Enhancing brain health in the global south through a sex and gender lens
Open accessAbstract
Gender inequality substantially impacts society, disproportionately disadvantaging women, especially in the Global South. This inequality correlates with brain health outcomes for women, including a higher risk of cognitive decline and dementia. This perspective highlights how sex-linked biology and gender disparities affect women's brain health in the Global South through various pathways, such as differential exposome, health behaviors, and gender biases in research and healthcare systems. Alzheimer's disease and other brain health conditions exemplify how sex-specific risk factors and gender-related health barriers interact to influence brain health. We advocate for incorporating sex/gender considerations in research, policy, and clinical practice to improve brain health interventions in the Global South. Additionally, we propose using the patient and public involvement framework to effectively tailor health strategies that address these factors.
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Resilience is understudied in the majority world, including low-, middle-, and upper-middle-income countries, where socioeconomic inequities, environmental stressors, high disease burdens, and limited healthcare access create distinct health trajectories.
“While extensively studied in high-income countries, resilience remains underexplored in the majority world, including low-, middleand upper-middle-income countries—where socioeconomic inequities, environmental stressors, large burdens of infectious and noncommunicable diseases and limited healthcare access shape unique health trajectories6–15.”
From Resilience and brain health in global populations (2025) · cites this paper as [7]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredTransgender and gender-diverse individuals face distinct brain health challenges, especially in low-resource settings, due to stigma, discrimination, and limited access to care, which can increase allostatic load.
“Transgender and gender-diverse individuals face distinct brain health challenges, especially in low-resource settings due to stigma, discrimination and limited access to care, which can increase allostatic load7.”
From Resilience and brain health in global populations (2025) · cites this paper as [7]
The “Gender-biased health systems” section says transgender women in the Caribbean face healthcare discrimination that may limit access to brain health services, and that violence against sexual and gender minorities in Southern Africa contributes to chronic stress and poor mental health. The “Making the case for sex and gender” section links inequality to increased allostatic load specifically for women; it does not make that link specifically for transgender and gender-diverse people. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSex, gender, ethnicity, and age influence resilience through their effects on stress responses.
“Sex, gender, ethnicity, and age all shape resilience via their influence on responses to stress7,99–106.”
From Resilience and brain health in global populations (2025) · cites this paper as [7]
In “Making the case for sex and gender” (page unavailable), the paper says gender inequalities could increase women’s allostatic load from chronic stress, with worse brain-health outcomes. It also discusses women’s cognitive resilience in early Alzheimer’s disease (“Sex related differences in risk factors and brain health conditions,” page unavailable). It does not establish that sex, gender, ethnicity, and age all shape resilience through their effects on stress responses. (LLM, conf=0.76)
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Metabolic syndrome in indigenous communities in Mexico: a descriptive and cross-sectional study
Mendoza‐Caamal, E., Barajas-Olmos, F. M., Garcia‐Ortíz, H., Cicerón-Arellano, I., Martínez-Hernández, A. G., Córdova, E. J., Esparza‐Aguilar, M., Contreras-Cubas, C., Centeno-Cruz, F., Cid-Soto, M. A., et al. (2020) · BMC Public Health · doi:10.1186/s12889-020-8378-5 · Cited by 63 · see citing works
The association between allostatic load and brain: A systematic review
Lenart-Bugla, M., Szcześniak, D., Bugla, B., Kowalski, K., Niwa, S., Rymaszewska, J., & Misiak, B. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105917 · Cited by 61 · see citing works
Addressing the gaps between socioeconomic disparities and biological models of dementia
Ibáñez, A. M., Legaz, A., & Ruiz-Adame, M. (2023) · Brain · doi:10.1093/brain/awad236 · Cited by 60 · see citing works
Towards an understanding of women’s brain aging: the immunology of pregnancy and menopause
Barth, C., & de Lange, A. G. (2020) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2020.100850 · Cited by 59 · see citing works
Relationship between parenthood and cortical thickness in late adulthood
Orchard, E. R., Ward, P. G. D., Sforazzini, F., Storey, E., Egan, G. F., & Jamadar, S. D. (2020) · PLoS ONE · doi:10.1371/journal.pone.0236031 · Cited by 59 · see citing works
Allostatic load and mental health: a latent class analysis of physiological dysregulation
Carbone, J. T. (2020) · Stress · doi:10.1080/10253890.2020.1813711 · Cited by 59 · see citing works
Educational disparities in brain health and dementia across Latin America and the United States
Gonzalez‐Gomez, R., Legaz, A., Moguilner, S., Cruzat, J., Hernández, H., Baez, S., Cocchi, R., Coronel‐Olivero, C., Medel, V., Tagliazuchi, E., et al. (2024) · Alzheimer's & Dementia · doi:10.1002/alz.14085 · Cited by 55 · see citing works
Beyond sex differences: short- and long-term effects of pregnancy on the brain
Puri, T. A., Richard, J. E., & Galea, L. A. M. (2023) · Trends in Neurosciences · doi:10.1016/j.tins.2023.03.010 · Cited by 53 · see citing works
Examining Sex Differences in Autism Heritability
Sandin, S., Yip, B. H. K., Yin, W., Weiss, L. A., Dougherty, J. D., Fass, S. B., Constantino, J. N., Hailin, Z., Turner, T. N., Marrus, N. M., et al. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.0525 · Cited by 48 · see citing works
Global South research is critical for understanding brain health, ageing and dementia
Baez, S., Alladi, S., & Ibanez, A. (2023) · Clinical and Translational Medicine · doi:10.1002/ctm2.1486 · Cited by 47 · see citing works
The role of sex and gender in hypertension
Azizi, Z., Alipour, P., Raparelli, V., Norris, C. M., & Pilote, L. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-022-00789-4 · Cited by 47 · see citing works
Influence of metabolic syndrome on cerebral perfusion and cognition
Livingston, J. M., McDonald, M. W., Gagnon, T., Jeffers, M. S., Gomez-Smith, M., Antonescu, S., Cron, G. O., Boisvert, C., Lacoste, B., & Corbett, D. (2020) · Neurobiology of Disease · doi:10.1016/j.nbd.2020.104756 · Cited by 45 · see citing works
Sex Differences in Brain Disorders
Ziemka‐Nałęcz, M., Pawelec, P., Ziąbska, K., & Zalewska, T. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241914571 · Cited by 41 · see citing works
The expectant brain–pregnancy leads to changes in brain morphology in the early postpartum period
Chechko, N., Dukart, J., Tchaikovski, S. N., Enzensberger, C., Neuner, I., & Stickel, S. (2021) · Cerebral Cortex · doi:10.1093/cercor/bhab463 · Cited by 39 · see citing works
Schmitt, M. L., Gruer, C., Hagstrom, C., Adenu-Mensah, N. E., Nowara, A., Keeley, K., & Sommer, M. (2022) · Frontiers in Reproductive Health · doi:10.3389/frph.2022.1018217 · Cited by 36 · see citing works
Mortberg, M. A., Vallabh, S. M., & Minikel, E. V. (2022) · Scientific Reports · doi:10.1038/s41598-022-21820-1 · Cited by 33 · see citing works
Barriers in household access to medicines for chronic conditions in three Latin American countries
Emmerick, I. C. M., Luiza, V. L., Camacho, L. A. B., Vialle-Valentin, C. E., & Ross‐Degnan, D. (2015) · International Journal for Equity in Health · doi:10.1186/s12939-015-0254-z · Cited by 31 · see citing works
Age at Menarche and Time Spent in Education: A Mendelian Randomization Study
Gill, D., Fabiola Del Greco, M., Rawson, T. M., Sivakumaran, P., Brown, A., Sheehan, N. A., & Minelli, C. (2017) · Behavior Genetics · doi:10.1007/s10519-017-9862-2 · Cited by 30 · see citing works
Craske, M. G., Herzallah, M. M., Nusslock, R., & Patel, V. (2023) · Nature Mental Health · doi:10.1038/s44220-022-00012-w · Cited by 30 · see citing works
Adedeji, I. A., Ogunniyi, A. O., Henderson, D. C., & Sam-Agudu, N. A. (2022) · Dementia · doi:10.1177/14713012211065398 · Cited by 30 · see citing works
Torvik, F. A., Flatø, M., McAdams, T. A., Colman, I., Silventoinen, K., & Stoltenberg, C. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.02.001 · Cited by 29 · see citing works
Assessing Women Caregiving Role to People Living With HIV/AIDS in Nigeria, West Africa
Asuquo, E. F., Etowa, J. B., & Akpan, M. I. (2017) · SAGE Open · doi:10.1177/2158244017692013 · Cited by 27 · see citing works
Mújica, Ó. J., Sanhueza, A., Carvajal-Vélez, L., Vidaletti, L. P., Costa, J. C., Barros, A. J. D., & Victora, C. G. (2023) · International Journal for Equity in Health · doi:10.1186/s12939-023-01932-4 · Cited by 27 · see citing works
Wang, Y., Han, M., Zhang, Y., Wang, Y., Li, G., Huang, Z., Ma, Z., Ou, J., & Chen, R. (2023) · Nature Mental Health · doi:10.1038/s44220-023-00041-z · Cited by 23 · see citing works
Women’s empowerment and infant mortality in Latin America: evidence from 286 cities
Ortigoza, A. F., Braverman‐Bronstein, A., Hessel, P., Cecco, V. D., Friche, A. A. D. L., Caiaffa, W. T., & Roux, A. V. D. (2021) · Cities & Health · doi:10.1080/23748834.2021.1908794 · Cited by 20 · see citing works
Costa, J. C., Mújica, Ó. J., Gatica‐Domínguez, G., del Pino, S., Carvajal-Vélez, L., Sanhueza, A., Caffe, S., Victora, C. G., & Barros, A. J. D. (2022) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2022.100345 · Cited by 19 · see citing works
The aging brain: risk factors and interventions for long term brain health in women
Caldwell, J., & Isenberg, N. (2023) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000849 · Cited by 18 · see citing works
Gender Inequality in Latin America: A Multidimensional Analysis Based on ECLAC Indicators
Hernández, E. J. M., Gómez, M. J. F., & Barrera‐Mellado, I. (2021) · Sustainability · doi:10.3390/su132313140 · Cited by 18 · see citing works
Walking the talk for dementia: A unique immersive, embodied, and multi‐experiential initiative
Peres, F. A., Haas, A. N., Martha, A., Chan, M., Steele, M., Ferretti, M. T., Ngcobo, N. N., Ilinca, S., Domínguez-Vivero, C., Leroi, I., et al. (2024) · Alzheimer's & Dementia · doi:10.1002/alz.13644 · Cited by 15 · see citing works
Sanhueza, A., Carvajal-Vélez, L., Cueva, D. A., Caffe, S., Camacho, A. V., Berroterán, M. A., Horowitz, D., Gordillo-Tobar, A. E., Mújica, Ó. J., & Caribbean, E. W. E. C. L. A. A. T. (2022) · International Journal for Equity in Health · doi:10.1186/s12939-022-01682-9 · Cited by 13 · see citing works
The ENIGMA-Neuroendocrinology working group to bridge gaps in female mental health research
Heller, C., Barth, C., Silk, T. J., Vijayakumar, N., Carmona, S., Martínez‐Garcia, M., Kikinis, Z., Thomopoulos, S. I., Jahanshad, N., Salminen, L. E., et al. (2024) · Nature Mental Health · doi:10.1038/s44220-024-00224-2 · Cited by 10 · see citing works
Yu, S., Qian, L., & Ma, J. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e14677 · Cited by 9 · see citing works
Berkhout, S., Hashmi, S. S., & Pikula, A. (2024) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2024.1350294 · Cited by 6 · see citing works
Brain Health Is a Determinant of Mental Health
Eyre, H. A., Lundin, R., Falcão, V. P., Berk, M., Hawrot, T., Leboyer, M., Destrebecq, F., Sarnyai, Z., Reynolds, C. F., Lavretsky, H., et al. (2023) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2023.02.005 · Cited by 6 · see citing works
Goering, M., Albright, M. G., & Mrug, S. (2023) · Journal of Youth and Adolescence · doi:10.1007/s10964-023-01814-6 · Cited by 6 · see citing works
Metheny, N., Mkhize, S. P., Scott, D., & Hatcher, A. M. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241243348 · Cited by 5 · see citing works
SORL1 Polymorphisms in Mexican Patients with Alzheimer’s Disease
Toral-Ríos, D., Ruiz-Sánchez, E., Martínez‐Rodríguez, N., Maury-Rosillo, M., Rosas‐Carrasco, Ó., Becerril-Pérez, F., Mena‐Barranco, F., Carvajal-García, R., Silva‐Adaya, D., Delgado-Namorado, Y., et al. (2022) · Genes · doi:10.3390/genes13040587 · Cited by 5 · see citing works
Intersectional approaches are essential to identify the multiple sources of oppression.
Alegria, M. M., & Cheng, M. (2023) · Journal of Psychopathology and Clinical Science · doi:10.1037/abn0000842 · Cited by 2 · see citing works
Flagged first, then by citations
1 of the 115 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [15]Nations U Forging a Path Beyond Borders: The Global South. (United Nations Conference on Trade and Development (UNCTAD), New York, United States of America, 2018).
Cited by
Sorted by citations
The exposome of healthy and accelerated aging across 40 countries
Hernandez, H., Santamaria-Garcia, H., Moguilner, S., Farina, F. R., Legaz, A., Prado, P., Cuadros, J., Gonzalez, L., Gonzalez-Gomez, R., Migeot, J., et al. (2025) · Nature Medicine · doi:10.1038/s41591-025-03808-2 · Cited by 71 · see citing works
Stimuli‐Responsive Nano Drug Delivery Systems for the Treatment of Neurological Diseases
Dai, X., Li, W., Xie, D., Liu, B., Gong, L., & Han, H. (2025) · Small · doi:10.1002/smll.202410030 · Cited by 47 · see citing works
Resilience and brain health in global populations
Udeh-Momoh, C. T., Migeot, J., Blackmon, K., Mielke, M. M., Melloni, M., Cox, L., Yaffe, K., Santamaria-Garcia, H., Stern, Y., & Ibanez, A. (2025) · Nature Medicine · doi:10.1038/s41591-025-03846-w · Cited by 42 · see citing works
Alzheimer disease seen through the lens of sex and gender
Castro‐Aldrete, L., Einsiedler, M., Martínková, J., Depypere, H. T., Ang, T. F. A., Mielke, M. M., Sindi, S., Eyre, H. A., Au, R., Dimech, A. S., et al. (2025) · Nature Reviews Neurology · doi:10.1038/s41582-025-01071-0 · Cited by 39 · see citing works
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Linking the exposome to the brain–behaviour phenotype
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Women’s brain health and brain capital
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Self-citationSocial determinants of cognitive aging across 39 countriesPreprint
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Correa-Salazar, C., Rangel, G., Blandón, J., Agudelo-Avellaneda, E. N., Benitez, D. S. T., Quintero-Medina, N., Saray-Jaimes, V., Restrepo-Mantilla, M. L., Chaux-Rettberg, E., & Martinez-Donate, A. (2025) · Neuroscience · doi:10.1016/j.neuroscience.2025.06.020 · Cited by 1 · see citing works
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Childhood health through matrescence empowers women to sustain life-course brain health
Scher, M. S., Eyre, H. A., Adalat, S., Hartikainen, K. M., Berk, M., Ibáñez, A. M., & Markvarde, A. (2026) · npj Women s Health · doi:10.1038/s44294-026-00135-w · Cited by 1 · see citing works
Vidaurre, D., Morell-Ortega, S., Oyarzo, P., Butler, C., Charquero‐Ballester, M., Gadea, M., Morandat, F., Mansencal, B., Pierrick Coupé, A., & Manjón, J. V. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.09.21.677563
Marin‐Díaz, N. P., Binetti, S., Cañas, J., Panesso, C., Villacreses, J., Orellana, P., Gonzalez‐Silva, C., Cruzat, J. C., Migeot, J., Murgas, P., et al. (2026) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2026.1826530
- Authors
- Baez, S., Castro-Aldrete, L., Britton, G. B., Ibañez, A., & Santuccione-Chadha, A.
- Affiliations
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (PA)
- Venue
- Nature Mental Health
- Published
- 2024-10-28
- Volume
- 2
- Issue
- 11
- Pages
- 1308-1317
- ISSN
- 2731-6076 (ISSN-L)
- PMC
- PMC11984639
- OpenAlex
- W4403838086
- Cited by
- 15
- References
- 115
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 1
- FWCI
- 6.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Mental Health (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Alzheimer's Association (20-725707, SG-20- 725707)
- Agencia Nacional de Investigación y Desarrollo (15150012, ANID/FONDAP/15150012, 1210195, 1210176, 1220995)
- National Institutes of Health (15150012)
- National Institute on Aging (R01AG057234, P01AG019724, R01AG075775, R01AG083799)
- National Institute on Drug Abuse (75N95022C00031)
- Fogarty International Center
- Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (15150012)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
- Keywords
- brain health, sex differences, gender inequality, women's health, Global South, cognitive decline, dementia, Alzheimer's disease, exposome, sex-specific risk factors, gender bias in medicine, sex-inclusive research, patient and public involvement, health policy
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