Turning the global stroke commitment into action

Earlier this year, the World Health Assembly adopted its first comprehensive resolution on stroke [1]. The resolution aims to reduce the burden of stroke globally, covering prevention, acute care, rehabilitation and health-system readiness [2]. 

As a clinician and the Chief Medical Officer at Philips, I welcomed this decision. Stroke remains a major global health challenge.  It is the world’s second-leading cause of death worldwide and the third-leading cause of disability [3]. 

The WHO resolution is significant because it recognizes that reducing the devastating impact of stroke requires coordinated action across the entire care pathway. 

However, as we mark the first World Stroke Day since this landmark resolution, the key question is whether this commitment will ultimately improve stroke care for people around the world.  

The unmet burden of stroke

Stroke is distinctive among noncommunicable diseases, as many stroke cases can be prevented, and timely treatment and rehabilitation can improve outcomes. 

Many strokes are linked to risk factors, such as high blood pressure, that can be identified and managed, while treatments like intravenous thrombolysis and mechanical thrombectomy can reduce the risk of death or disability when delivered in time [2].

And yet, despite these advances, most people with stroke cannot access the care they need. The median global access rate for thrombectomy is below 3%, while approximately 87% of stroke deaths occur in low- and middle-income countries (LMICs) [2,3]. 

This is especially worrying when considering that almost 94 million people are living with the effects of stroke today, and that one in four survivors will have another stroke within five years [4].

The evidence is clear, but what’s missing is the system around it, which is the gap the WHO resolution aims to close [2].

National plans are the bridge

A global resolution sets the agenda, but national action is what delivers on its promise.

That is why countries must adopt the global commitment into their national plans. The resolution urges WHO Member States to include stroke in their national cardiovascular disease plans, neurological disorder strategies and universal health coverage planning, with dedicated objectives across prevention, acute care and rehabilitation. Where appropriate, a dedicated national stroke plan can do the same job.

A good plan translates the global commitment into local priorities. It names who is responsible, directs investment and gives governments and healthcare authorities a means to track progress. 

Without a clear and effective national plan, even the strongest resolution risks staying on paper.

What action looks like along the care pathway

"Action" can sound abstract, so it helps to be specific about what it means at each stage of care:
 

• Preventing stroke: Strengthen primary care so teams can identify and manage risk factors including high blood pressure, diabetes and atrial fibrillation. 
• Responding quickly: Build emergency pathways to help people recognize stroke signs, reach hospitals quickly, and receive timely imaging and treatment when appropriate. Timely care can significantly improve outcomes.
• Enabling recovery: Invest in stroke units, rehabilitation and long-term community support so people recovering from stroke and those who support them can access ongoing care. 
• Learning and improving: Use registries, surveillance and quality measures to identify gaps and monitor progress. 

A plan must be practical and accountable

The WHO resolution is clear about what makes implementation work: trained health workers, affordable access to medicines and services, sustainable financing, data to guide decisions, and attention to underserved populations [2].

I encourage every policymaker to turn these into three simple questions:
 

1. What are our country's biggest gaps along the stroke pathway?
2. Who is responsible for closing them?
3. How will we measure progress?

If a national plan can answer those questions, it is ready to deliver. If it cannot, it is not yet an effective plan.

The estimated direct and indirect costs of stroke globally are over USD 891 billion annually [3]. Investing in prevention and treatment may improve health outcomes and reduce the impact on health systems. 

An urgent need to improve health equity

The impact of stroke is growing, and people in low- and middle-income countries (LMICs) are disproportionately affected. Access to prevention, treatment and rehabilitation vary widely [3].

So, national plans should not assume every country starts from the same place. They need to reflect local needs and reduce geographic and financial barriers. For some countries, the priority will be improving blood pressure control in primary care settings. For others, it will be building stroke units or extending access to thrombectomy beyond major cities. 

Where someone lives should not decide whether they have a fair chance at recovery, and national plans must have this principle at their core.

Innovation is an enabler, not the whole answer

Timely care matters in stroke. Diagnostic imaging, image-guided therapy, and connected data can support care teams in making informed decisions and reducing delays.

However, technology only delivers as part of a connected ecosystem.  Imaging and interventional systems are most useful when teams have the training, pathways, infrastructure, and resources to use them, so people can access the care.

That is also why workforce training matters as much as equipment. Building skills, from emergency teams to interventional specialists, is what turns capability into access.