Preventing and managing stroke is a public health priority. Stroke is the world’s leading cause of disability. It is the second leading cause of death. Stroke occurs when an artery to the brain gets blocked or bursts, and is often caused by modifiable risk factors such as tobacco use, inadequate physical activity and unhealthy diet. Though one in four people are in danger of stroke in their lifetime, 70% of all strokes occur in low- and middle-income countries, which also account for 87% of stroke-related deaths and disability-adjusted life years. In the last four decades the incidence of stroke declined by 42% in high-income countries. In low- and middle-income countries it more than doubled.
The WHO South-East Asia Region is part of this story. The burden of stroke in the Region’s Member States reflects that of low- and middle-income countries generally, with morbidity and mortality compounded by several challenges. For example, the capacity of primary health care facilities to manage risk factors, including hypertension and diabetes, is often limited. So too is access to acute and emergency stroke care, in addition to services for post-stroke rehabilitation. Care within and across countries can vary significantly, and is influenced by a patient’s location, socioeconomic status, education and cultural beliefs.
Progress has been made. Since 2014 the battle against noncommunicable diseases (NCDs) has been one of the Region’s Flagship Priorities. All countries are striving to reduce premature mortality caused by NCDs by at least a quarter by 2025 (based on 2010 levels). By 2018, each Member State had developed a Multisectoral National Action Plan on NCDs that includes specific interventions to help prevent and manage stroke. They are now implementing them. The Colombo Declaration on accelerating the delivery of NCD services at the primary level, which the Region adopted in 2016, has catalyzed the scale up of frontline services Region-wide, and is helping all countries advance towards the Region’s Flagship Priority on universal health coverage (UHC).
For the Region to sustain and accelerate its progress, more work is needed. As Member States apply their national NCD action plans and identify opportunities to innovate, several areas should be of focus.
First, public outreach campaigns that promote healthy lifestyles should be augmented. The causal link between tobacco, alcohol and stroke should be more explicitly made and the benefits of abstention emphasized. Both messages should be communicated as widely as possible, including in schools and workplaces, as well as via popular media. Additionally, the consumption of fruits and vegetables – both anti-stroke superfoods – should be encouraged and the benefits of physical activity highlighted. As people age, the importance of regular blood pressure, blood-sugar and cholesterol check-ups should be imparted.
Second, Member States should continue to enhance NCD services at the primary level, with a focus on preventing, detecting and managing hypertension and diabetes. To do that, all primary facilities should be equipped with the technologies needed to detect the problems, as well as the medicines and medical products required to manage them effectively. All frontline staff should have the capacity to use and prescribe those technologies and medicines, and understand the need to screen at-risk groups as a matter of routine. Health workers should also be trained to provide healthy lifestyle counselling to help patients avoid NCDs in the first place.
Third, services for acute and long-term stroke care should be established or enhanced. Emergency services that are guided by national treatment protocols and which have efficient referral systems are crucial to preventing stroke-related disability or death. So too are staff that have the skills to support emergency care and management and act in accordance with protocol. Where stroke-related complications occur, access to services that provide rehabilitative care and therapy is essential, whether provided in a health care facility, a patient’s home or in the community. Access to occupational therapy or cognitive rehabilitation can be the difference between recovery or lifelong disability.
The opportunities for the Region to make further advances against stroke are many. Each of them must be grasped. Though our progress has been steady, it is by no means guaranteed. On World Stroke Day, WHO reiterates its commitment to supporting Member States prevent and manage stroke, both as an end in itself and as part of the Region’s Flagship Priorities on NCDs and UHC and its quest to achieve the ‘25x25’ and SDG targets. We know what needs to be done. We know how to do it. A healthier, happier and more productive Region is possible.