The air we breathe

29 September 2018, World Heart Day

Nearly one in five deaths from CVD and stroke are caused by air pollution... a total of 3 million deaths globally every year

Today on World Heart Day, WSO is standing with our partners in circulatory disease prevention, the World Heart Federation (WHF) to raise awareness of the strong link between the air we breathe, cardiovascular disease and stroke.

Outdoor and household air pollution are an increasingly important risk factor for CVD: according to recent research, air pollution is the cause of 19% of all CVD deaths, accounting for more than 3 million deaths each year. Recent stroke data shows an even stronger overall association between air pollution and stroke, with over 29% of the burden of stroke attributed to air pollution.
An estimated 7 million people die prematurely every year from air pollution: 1.4 million of these will be from stroke and over 2 million from heart disease. 

According to the WHO, 91% of the world’s population live in areas where air pollution exceeds the WHO guidelines limits. While the problem is clearly geographically widespread, the impact varies depending on where you live and your level of income.

In south Asia and eastern and central sub-Saharan Africa, air pollution is the third highest contributor to stroke, accounting for almost 40% of the stroke burden. In China and India, almost 22% of stroke burden (as measured by DALYs) in 2013 were attributed to ambient PM2.5 air pollution. Although household air pollution from solid fuels did not contribute to stroke burden in high-income countries, almost a fifth of stroke burden in low-income and middle-income countries was attributed to household air pollution in 2013 (especially in Asia and sub-Saharan Africa).
Professor David Wood, WHF President, comments: “Reducing exposure to air pollution has become a crucial challenge that the world needs to face if we are to continue advancing in our goal to reduce the impact of non-communicable diseases, especially cardiovascular disease - the world's biggest killer. On World Heart Day, we are raising awareness of poor outdoor and household air quality as an increasingly important risk factor, and bringing together all those involved in cardiovascular health from every country in the world in the fight to reduce CVD."

President of the World Stroke Organization, Prof Werner Hacke added, 'Stroke is associated with a several heart conditions and an estimated 80% of premature deaths from both stroke and CVD could be prevented. This is why we are committed to collaborating with WHF and our partners the Global Coalition for Circulatory Health to deliver a robust prevention agenda. This includes not only increasing public awareness of the links between CVD and stroke, but also working with governments to put in place population-based policies and investments that will scale up improvements in the health of our communities.’

The case of air pollution shows us that reducing stroke and CVD can't be achieved through individual lifestyle change alone. While there are things that we can all do as individuals to reduce our stroke risk, turning the tide on the global tsunami of CVD, stroke and other non-communicable diseases will happen much faster if action is taken at government and individual level.’

On World Heart Day, WHF is calling on each and every one of us to make a commitment to heart health. WSO's hand on heart promise is to continue to strengthen our partnership work so that together we can address shared risk factors for CVD and stroke and help people live longer and healthier lives.’

REFERENCES:

¹Source: GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390, 1345–1422 (2017).

²Source: WHO

³Source :WHO

⁴Source: Nature Reviews Cardiology volume 15, pages 193–194 (2018).

⁵https://vizhub.healthdata.org

Time to act. Time to delver. Time to save lives

27 September 2018, New York

The World Stroke Organization stands with our partners and nearly 300 civil society organisations to call on world leaders to go above and beyond the timid, unambitious commitments contained in the Political Declaration(link is external) of the third UN High-Level Meeting on Noncommunicable Diseases (UN HLM on NCDs), adopted in New York on 27th September 2018. 

Governments cannot afford to continue sleepwalking into a sick future. The world is reaching an inflection point and a tepid response to NCDs is simply not an option – for the sake of billions of people around the world, it is time for a radical change. Global preventable death, disability, and suffering from NCDs continue to rise because of governments’ failure to act and invest for health. At the current rate of progress, more than half of all countries in the world will fail to meet the Sustainable Development Goal (SDG) 3.4 NCD to reduce the rate of premature deaths from NCDs by one third by 2030. 

Whilst we commend the Heads of State and Government embracing the opportunity the HLM presents to celebrate initiatives and progress, we contend that past actions will be insufficient to drive future change. Decisive new action is urgently needed to halt the tsunami effect of NCDs - on people, families, communities, and economies. The imperative for action has never been clearer. Over the coming decade, millions more people and communities will lose loved ones to avoidable and early death due to government inertia. Millions more will suffer pain, disability and anguish because of lack of diagnosis and treatment. Millions will struggle with entrenched poverty caused by catastrophic out of pocket health expenditures. These millions of people each have lives, stories and futures that could be much better. The world’s most marginalised populations are most at risk, exacerbating health inequalities and hindering social and economic development. 

The Heads of State and Government that attended the 2018 UN HLM on NCDs have the power to rise up as a united and formidable force against the scourge of NCDs. There is now palpable urgency  and impatience for these political leaders to return home and follow up with action and investment, and to coordinate across the whole of government and whole of society, igniting the crucial collective response required to overcome the surging tide of NCDs.

Shortcomings of the Political Declaration 

Governments have squandered the opportunity of this HLM to close the financing gap for NCDs with real commitments for the health of their people. Leaders who neglect to make significant investments in NCDs are failing their citizens and will be responsible for untold avoidable suffering and loss of life. Actions to save lives are simple and extremely cost-effective; investing in the tried-and-tested WHO Best Buy interventions yields a seven-fold return in low- and lower-middle-income countries. 

The absence of strong language on implementing the Best Buys, which focus on taxation, regulation and legislation, is a glaring omission from the document. This reflects interference and undue influence of health-harmful industries over a few countries who were prepared to shamelessly block progress for all. We are deeply disappointed that too few countries were prepared to stand up and show real leadership to put the health and wellbeing of their people ahead of the short-term and short-sighted economic interests of the few. 

Implementing the 16 Best Buys worldwide would save 9.6 million lives by 2025, according to new data by WHO. The enormous life-saving potential of these proven, cost-effective measures in the remaining years until our 2025 deadline includes, for example, nearly 70,000 lives in South Africa, 150,000 in Egypt, almost 250,000 in Italy, 340,000 in Germany, over half a million in the USA,  1.3 million in India and over 1.7 million in China. Failure to comprehensively implement these measures - and to try to block others - to save all these lives is inexcusable. 

The anaemic stance on accountability encapsulated within the document is perhaps its greatest failing. The scheduling of the next UN HLM on NCDs in seven years’ time risks prolonged procrastination, when today’s political leaders need to realign the trajectory of progress immediately to meet the targets that they have committed to for 2025 and 2030. We remind our leaders that their failure to date to deliver on their commitments at the 2011 and 2014 UN HLMs is not just statistics and economic losses, it is unnecessary suffering and preventable death in every country. We deplore the absence of new ambitious time-bound commitments and accountability measures in the Declaration to propel the response forward. Robust independent accountability mechanisms, including NCD Countdown 2030, will be essential to ensure that the promises made by the international community are delivered. 

Building on the foundations for a healthier future for all

Despite these disappointments in the Declaration, the display of leadership throughout the negotiations on the 2018 UN Political Declaration from several countries in Latin America, the Caribbean, and the Pacific Region was inspiring, with demonstrable commitment to their people and communities - exemplifying the mantra - ‘ENOUGH. Together we are stronger. Together we can beat NCDs.’ The inclusion of a paragraph in the 2018 UN Political Declaration on engaging civil society and people living with and at risk of NCDs in national NCD responses is a clear indication that governments have seen the value of working with civil society and the people most affected. 

Recognition of mental health and environmental risk factors for NCDs as core components of the NCD response reflects the reorientation towards a ‘5 x 5’ approach and is a definitive and crucial step towards more fully inclusive action for NCDs. Civil society was also pleased to see the negotiations on the Political Declaration successfully concluded with a compromise on the language concerning the Trade-Related Aspects of Intellectual Property Rights (TRIPS), which has important implications for essential medicines for treatment and care for millions of people living with NCDs worldwide. And, for the first time, an NCD Declaration includes language on respecting human rights obligations. This lays strong foundations for preparations towards the 2019 UN HLM on Universal Health Coverage - in which we expect to see NCD prevention and control fully integrated. 

The 2018 HLM on NCDs is a watershed moment for the NCD movement. We will not rest, we will not be polite in our own dedication and energy for a world free from preventable suffering and death from NCDs. We implore leaders: talk to your people and hear their stories, look at the data and commit to action for the sake of the people that the numbers represent, and ask yourselves: are you doing enough to ensure the health and well-being of your people, your societies, and your economies? We will hold leaders to account for their commitments, the organisations who obstruct progress, and those whose action or inaction are costing us all dearly.

We have had enough of inaction on NCDs. We have had enough of apathy. It’s time to invest. It’s time to act. It’s time to deliver. It’s high time to save lives.

Download the NCD Alliance partners statement

See list of signatories

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2. WHO (2018) NCD Country Profiles: http://www.who.int/nmh/publications/ncd-profiles-2018/en/

WSO President calls for quick and decisive action on NCDs at UN High Level Meeting

Today the the UN world leaders are gathered to agree and commit to a programme of action to accelerate progress on NCDs. While the proposed outcome document for the UN High Level Meeting on NCDs doesn't go far enough, it is perhaps our best opportunity to date to address the diseases which - world-over - are most likely to kill us and cause immeasurable suffering. WSO President Werner Hacke will attend the meeting and has prepared this oral statement calling for fast and decisive action and offer support to Member States in their work to tackle the risk factors for stroke and other NCDs.

President's Statement for UN High Level Meeting on Prevention and Control of Noncommunicable Diseases, 27th September 2018

My name is Werner Hacke, a Neurologist from Germany and I speak here as the President of the World Stroke Organization.

Every year, almost 15 million human beings die of stroke and many more survive with a lifelong burden of physical, cognitive, mental, and socio-economic impairment. This cruel tragedy leaves families desperate and could be avoided. Stroke is both preventable and treatable.

Stroke shares the same risk factors as cardiac diseases and other NCDs such as smoking, high blood pressure, diabetes, obesity, lack of execise, alcohol abuse and unhealthy foods.

These facts have been well known for decades and the solutions are obvious and cost effective, but actions are slow and reluctant.

Any further delay caused by lack of political will and weak compromises, will result in a massive increase of patients suffering and dying from stroke and other NCDs, especially in poor societies. We have had enough futile discussions about facts that no one can seriously deny.

For many scientists and NGOs, the proposed outcome document may look repetitive, timid and not like a big break through- but at least it's a signal.

Its time to act now and take quick and clear decisions. Otherwise unnessary premature deaths and suffering will grow dramatically, and the responsibility for this unfortunate development will rest with us.

Therefore the WSO will support all member states in their efforts to improve prevention, get rid of dangerous lifestyles, provide access to medical services, broaden health coverage and access to essential drugs, not only for stroke.

Driving Sustainable Action for Circulatory Health

This week World Stroke Organization President Werner Hacke, along with Vice President Michael Brainin, Global Policy Chair Bo Norrving and Chief Executive Mia Grupper, are in New York to attend the Third UN High Level Meeting on Non-Communicable Diseases (#UNHLM3).

The meeting, taking place on the 27th September, is focused on accelerating progress and identifying actions required to deliver on priorities that UN Members States committed to over five years ago.

While the title of the meeting may sound rather dry and the UN might feel a bit distant, there could not be more at stake. This could be our best opportunity to tackle the diseases that are most likely to kill us in the next 10 years.

The HLM will be attended by Heads of State and Minsters from around the world. This is a critical opportunity to hold them to account and to ensure that they use the evidence of what works to drive action on NCDs.

Together, heart disease, stroke diabetes and kidney disease represent the single largest cause of death worldwide, accounting for around 20 million deaths and staggering total of 374 million years of life lost to death and disability in one year alone. Stroke accounted for 116 million years of life lost in 2016 alone. While people of all ages and all continents are at risk, the burden of disease is felt disproportionately in low to middle income countries where individual suffering is compounded by access barriers and capacity of healthcare and where social and economic development is hampered poor health of the population.

The good news is that because these diseases share several common risk factors, coordinated action on prevention and treatment can result in major gains - and at a much lower cost than dealing with the consequences. WHO and World Economic Forum have identified key policy 'Best Buys' and a recent Lancet Taskforce series on NCD economics economics has indicated dollar for dollar returns that would come from addressing in NCDs now. We also know that where governments haven take responsibility and put in place policies and programmes, progress has been made.

This is why, in addition to raising awareness of specific issues in stroke prevention, treatment and support, the WSO is working as a key partner in the Global Coalition for Circulatory Health to push for more urgent focus and to support coordinated efforts by governments and other stakeholders.

Our joint calls are captured in a White Paper which was launched at a UN side event today.  Driving Sustainable Action for Circulatory Health sets out the key pillars of action that will ensure delivery of global goals on disease reduction:

Pillar 1: Prioritising multi-sectoral and cost-effective interventions

Pillar 2: Fostering access to the prevention and care of circulatory diseases

Pillar 3: Mobilising resources for circulatory health

Pillar 4: Measuring and tracking progress

About the Global Coalition for Circulatory Health

Up Again After Stroke

This year the focus of World Stroke Day is on life after stroke. Around 80 million people living in the world today have experienced a stroke and over 50m survivors live with some form of permanent disability as a result. 

While for many, life after stroke won’t be quite the same, our campaign aims to show that, with the right care and support, a meaningful life is still possible. As millions of stroke survivors show us every day, it is possible to get #UpAgainAfterStroke.

While the impact of stroke is different for everyone on 29th October 2018, we want to focus the world’s attention on what unites stroke survivors and caregivers; their resilience and capacity to build on the things that stroke can’t take away and their determination to keep going on the recovery journey.

Join with us

Our website has resources and key messages to help you raise awareness of life after stroke issues on World Stroke Day. Here's how you can join with us and show support and solidarity with stroke survivors on World Stroke Day:

• Download campaign social media resources from the campaign website www.worldstrokecampaign.org; If you have some design skills and software and want to adapt materials for local use contact campaign@world-stroke.org
• Change the heading pictures on your account and share social posts with your networks.
• Share your personal experience as a stroke survivor or caregiver on Facebook and twitter. Be sure to include the campaign hashtag #UpAgainAfterStroke so that your experience is seen and shared.
• If you don’t use social media, share your story of stroke recovery on the World Stroke Campaign website. 

Breaking Up Sitting Time after Stroke (BUST-Stroke)

Coralie English (@Coralie_English) 

Frequent, short bouts of exercises in standing can reduce your blood pressure after stroke

We have all heard the media stories about the dangers of sitting time ‘beware the chair’, ‘sitting is the new smoking’ and other such sensationalized headlines. Is there any truth to such statements and what, if anything, is the relevance to stroke recovery? Firstly, yes there is some truth to the headlines. 

While comparisons to the health risks of smoking are nonsensical, we do know that spending long periods of time sitting down each day is not good for you, particularly if you are also not getting enough exercise of the ‘huffing and puffing’ type. In fact, a large meta-analysis of data from over 1 million adults published in The Lancet in 2016 showed that amongst those people with the lowest levels of ‘huffing and puffing’ exercise, higher levels of sitting time were associated with a very large increase in the risk of cardiovascular disease. This is relevant for people with stroke for two reasons. 

• First, people with stroke are at particularly high risk for recurrent stroke and other cardiovascular diseases. 
• Second, we know that people with stroke fit this profile of very low levels of physical activity and high sitting time ((click here for link)). 

So, what can we do about it? 

Breaking up sitting time with frequent, short bouts of light intensity activity (e.g. exercises while standing or walking) may help. Studies in other population groups have found beneficial effects for this approach. 

My group has just completed the first ever study of this approach in people with stroke. We conducted a trial under tight experimental conditions and found that when stroke survivors stood up every 30 minutes and performed 3 minutes of light intensity exercises in standing (mini-squats, toe raises and marching on the spot), they had lower blood pressure over the day, compared to sitting continuously for 8 hours. Most importantly, this benefit occurred even in people who were taking blood pressure lowering medications. This is an important finding, because high blood pressure is the leading risk factor for stroke, and every small reduction in blood pressure reduces risk. Of course, doing standing exercises strictly for 3 minutes every half-hour each and every day is not feasible. Our group is now testing more practicable doses of exercises and their effects on blood pressure. In the meantime, ‘move more, sit less’ is a good mantra to live by for all of us!

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