World stroke day 2009

Stroke is a leading cause of premature death and disability globally. The World Health Organization has estimated that in 2002, there were 15·3 million strokes worldwide, more than a third of which (5·5 million) were fatal (1). Stroke deaths account for approximately 10% of all deaths (2). If appropriate action is not taken, the number of global deaths due to stroke is projected to rise to 6·5 million in 2015 and to 7·8 million in 2030 (3).

Over the past four decades there has been a significant decrease in stroke incidence in high-income countries and an increase in incidence in low- and middle-income countries (LMIC) (4). 87% of the burden of stroke, as measured in disability-adjusted life years (DALYs), is borne by LMIC, at present, exceed stroke ranks fifth overall as the cause of lost DALYs (1, 2). The overall stroke incidence rates in LMIC at present, exceed the level of stroke incidence in high-income countries (4). Low- and middle-income countries are experiencing a rise in the burden of non communicable diseases (NCDs) including stroke and other atherosclerotic vascular diseases due to population ageing and a rising prevalence of modifiable risk factors including: tobacco use, unhealthy diet, physical inactivity, obesity and raised levels of blood pressure, blood glucose and blood cholesterol (5). The decline in stroke burden in high-income countries is due to a combination of: reduction of exposure to cardiovascular risk factors, treatment of hypertension, diabetes and hyperlipidaemia, availability of imaging technologies for diagnosis, improvement in acute care of stroke and stroke rehabilitation (4).

There are several reasons why the primary prevention of stroke should be prioritised and is likely to have a greater impact on stroke burden than even the best interventions after the event. First, even in high-technology settings, the proportion of patients who are dead or disabled at six months after a stroke is about 62% (6).

Second, stroke has a high case fatality with a mean total stroke case fatality in LMIC of about 27% and a much higher case fatality (39%) for primary intracerebral haemorrhage (4).

Third, acute care of stroke, access to high-cost technologies for diagnosis of stroke and multidisciplinary stroke care are beyond the capacity of weak health systems in LMIC.

Recognising the public health challenges posed by stroke, the implementation plan of the Global Strategy for Prevention and Control of NCDs endorsed by the WHA in May, 2008, has prioritised stroke within the four major NCDs for global action (7). The implementation plan is a call to action for countries to address NCDs including stroke by positioning health in all government policies, developing integrated national NCD policies, investing in research and monitoring and working together through partnerships.

The World Stroke Organization, an NGO in Official Relations with the World Health Organization is promoting World Stroke Day to raise awareness of stroke across the world. The World Stroke Day activities will take place on 29 October. The objective is to motivate people, health workers, policy makers, governments and aid agencies to take action against stroke. The WSO will be delivering tools to support advocacy activities and media releases. The WSO will also be providing awards to the most innovative and effective activities in different regions of the world to recognise efforts that heighten stroke awareness.

The activities of the World Stroke Day should strengthen policies and programmes to reduce mortality and disability related to stroke, and ensure that stroke, in the context of cardiovascular and other major NCDs, is placed more firmly on the health and development agenda at national and global levels. The majority of strokes occurs because what is already known about the disease is not translated into action, particularly in the area of prevention. This year's World Stroke Day theme ‘Stroke – What can I do?’ is a reminder that everyone has a role to play in curbing this serious and life-threatening disease that is largely preventable.

The views expressed in this paper are solely the responsibility of the author and do not necessarily reflect the decisions or stated policy of the World Health Organization or its Members States.