The ammunition to fight stroke and NCDs together

A Call to Action and Ammunition Needed to Beat Stroke and NCDs

By Prof Bo Norrving, WSO Global Policy Committee Chair

Next week I will be in Montréal, alongside 2500 stroke leaders and stakeholders spanning clinical practice, research, rehabilitation and patient and caregiver organizations. The expertise and individual interests represented at the biennial World StrokeCongress may be diverse, but our common commitment is the same – to fight stroke and reduce its devastating impact on individuals and society.

As the world’s second largest cause of death and disability it is a battle well worth fighting, but one that we don’t have to – not should we - take on alone. Globallly, regionally and nationally there are networks and alliances working to break down the traditional siloes between disease groups in order to increase the speed at which the world addresses the diseases that are most likely to kill us.  We know, that by connecting the dots and coordinating our efforts with others who have a shared investment in beating NCDs, we can achieve more, maximise our investments and move faster than we can individually. When investments have been slow to come, and governmental commitments to change continue to disappoint, this could be the key to making progress.

The sense that together we are stronger, is certainly the driving force for collaboration between the NCD Alliance and the World Stroke Organization (WSO) and the rationale behind our latest partnership collaboration Acting on Stroke and NCDs. The aim of this policy brief, which will be launched at the World Stroke Congress in Montréal, is to clearly articulate the shared prevention and treatment issues for NCD stakeholders and to set out key priorities for action at global, regional and national level. It is our hope that Acting on Stroke and NCDs provides not just a call to action, but the ammunition needed to beat NCDs.

The publication clearly sets out the contribution to stroke to global NCD mortality and identifies the shared and specific gaps in current approaches to addressing stroke and NCDs. When only 6% of all people who have a stroke have no comorbidities and when comorbidities result in not only higher healthcare, individual and social costs, this policy brief sets out a strong evidence-based argument and some clear action points that will turn the tide on stroke and NCDs .

How to respond to the challenge of stroke and NCDs

Invest in prevention

Given that 90% of strokes are linked to 10 modifiable risk factors, several of which are shared by a number of NCDs, investing human and financial resources in diagnosis, education and risk reduction will deliver advances across the board

Ensure access to acute and chronic speciality care

People need to be treated in services and by clinicians in accordance with clinical practice guidelines for NCDs. Access to stroke units and to acute therapies is a backbone in stroke care, as is rehabilitation and long-term support.

Strengthen the primary healthcare network

Access to a solid primary care network is essential to effective prevention and long-term treatment of stroke and NCD. Financial barriers and out of pocket costs for prevention, diagnosis and treatment needs to be reduced. Universal health coverage should cover essential diagnostic and treatment.

Implement the WHO HEARTS Technical package

Taking the seven steps set out in this package would ensure that the right medicine reaches stroke patients at the right time and at an affordable rate.

Every 2 seconds, someone somewhere in the world has a stroke, the clock is ticking and we don’t have time to wait – strengthened actions on stroke and NCDs are urgently needed. Let’s gather our allies, target our actions and work for upscaled efforts. We have had ENOUGH on political inertia on NCDs.

REPORT Educational Stroke Program in Brazil

Endorsed by World Stroke Organization 

The Ministry of Health of Brazil published on April 12th 2012 a national policy for stroke. The policy included the organization of stroke care in local networks integrating all points of care for stroke assistance (primary care professionals, pre-hospital Emergency Medical System and hospitals), development of stroke units, payment of tPA for the government and better reimbursement for stroke patients treated in stroke units.

To help the Ministry of Health implement this policy, we launched on June 20th 2012, an Educational Stroke Program, a partnership between the Brazilian Stroke Society, Brazilian Academy of Neurology, Brazilian Stroke Network, Brazilian Medical Association and the Ministry of Health and endorsed by the World Stroke Organization.

The educational program consisted of two sections; firstly an online component and secondly via a face to face meeting.

The lectures were prepared by stroke neurologists, based on international practice guidelines, and has trained all professionals linked to stroke assistance, including primary care professionals to improve primary and secondary prevention.

The online course is free.

Our online course trained more than 6000 doctors and 4000 other health professionals.








In 2017 we had several in person training:
* pre-hospital - SAMU (8)
* stroke centers (39)
* community hospitals (5)
* primary attention (2)
* neurologists (2)

Now in 2018 we are planning to renew the online lectures.




Dr Sheila Martins

World Stroke Day 2017 - A Message from our President

Today I am in Moscow where, in partnership with the Russian Ministry for Health, we we have held the first ever World Stroke Day Congress.  This event is just one of hundreds of activities taking place in honour of World Stroke Day. From Singapore to Sao Paolo, events and activities are taking place on the streets and in government buildings to raise awareness of stroke and prevention. This is urgent and necessary work. Every 2 seconds someone in the world has a stroke. We have no time to spare.

In low and middle-income countries stroke has reached epidemic proportions, with evidence showing that younger people are increasingly at risk. This is particularly devastating in these countries where resources for healthcare and social support is scarce.

In high-income countries, where the incidence of strokes has gone down, access to treatments and an ageing population means that - while more people survive – many are living with significant disabilities and long-term support needs. Last year stroke accounted for 116 million years of life lived with disability.

Regardless of age, or where a person lives the impact of stroke on individuals and families is enormous. The pressure on healthcare services and economies is unsustainable. 

We all have good reasons to prevent stroke and the good news is that stroke prevention is possible if we take individual and collective steps. 90% of strokes are linked to just 10 risk factors that we can all do something about. Use today to get informed about risks and prevention and join with us to make sure that stroke gets the attention and resources it deserves. Help us deliver a world free from stroke.

Thank you for being part of World Stroke Day!

Prof Werner Hacke, President, World Stroke Organization

NEWS RELEASE World Stroke Day 2017

New Global Disability Figures Spur WSO Call for Urgent Action on Stroke Prevention

The World Stroke Organization, a membership organization representing over 55,000 professionals and many more stroke patients worldwide, has today called for urgent action to prevent stroke. The call, made in advance of World Stroke Day on the 29th October, comes in response to new data that shows stroke was responsible for over 116 million years of life lived with disability (YLD) worldwide in 2016. This adds to existing global mortality data that positions stroke as the second largest cause of death.

There are an estimated 17 million strokes worldwide each year.  While stroke incidence and mortality rates in high income countries have been on the decline, progress is still slow and uneven. There are also indications that the risk factors for stroke such as hypertension, obesity, diabetes and smoking are becoming increasingly prevalent in both high and low-income countries. This has the potential to further slow progress on stroke prevention.

WSO President Werner Hacke said ‘In many low-to-middle income countries stroke has reached epidemic proportions. In these countries, the capacity of health and social care systems to provide treatment and the long-term support that stroke survivors and their families need is also limited. This has disastrous effects on individuals, families as well as on economic development.’ 

Professor Hacke continued ‘On World Stroke Day 2017 our members are sending out a global message that stroke is preventable and that we all have good reasons to prevent it. We know that 90% of strokes are associated with just 10 risk factors that we can all do something about. Addressing these risk factors would not just have a major impact on stroke, they would also prevent deaths from other non-communicable diseases. Giving urgent priority to prevention now will yield obvious benefits in terms of reduced human, social and economic costs.’

The World Stroke Organization has called on governments to implement population wide prevention strategies; remove financial barriers to prevention screening; develop regional and national strategies to reduce premature deaths from NCDs by 30% by 2030.

World Stroke Day is being commemorated at events worldwide on 29th October 2017. More information can be found on the campaign website. 

Join the conversation #WorldStrokeDay

United in Prevention - announcing the Global Coalition for Circulatory Health

The World Stroke Organization is proud to announce our active participation in the Global Coalition for Circulatory Health launched on 18th October 2017. The Coalition brings together professional organisations and people living with and affected by circulatory diseases, to advocate for international and national actions to prevent and control circulatory diseases many of which contribute to stroke.

Here, David Wood, President of the World Heart Federation highlights the need turn 'what we know' into 'what we do' in relation to public health prevention and health system strengthening.
Circulatory diseases, including heart disease and stroke, are the leading cause of death and disability in the world, killing around 17.7 million people a year. This means it is responsible for a third of all deaths on the planet and numbers are set to rise, to an estimated 23 million by 2030.

It is a terrible burden on our society, felt even more keenly in low- and middle-income countries where factors such as rapid urbanization, tobacco use and obesity are an increasing drain on national health systems.

Business as usual not an option for addressing NCDs

Government and NGO leaders from around the world are today convened in Montevideo, Uruguay for the WHO Global Conference on Non-Communicable Diseases (NCDs).

The conference which will run until the 20th October, has been called in the face of slow progress towards global targets to reduce NCDs by 30% by 2030.

The World Stroke Organisation will be represented in Montevideo by Board Member Sheila Martins, who will add WSOs voice to the call for governments to stand by their commitments to SDG3 by addressing the policy and investment issues which are slowing progress on disease reduction.

There are fundamental conditions associated with all NCDs such as poverty, education, environment, human rights and strength of health systems which urgently need to be addressed. Along with our NCD Alliance partners we will be advocating for the development of coherent public health policies and health systems investments that will underpin prevention and improved and more equitable outcomes for stroke patients globally.

Our key message to governments is that urgent action is required to prevent stroke and other NCDs which limit human potential and financial resources available to support healthy communities. 90% of strokes are associated
with 10 modifiable risk factors that, if addressed, would support reduction of Alzheimers, heart disease, hypertension, cancers and diabetes all of which post major challenges to national and global health systems and economies. The time to act is now.

• Visit the WHO website for more information about the WHO Global Conference on Non-Communicable Diseases
•  To find out more about the World Stroke Organization's campaign to prevent stroke visit the World Stroke Campaign website
• For conference news and to join the conversation follow #BeatNCDs on twitter

A Wolf in Sheep's Clothing - Foundation for a Smoke Free World

A message from World Stroke Organisation President, Prof. Werner Hacke

As you may have read, last week a new initiative was launched named the Foundation for a Smoke Free World. This foundation – whose leadership includes former WHO official Dr Derek Yach – is a tobacco-industry-funded initiative, set to receive $80 million of annual funding over the next 12 years from tobacco business Philip Morris International (PMI).

Alongside our colleagues at the WHO Framework Convention on Tobacco Control and the World Heart Federation,  the World Stroke Organization condemns this initiative in the strongest possible terms as an attempt by the tobacco industry to interfere in, and subvert, public policy.

Despite funding a foundation that claims its goal is to ‘eliminate smoking’, PMI continues to invest billions of dollars in marketing cigarettes worldwide, focusing many of these efforts in low- and middle-income countries where stroke, alongside other diseases related to tobacco use pose a growing individual and health system burden. 

Throughout previous decades, the tobacco industry – including PMI – has sought to maintain its profits by sowing misinformation among the public and blocking policies designed to protect public health. PMI’s recent failed attempt to sue the government of Uruguay for implementing anti-smoking legislation is just one recent example of these efforts.

Tobacco use is associated with around 1 in every 10 strokes and according to current WHO projections, tobacco use will kill a total of one billion people this century.  As the leading global organization that brings together the stroke community to create a world free from stroke, the World Stroke Organization is committed to support all legitimate efforts to achieve a smoke-free world.

The best path to tackle this epidemic and achieve a smoke-free world is by implementing policies set out in the WHO FCTC – not by engaging with an industry that has shown repeatedly that it cannot be trusted to defend, let alone promote, public health.

We ask you to share information on this foundation with your colleagues and networks, so that the stroke community can be on guard against these attempts to undermine progress we are all working hard to achieve.

The World Stroke Organization strongly endorses the efforts of the World Health Organisation to reduce tobacco-related illness and death

Stephen Davis and Valery Feigin, on behalf of the World Stroke Organization 

Stroke is a leading cause of death and disability, particularly in low and middle-income regions. Smoking is a major modifiable risk factor for stroke, with similar risk in women and men. Smoking (both active and passive) has been known as one of the most important risk factors for stroke for many years. In the most recent Global Burden of Disease 2015 Study, smoking was ranked the 5th most important risk factor for stroke accounting globally for almost 26 million disability-adjusted life years (DALYs) (23%) due to stroke, with the bulk of the burden (almost 22 million DALYs or 85% of stroke-related DALYs due to smoking) born in low- to middle-income countries. Smoking accelerates atherosclerosis in the cerebral arteries, an important cause of stroke.

A gram of prevention is worth a kilo of cure

A gram of prevention is worth a kilo of cure - reducing the burden of stroke in Europe

By Jon Barrick, President of SAFE and World Stroke Campaign Committee Chair

Over the past two decades Europe has seen a welcome reduction in the proportion of people having a stroke and for those who do experience stroke, their chances of recovering have greatly improved. The continent not only boasts some of the best stroke care in the world but has pioneered important developments in the prevention and treatment of stroke; supports an active stroke research community and has active patient advocacy organisations in almost every country.

It sounds like we’ve got it sorted doesn’t it? I should really be out of a job, but in spite of all this progress we still have a long way to go before people in Europe can expect to receive the same level of care, let alone aspire to the WSO vision of  ‘a life free from stroke’. Across the continent, there is still so much to do to reduce the burden of stroke that any hopes of a quiet retirement walking my dog have been reluctantly set aside.  Despite reduced stroke prevalence figures, overall numbers of stroke are set to increase by 34% by 2035, not only devastating an additional 300,000 lives, but taking the cost to the EU economy far higher than the current estimate of €45bn a year.

As the British saying goes ‘an ounce of prevention is worth a pound of cure’ and regardless of whether you prefer your quantities in metric or imperial, research estimates that over 90% of strokes are associated with 10 modifiable risks. In the context of an ageing population and concomitant increases in health and social care costs, you would expect to see political leaders and health providers doing everything within their power to reduce burden of stroke. And while the vast majority of European countries have indeed developed national guidelines for primary and secondary stroke prevention, in many countries these aren’t comprehensive or universally delivered.

While treating high blood pressure alone would almost halve the number of strokes, hypertension is significantly under-treated across Europe. Research indicates that well below half of the people who are actually being treated for high blood pressure, aren’t on enough medication to bring it to the desired target level anyway.  An abnormal heart rhythm (Atrial Fibrillation or AF), which is associated with a three to five fold risk of stroke and higher stroke related mortality and disability, is also significantly undiagnosed and under-treated.  For almost a quarter of stroke patients a diagnosis of AF only comes after they have had a stroke, despite diagnosis being as simple as taking a pulse. Even after stroke, when the risk is clearly known, AF is still an under-treated condition.

It’s not just in the treatment of underlying conditions that Europe shows room for improvement, from Sweden to Greece and Ireland to Estonia, public awareness of stroke risk factors would also benefit from more focused attention. Across the board, relatively few people are able to correctly identify all significant stroke risk factors and unsurprisingly underestimate their individual risk of stroke. Where is the motivation to listen to stroke prevention messages, let alone change your behaviour, if you don’t think stroke is likely to touch your life? While campaigns and public education initiatives have been implemented across the region - including many that are delivered as part of the World Stroke Campaign - more attention needs to be paid to measuring impact in relation not just to awareness but also to behaviour change.

And going beyond awareness, as my colleagues at WSO have highlighted elsewhere, we need to review some of our basic assumptions about public health interventions to tackle stroke. By implementing population-wide approaches that focus on creating healthier communities through for example, public smoking bans, taxing unhealthy foods, addressing obesogenic environments and tackling air pollution, we have the potential to deliver a double blow to stroke and to a range of diseases that share the same contributing factors. 

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The European Union now has the evidence and the opportunity to show leadership on stroke prevention, delivering solutions that can be learned from in other developed and developing regions of the world. Their first port of call should be the recommendations in SAFE’s Burden of Stroke in Europe Report.