The importance of advocacy in advancing stroke care: The global stroke action coalition

Abstract

Stroke represents one of the most significant global health challenges of the 21st century, with 11.9 million people experiencing stroke annually and a disproportionate burden falling on low- and middle-income countries, where 87% of stroke deaths and 89% of disability occur. Despite stroke being highly preventable—with 84% of the burden attributable to modifiable risk factors—and the availability of treatments that have proven to reduce the rate of death or disability, including stroke units, thrombolysis, and thrombectomy, these interventions remain inaccessible to most of the world’s population. Advocacy—systematic efforts to influence policy, practice, and resource allocation through evidence-based engagement with decision-makers—has achieved notable successes such as establishing stroke units globally. However, individual advocacy efforts face structural limitations in addressing global stroke challenges. The Global Stroke Action Coalition (GSAC) was formed in 2024 as a coordinated, multi-sectoral initiative convened by the World Stroke Organization, uniting scientific, civil societies, and industry partners to transcend these limitations. The Coalition leverages established infrastructure and expertise to create a unified advocacy force capable of commanding attention from global health leaders. Centered around five strategic priorities—integrating stroke into national non-communicable disease (NCD) strategies, developing National Stroke Action Plans, securing funding commitments, implementing monitoring systems, and including survivors in policy development—the Coalition successfully utilized the 2025 UN High-Level Meeting on Non-Communicable Diseases to further elevate the position of stroke on the global agenda. Key achievements include securing ministerial commitments from 10 countries and launching the “Every Minute Counts” campaign. The Coalition’s coordinated approach demonstrates that systematic, evidence-based advocacy can transform stroke care delivery globally, providing a framework for sustained collaboration across sectors and regions essential for meeting Sustainable Development Goal targets and reducing the devastating burden of stroke worldwide.

Introduction

Stroke is one of the most significant global health challenges of the 21st century. The World Stroke Organization (WSO) global burden of disease analysis shows that 11.9 million people have a stroke each year, with the burden falling disproportionately on low- and middle-income countries (LMICs), where 87% of stroke deaths and 89% of stroke-related disability occur, driven largely by demographic shifts and the growing prevalence of modifiable risk factors. ¹ Age-standardized stroke incidence rates vary dramatically from approximately 60 per 100,000 population in high-income regions to over 300 per 100,000 in parts of Eastern Europe, Central Asia, and sub-Saharan Africa. ² Case fatality rates in certain LMICs exceed 30% within the first month post-stroke, compared to less than 10% in countries with advanced stroke care systems, perhaps reflecting inadequate access to evidence-based acute care, including stroke units, thrombolysis, and thrombectomy. ¹ These disparities are compounded by significant within-country inequalities affecting rural, socioeconomically disadvantaged, and ethnic minority populations.^3,4

The current cost to global economies exceeds US$890 billion (0.66% of global gross domestic product (GDP)), projected to reach US$1.6 trillion by 2050 without intervention. ⁵ These financial pressures are particularly devastating in LMICs, where out-of-pocket healthcare expenses can push patients and their families into economic hardship, perpetuating cycles of poverty. ⁶ Beyond direct healthcare costs, stroke creates devastating ripple effects—survivors often face physical limitations, cognitive impairments, depression, and social isolation, while caregivers (predominantly women) sacrifice educational and economic opportunities. ⁷ The societal impacts are equally profound, as communities lose valuable contributions from both stroke survivors and their caregivers, while social support systems and community resources become strained. ⁸ These effects are magnified in settings with limited rehabilitation services, assistive technologies, and social support programs. In many lower-resourced regions, stroke affects individuals during their most productive years, creating intergenerational consequences as families lose primary income earners and children may forego education to provide care or to supplement family income.^9,10

Prevention remains the most cost-effective approach to reducing the global burden of stroke. Stroke is highly preventable, with 84% of the stroke burden in 2021 attributable to 23 modifiable risk factors, including high blood pressure, air pollution, excess body weight, smoking, and physical inactivity. ¹ Population-level interventions such as salt reduction policies, tobacco control measures, and improved access to antihypertensive medications have demonstrated remarkable success in reducing stroke incidence across diverse healthcare systems. ¹¹ Secondary prevention following transient ischemic attack (TIA) or minor stroke is equally critical, with appropriate management reducing subsequent stroke risk by up to 80%. ¹² Despite this compelling evidence, prevention strategies remain underutilized globally, representing a significant missed opportunity to reduce both human suffering and healthcare costs.

While stroke prevention is fully integrated within the non-communicable disease (NCD) landscape, several factors necessitate stroke-specific advocacy approaches. Hypertension management, as the single most important modifiable risk factor for stroke, requires specialized attention within prevention strategies. Stroke heterogeneity presents unique challenges, encompassing ischemic stroke/TIA, intracerebral hemorrhage, and subarachnoid hemorrhage, each with distinct treatment requirements. Unlike many NCDs, stroke requires time-critical interventions demanding specialized infrastructure and training for emergency response. Addressing stroke requires a comprehensive approach across the entire care continuum—from primary prevention and risk factor management, through acute intervention and emergency response, to rehabilitation and long-term community support. This continuum-of-care framework recognizes that effective stroke management demands coordinated action at multiple levels, with each phase requiring specialized infrastructure, trained workforce, and integrated care pathways.

The paradigm of stroke being an untreatable illness has dramatically shifted with three cornerstone interventions that have transformed care. Stroke units offer specialized care, resulting in a 22% reduction in mortality and improved functional outcomes; ¹³ however, stroke unit coverage is concentrated in high-income countries. Intravenous thrombolysis provides clot-dissolving therapy within the first few hours of symptom onset and in selected stroke patients up to 9 hours—or in wake-up strokes—using perfusion imaging to identify salvageable brain tissue (penumbra) where restoring blood flow can reduce disability. ¹⁴ Mechanical clot removal with endovascular thrombectomy offers dramatic improvements for patients with a large vessel occlusion, ¹⁵ but access to this intervention is extremely low globally, with disparities noted between countries by income level. ¹⁶ Rehabilitation services face similar constraints, with less than 20% of stroke survivors in LMICs receiving adequate rehabilitation support. These disparities are further compounded by structural barriers, including insufficient numbers of trained neurologists and stroke specialists, limited access to computed tomography (CT) and magnetic resonance imaging (MRI), weak referral and emergency transport systems, and fragmented care pathways that fail to support patients’ transition from hospital to community.

Despite proven efficacy, these interventions remain inaccessible to most of the world’s population. This implementation gap represents both a moral imperative and a strategic opportunity—the existence of highly effective treatments makes the case for urgent advocacy more compelling than ever, with a demonstrated potential impact.

The urgency of addressing stroke is further underscored by its significance within Sustainable Development Goal Target 3.4, which aims to reduce premature mortality from NCDs by one-third by 2030. Stroke and heart disease interventions represent key elements essential for achieving this target, with stroke responsible for 17% of NCD-related deaths ¹⁷ —making action critical for meeting global commitments.

The role of advocacy in transforming stroke care

Advocacy is a systematic effort to influence policy, practice, and resource allocation to address pressing challenges. ¹⁸ Health advocacy manifests through diverse actors working across multiple levels to create change. Strategies vary by context and audience. Individual advocates include stroke survivors sharing their experiences with policymakers, caregivers highlighting gaps in support services, and healthcare professionals presenting clinical evidence to hospital administrators and healthcare authorities. Professional organizations advocate through position statements, clinical guidelines, and policy recommendations to health ministries. Civil society groups mobilize public awareness campaigns, lobby for legislative changes, and hold governments accountable for health commitments. ¹⁹

Successful advocacy requires credible evidence on interventions and their impact, compelling narratives that resonate with decision-makers, strategic timing aligned with policy windows, and sustained engagement that maintains pressure for change. Advocates must understand both the technical aspects of stroke care and the political dynamics that influence health system decisions.

The power of advocacy lies in its ability to create systemic change. Stroke advocacy efforts have already demonstrated remarkable success: stroke units exist today because advocates convinced health systems that specialized care saves lives and reduces costs. Thrombolytic therapy became widely available because advocates worked to establish treatment protocols and secure coverage by payors. Public awareness campaigns about stroke warning signs—such as the “FAST” campaign—emerged from advocacy efforts that recognized the critical importance of rapid response. ²⁰

However, individual advocacy efforts face structural limitations in addressing global challenges related to stroke. Healthcare professionals may secure local improvements but struggle to influence national policy. Current stroke advocacy operates through multiple independent channels, with single organizations struggling to access global health decision-makers. The complexity of stroke demands a comprehensive response that transcends organizational boundaries, highlighting the need for a coordinated approach that can command attention from global health leaders.

The coalition approach

The coalition approach strategically leverages the established infrastructure, credibility, and expertise of existing stroke organizations rather than creating a new standalone entity. This model respects and amplifies the vital work of regional and national stroke societies, recognizing their complementary roles while creating a unified voice for coordinated global advocacy that addresses current limitations by unifying diverse voices into a coordinated force commanding attention from health leaders while maximizing collective impact through pooled resources. Building on existing organizational strengths ensures authentic representation across regions and income settings, harnesses complementary capabilities, and maintains sustained advocacy pressure across multiple channels simultaneously—all while avoiding the time, cost, and fragmentation that would result from creating yet another competing entity in an already complex landscape.

Formation and membership

The Global Stroke Action Coalition (GSAC) is a coordinated, multi-sectoral initiative convened by the WSO that represents an alliance of scientific, civil society, and industry partners (Table 1). Civil society and scientific society organizations known to WSO were invited to join the Coalition, with individual organizations determining whether to participate and at what level of engagement (partners, supporters, etc.). At the same time, industry partners were also invited to contribute technical expertise and resources. Coalition members work together to advance policymakers’ awareness of key stroke issues and to highlight opportunities to reduce the global burden through cost-effective, evidence-based interventions across the care pathway. The diverse membership facilitates inclusive representation across geographical regions, income levels, and disciplinary perspectives. The meaningful involvement of people with lived experience of stroke has been facilitated through a dedicated Lived Experience Ambassador Group. The commitment to a collaborative approach is reflected in a relatively flat governance structure, with co-chairs from WSO and all partners each having one or two representatives at the coalition virtual table, who actively participate in program development and decision-making, supporting the contribution and sharing of expertise, resources, advocacy platforms, and networks. The coalition maintains communication with the broader stroke stakeholder community, ensuring that its advocacy efforts authentically represent the diverse needs and priorities of the global stroke community.

Table 1.

Global stroke advocacy coalition membership.

Civil society partners	Industry partners	Civil society supporters
World Stroke Organization (convenor) American Stroke Association Chinese Stroke Association European Stroke Organisation March of Dimes Canada Stroke Association UK SVIN: Mission Thrombectomy	Boehringer Ingelheim/Angels Bayer Ipsen Medtronic Neurovascular Philips	Asia Pacific Stroke Organisation The Heart and Stroke Foundation South Africa

UN High-Level Meeting on Non-Communicable Diseases

Several converging factors made 2025 the optimal time for coordinated intersectoral stroke advocacy. Technological innovations and the advancement of digital health have made prevention, treatment, and rehabilitation more accessible.^21–24 There was accumulating evidence for cost-effective interventions across the care continuum, coupled with growing political recognition of NCDs as barriers to sustainable development. ²⁵ Most significantly, the revolution in stroke therapies and community-based services provided compelling justification for immediate action.

The 2025 UN High-Level Meeting on Non-Communicable Diseases presented a critical opportunity to elevate stroke on the global health agenda. These high-level meetings convene world leaders to review progress and make political commitments on NCDs, establishing global priorities and catalyzing resource allocation. Despite its societal and health system impact, stroke had historically been subsumed under broader cardiovascular disease frameworks, diluting focused attention and resources. The convergence of therapeutic advances, evidence for cost-effective interventions, and mounting demographic pressures created an unprecedented opportunity to secure stroke-specific recognition and commitments at this pivotal global policy moment. Effective treatment must integrate across the entire care continuum, spanning acute therapies, rehabilitation, and chronic phase support. ²⁶ In addition, demographic pressures from aging populations predicted increasing stroke prevalence without intervention. ²⁷

Coalition aims and strategic priorities

The Coalition established a comprehensive framework and Theory of Change (https://www.strokeactioncoalition.org/resources) that guides its strategic activities across multiple timeframes and levels of engagement. This framework aligns immediate advocacy opportunities with longer-term systemic change, creating a coherent roadmap for transformative action. The Coalition’s approach is structured around five key policy priorities that call on global health leaders to:

1. Make stroke a priority part of national NCD strategies;

2. Develop National Stroke Action Plans;

3. Commit to funding stroke action now;

4. Implement robust stroke monitoring systems;

5. Include stroke survivors and caregivers in policy development.

More detail is available at: https://www.strokeactioncoalition.org/our-call-to-action

The Coalition’s immediate focus centered on maximizing the opportunity presented by the 2025 UN High-Level Meeting on Non-Communicable Diseases while laying the foundations for sustained impact beyond this milestone event. For the UN High-Level Meeting, the Coalition sought to secure substantive stroke-specific language in the official outcome document that acknowledged the distinct burden of stroke and established specific commitments for action. The Coalition worked to ensure that stroke was prominently featured in the statements and national commitments of Member States announced during the meeting, while increasing its visibility through strategic side events, media engagement, and expert briefings throughout the preparatory process and the meeting itself.

Beyond the UN High-Level Meeting, the Coalition’s goals expand to address broader systemic change guided by these five priorities. The Coalition aims to strengthen national policy frameworks by supporting the development and implementation of comprehensive stroke strategies that align with health system priorities. It seeks to enhance health system capacity for integrated stroke prevention and care across the continuum, particularly emphasizing the integration of prevention, treatment, rehabilitation, and long-term support. The Coalition also works to establish long-term partnerships beyond traditional healthcare sectors to address the social determinants of stroke risk and outcomes.

Coalition activities and achievements

The GSAC has achieved significant momentum since its formation in 2024, with several key milestones demonstrating growing recognition of stroke as a global health priority requiring coordinated action. The Coalition was officially launched with broad international participation, bringing together leading stroke organizations, healthcare professionals, policymakers, industry, and individuals with lived experience from across the globe. This diverse membership, supported by agreed shared priorities expressed in the Stroke Action Now policy brief, enabled members to speak with a unified voice while ensuring representation of varied perspectives and regional contexts.

Since its launch, the Coalition strategized and contributed to the preparatory processes for the 2025 UN High-Level Meeting on Non-Communicable Diseases, achieving several important milestones:

• Representatives participated in the NCD hearings in New York City in May 2025, presenting evidence and advocating for stroke-specific recognition in the meeting outcomes.

• The Coalition provided comprehensive input on the zero draft of the UN High-Level Meeting outcome document.

• Ministerial engagement in a side event at the 78th World Health Assembly in May 2025 raised awareness among Member States and key stakeholders about the urgent need for coordinated stroke action and strategies that had been successfully adopted in countries with diverse healthcare structures and economic contexts.

• The event also served as the launch of the Coalition’s Every Minute Counts campaign, which aimed to engage stroke stakeholders in supporting the global call to action.

• The Lived Experience Ambassador Group collaborated as organizers and speakers in advocacy events and communications.

• An invitation to Ministries of Health was extended through the networks of coalition members, of which 10 (Antigua and Barbuda, Brazil, Costa Rica, Colombia, Dominican Republic, Egypt, Guatemala, Jamaica, Panama, and Somalia)—formally committed their support to the Coalition’s strategic objectives as Stroke Action Ambassadors,

• Additional ministerial representatives (Egypt, CDC Africa, UAE) joined the Stroke Action Global Coalition at a UN High-Level Meeting in New York City, demonstrating broad international recognition of stroke as a priority.

• The Coalition also instituted advocacy and media engagement training for coalition members alongside the development and delivery of a high-profile public advocacy campaign.

• Coalition members and lived experience ambassadors successfully utilized their public relations resources to secure coverage of key issues in top-tier media outlets, including The Guardian, La Repubblica, Forbes, and El País.

Please see the Global Stroke Advocacy Coalition website for more information regarding coalition activities: https://www.strokeactioncoalition.org/

Future direction and sustaining momentum

The Coalition has committed to continuing collaborative advocacy efforts beyond 2025, with specific next steps to be determined based on the outcomes and impact of 2025 endeavors. The Coalition remains committed to advancing the five policy priorities globally: establishing and strengthening stroke systems of care, ensuring equitable access to acute stroke interventions, improving access to rehabilitation and community support, addressing risk factors through prevention strategies, and building sustainable advocacy coalitions. The adoption of the UN Political Declaration on Noncommunicable Diseases and mental health represents a significant milestone, with three fast-track targets particularly relevant to stroke: achieving hypertension control for 150 million additional people, reducing the number of tobacco users by 150 million, and ensuring 150 million more people have access to mental health care. Building on this momentum and the learnings from 2025 activities, the Coalition will maintain sustained advocacy pressure at national and global levels to ensure stroke remains a priority with adequate resources and political commitment, working toward measurable improvements in stroke prevention, treatment, and outcomes for populations worldwide.

Conclusion

The GSAC provides a coordinated framework for addressing stroke through evidence-based advocacy, strategic engagement, and sustained collaboration across sectors and regions. The Coalition’s approach recognizes that the unique considerations of stroke require targeted attention and specialized responses. The five critical policy priorities provide a roadmap for transformative action spanning immediate UN High-Level Meeting engagement to longer-term capacity building and policy development. These priorities reflect the complexity of addressing stroke burden at a global scale while providing concrete pathways for governments to take decisive action. If countries fail to address stroke now, NCD targets will not be met. Acting now means cementing commitments, policies, and investments that can save lives and dramatically improve outcomes for millions of people worldwide.