World Stroke Day 2020 News Release

29 Oct 2020

WSO leader calls on governments to prioritise population-based approaches to public health, as adult lifetime risk of stroke increases from 1 in 6, to 1 in 4.

To mark World Stroke Day on Oct 29th 2020, has issued a call to governments and policy makers to prioritise population-based approaches to public health improvement as part of future public health strategies. ‘Current approaches to prevention have failed to deliver any significant impact on CVD and stroke prevention’, said WSO President, Prof Michael Brainin. ‘The adult lifetime risk of stroke is now 1 in 4, compared to 1 in 6 less than a decade ago. Global progress on prevention has stalled, at an enormous cost to individuals, and an increasing cost to society.

The failure has been made even more visible by the current global health and economic crisis, where poor population health and fragile healthcare systems have combined with COVID-19 infection to deliver a perfect storm. As we navigate and emerge from the current global crisis, we strongly encourage governments to prioritise population-based strategies that will improve health, build more resilient societies and aid the global economic recovery.’

UN member states have committed to reduce premature mortality from non-communicable diseases by one third by 2030. As the second leading cause of death and the leading cause of disability addressing the risk factors for stroke is essential to delivering on that commitment.

Prof Valery Feigin, a public health researcher based at New Zealand’s AUT, who serves on the WSO Executive Committee added, ‘Now more than ever, we must ensure that approaches to prevent stroke are not only cost-effective and evidence-based. When 80% of strokes happen to people who are not categorized as high-risk, we clearly need to rethink our approach. Clinically-focused patient screening strategies often fail to identify and support people with low and moderate risk to ensure that they remain healthy in the longer-term and here is scant, robust scientific evidence that national screening programs offer value for money in terms of reducing the burden of disease.

‘Identifying people and labelling them as low-risk gives them false reassurance and reduces their motivation to take action. By placing all our bets on identifying and treating diseases of the circulatory system, we are missing the opportunity to intervene on the causes much earlier in the prevention timeline where the costs are lowest. What we need is a focus and commitment to the implementation of policies such that address tobacco use, alcohol consumption, exercise and diet that help people to make healthier choices. In a challenging economic environment this also makes sense; the benefit-cost ratio for every dollar spent on population-wide primary prevention is 10.9. While there is a place for screening and management of clinical risk factors, our strong recommendation is that it should be complementary to population-based strategies, not the other way around.’

Today’s call builds on the WSO Declaration on Prevention of Stroke and Dementias, published in the The Lancet Neurology earlier in 2020. Key principles in the Declaration that the global stroke body is recommending include:

1 Adoption of population wide strategies that reduce exposure to stroke risk factors such as tobacco, alcohol and food policies, as well as action to address environmental risk factors, including air pollution, across the lifespan of the whole population.

2 Implementation and promotion of motivational mobile technologies, e.g. the WSO endorsed StrokeRiskometer, to identify individual risks and support action on lifestyle risk factors among adults.

3 Access to low dose combination of generic blood pressure and lipid-lowering therapies in one polypill for middle age and older adults with at least two behavioural or clinical stroke risk factors.

4 Investment, training and deployment of community health workers to facilitate implementation.

In The Lancet Neurology article, WSO presented combined research evidence that shows a combination of these interventions would lower the incidence and of stroke by 50% and dementia incidence by 30% while contributing to decrease in incidence of other non-communicable diseases which share common risk factors.

WSO President Prof Michael Brainin, who champions the organization’s prevention effort said ‘COVID-19 has spurred previously inconceivable levels of government intervention and individual behaviour change around the world, but we have been effectively living with a stroke pandemic and a failing prevention strategy for years.

The need for similar, radical action on stroke is clear and our prevention principles provide low cost, evidence-based approaches that if implemented globally would not only save millions of lives but would deliver savings of hundreds of billions of dollars annually. This is money that will be desperately needed to strengthen global health systems and to fuel economic recovery in the wake of COVID-19.’

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