer, C., et al. (2015). Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028. The Photovoice Project Exploring dementia risk through a planetary health lens The exploration of dementia risk reduction from a planetary health perspective was the objective of a research project supported by the Health Research Council (HRC) of New Zealand. The research used photovoice, a participatory research method that empowers individuals to take and share photographs representing their perspectives on the particular issue, with the goal of fostering dialogue and promoting awareness. As part of this project, 14 Auckland residents aged between 40 and 65 years captured images and narratives that reflect the intersection of their daily lives, lifestyle, environmental conditions, and brain health. The project was conducted by Associate Professor Susanne Röhr from the School of Psychology at Massey University, an epidemiologist and public health researcher who specialises in brain health and dementia prevention, and Northshore-based professional photographer Alena Iakusheva, blending science and art. The research methods in a nutshell Participants were recruited through social media advertisements and flyers distributed in the Northshore and central Auckland area at the beginning of 2024. Criteria to participate were “midlife” age, as this is currently considered a critical stage for brain health improvement before dementia risk signficantly increases with increasing age, and an interest in photography, brain health, and environmental sustainability. Those who decided to take part in the project joined up to five 90-minute evening sessions, held fortnightly at the Mary Thomas Centre in Takapuna, Auckland, between April and June 2024. During the sessions, the group learned about brain health and risk factors for dementia and the concept of planetary health. We discussed the essentials of photography, and every participant had the opportunity to do a one-on-one photography training session with Alena Iakusheva to discuss specific areas of interest, catering to the different levels of photography skills that everyone brought to the project. Using their own devices – anything from DSLR cameras to smartphones – the participants were then encouraged to “venture out” and capture images. We then went through a selection process, and each participant picked their two favourite photos and wrote captions to put the images in context and convey meaning in light of the topic. For the creation of the captions, we used the so called SHOWeD technique, a participatory method typically used in photovoice research, to facilitate reflection around images. SHOWeD stands for: S: What do you See here? H: What is really Happening? O: How does this relate to Our lives? W: Why does this situation, concern, or strength exist? e: How could this image educate people? D: What can we Do about it? In addition, participants completed a standardised pre- and post-survey, collecting anonymous data on sociodemographic information, knowledge about dementias and their risk and protective factors, and ecological stress, which will be analysed and published together with the photovoice material in a scientific journal. An exhibition to raise awareness The resulting 28 photographs and captions are shown in an exhibition hosted by Lake House Arts Centre in Takapuna, Auckland, in September and October 2024. The exhibition, titled “Protecting the Planet and Our Brains: A Photographic Exploration”, alongside this affiliated booklet which contains all images and narratives, too, aims to raise awareness about the potential to enhance brain health and reduce the risk of dementia by addressing both lifestyle factors and broader environmental influences – a necessity in times of climate change. Viewers and readers, respectively, are invited to reflect on how sustainable living practices and our engagement with others and the environment can contribute to healthier brains and a healthier planet for generations to come. The Lamp A lamp combined with nature. Nature is combined with modern technologies. It shows that not everything needs to be in perfect condition. The lamp was consumed by a bush and was revealed when the bush was cut back. It survived being overwhelmed. Show care to look after things and hopefully they will last longer. Dave Jones Book Box A book sharing box in the community. People are encouraged to keep reading by swapping books. Reading is very good for the brain. This is purely communities working together to look after each other. Encourages everyone to read. Keep reading so you have an excuse to swap a book. Dave Jones Enlightenment (Become Completely Mentally Healthy) This photo represents Buddha. Who preached the philosophy of Enlightenment. Buddha preached to us the universal truth, the reality of the world. To become enlightened, we have to tame and calm down our thinking process and be mindful in each and every moment. If people could interact more with nature and be mindful, they can definitely become enlightened. Himasha Gamage