Understanding Stroke in a Global Context

Shanthi Mendis

• Publisher: Bentham Science Publishers
• Year: 2017
• Print ISBN: 9781681085258
• eBook ISBN: 9781681085241
• Topic: Medicine
• Subtopic: Neurology

Stroke is one of the most debilitating diseases which poses a significant economic burden on society. Increasing exposure to behavioural risk factors for stroke (tobacco use, unhealthy diet, physical inactivity and excessive alcohol consumption) and air pollution are driving up the worldwide stroke burden. Although medical interventions to prevent and manage stroke have advanced considerably over the last two decades, they are not consistently implemented worldwide. Therefore, health outcomes of stroke treatment vary throughout the world. Understanding Stroke in a Global Context addresses this serious disconnect between advances in stroke interventions and their implementation at the national level. The book aims to improve the reader's understanding of stroke and its links to the UN Sustainable Development Goals (SDGs).
Eight chapters present information about various aspects of stroke: causes, symptoms, signs and consequences, the challenges of stroke prevention, the magnitude of the stroke burden, medical and surgical interventions for managing stroke including stroke units, the links between stroke and the SDGs and, finally, the social and economic costs of stroke.
Key features of this volume include:
- coverage of stroke information from multidisciplinary angles
- simple reader friendly format for a broad audience
- information about UN SDGs relevant to stroke healthcare
- data on socioeconomic burden of stroke This volume is a concise handbook for healthcare policy makers, lay people, journalists, public health practitioners, under-graduate and post-graduate students, and early career level health professionals working in the fields of stroke medicine, non-communicable disease programs and healthcare development at local and national levels.

Sustainable Development Goals and Stroke

Shanthi Mendis^*

Geneva Learning Foundation, Former Senior Adviser, World Health Organization, Geneva, Switzerland

Abstract

The 2030 Agenda for Sustainable Development is an ambitious initiative of the United Nations, with 17 goals and 169 targets, integrating health, economic development, elimination of extreme poverty, social inclusion, environmental sustainability and good governance. The 17 Sustainable Development Goals focus on: poverty; hunger; health education; gender equality; water and sanitation; energy; economic growth and employment; industry, innovation and infrastructure; inequality; sustainable cities; consumption and production; climate change; marine resources; terrestrial ecosystems; peace, justice and accountability; and global partnership for sustainable development. There is a mutually reinforcing relationship between health and the three dimensions of sustainable development – social, economic and environmental. The connectors are health systems, behavioural, biochemical and environmental risk factors, ecosystems and the social and structural determinants of health, including enabling legal environments, financing and governance. In recognition of the negative impact of NCDs including stroke on development, they have been specifically incorporated in Goal 3 of the Sustainable Development Goals. Goal 3 addresses all major health priorities, including stroke and other NCDs, integral for the attainment of the Sustainable Development Goals. The 2030 Agenda for Sustainable Development, integrating health with economic, social and environmental dimensions of development, offers an unprecedented opportunity to address stroke (NCDs) and their determinants through multisectoral and multidimensional approaches.

Keywords: Accountability, Climate change, Consumption and production, Education, Employment, Energy, Gender equality, Health, Industry, Inequality, Infrastructure, Innovation, Justice, Marine resources, Millennium Development Goals, Noncommunicable diseases, Peace, Poverty, Stroke, Sustainable Development Goals, Sustainable cities, Terrestrial ecosystems, Water and sanitation, economic growth, hunger.

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^* Corresponding author Shanthi Mendis: Geneva Learning Foundation, Geneva, Switzerland; Tel/Fax: [phone]; E-mail: [email protected]

INTRODUCTION

This chapter addresses the following questions.

1. What are the health-related Millennium Development Goals (MDGs)?
2. What is the 2030 Sustainable Development Agenda?
3. How are the Sustainable Development Goals linked to health and stroke (noncommunicable diseases)?
4. What are the 17 Sustainable Development Goals and 169 targets?

1. What are the health-related Millennium Development Goals?

The eight Millennium Development Goals (MDGs), adopted in 2000, included three health-related goals: reduction in child mortality (Goal 4); reduction in maternal mortality and access to reproductive health care (Goal 5); and reversing the spread of HIV/AIDS, tuberculosis and malaria (Goal 6) [1]. These were instrumental in focusing global attention, development aid and national policies and resources in low- and middle-income countries on these important health issues [2, 3]. By 2015, unprecedented gains were made in combating malaria and tuberculosis, and providing access to antiretroviral medicines [4]. Although gaps remain in access to antenatal care and skilled birth attendance, in some parts of the world, considerable progress was made in the reduction of preventable infant and maternal mortality [4]. NCDs, (including stroke), were not included in the Millennium Development Goals and, therefore, received little global and national attention. In early 2000, bilateral aid for tackling NCDs dropped [5] despite their burgeoning contribution to the burden of global disease.

2. What are the Sustainable Development Goals (SDGs)?

The 2030 Agenda for Sustainable Development has merged the unfinished tasks of the Millennium Development Goals with the Agenda articulated in the 2012 United Nations Conference on Sustainable Development [5, 6]. It is an ambitious Agenda with 17 goals and 169 targets, integrating health, economic development, elimination of extreme poverty, social inclusion, environmental sustainability and good governance. While the Millennium Development Goals focused on low-income countries, the 2030 Agenda for Sustainable Development is universal and relevant to the whole world. The brief outline below on the Sustainable Development Goals and targets is based on information and data obtained mainly from United Nations documents.

3. How are the Sustainable Development Goals linked to health and stroke (noncommunicable diseases)?

The right to health is the most important fundamental human right [7]. According to the WHO definition: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. There is a reciprocal reinforcing relationship between health and all three aspects of sustainable development – social, economic and environmental. Action on the social and environmental determinants of health is in turn critical to creating inclusive, peaceful, equitable, economically productive and healthy societies [8]. The 2030 Agenda for Sustainable Development is based on this broader notion, extending it to incorporate other species, ecosystems and health risks. The health status of people is dependent on the wide-ranging and interlinked impact of social, economic, behavioural and environmental determinants, including biodiversity and ecosystems. The connectors are health systems, behavioural, biochemical and environmental risk factors, ecosystems and the social and structural determinants of health, including enabling legal environments, financing and governance [8].

The 2030 Agenda for Sustainable Development offers an unprecedented opportunity to address prevention and control of stroke (NCDs) from a multisectoral platform. In this context, to implement policies to effectively address stroke (NCDs), three strategic moves are required. First, governments need to reframe prevention and control of stroke (NCDs) from the disease model to embrace the multisectoral prevention model that underpins the 2030 Agenda for Sustainable Development. Second, health policy-makers need to emphasize and insist on health and health equity in all relevant policies of the agenda. The health sector needs to support and collaborate with other sectors to develop and implement policies and programmes in a way that optimizes co-benefits for all sectors involved [8, 9]. Third, health advocates need to engage with global governance structures to finance and implement the Sustainable Development Goals, including Goal 3 for health. The broad and interlinked nature of the Sustainable Development Goals make this repositioning more practical, feasible and indeed necessary.

4. What are the 17 Sustainable Development Goals and 169 targets?

4.1. Sustainable Development Goal 1

Sustainable Development Goal 1 calls for an end to poverty in all its forms by 2030. The international poverty line is currently defined at US$ 1.90 or below per person per day. In 2012, about 13% of the world’s population was living below the poverty line [10]. If current growth rates prevail for the next two decades, the global poverty rate is expected to fall around 6% in the next 20 years. To eliminate poverty, the poor and vulnerable need to be provided opportunities and access to social protection programmes including social and food assistance, child and maternity benefit programmes as well as social insurance and labour market schemes.

According to United Nations data sources, currently, most poor people in the world do not have access to social protection schemes. In low-income countries, only one out of five poor persons receive any type of social protection [10, 11]. Coverage is better in middle-income countries with two out of three receiving social protection in upper-middle-income countries. The coverage gap is particularly wide in Southern Asia and sub-Saharan Africa.

Table 6.1 Sustainable Development Goal 1 targets.

1.1 By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than US$ 1.25 a day. 1.2 By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions. 1.3 Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable. 1.4 By 2030, ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services, ownership and control over land and other forms of property, inheritance, natural resources, appropriate new technology and financial services, including microfinance. 1.5 By 2030, build the resilience of the poor and those in vulnerable situations and reduce their exposure and vulnerability to climate-related extreme events and other economic, social and environmental shocks and disasters. 1.a Ensure significant mobilization of resources from a variety of sources, including through...

Table of contents

• Welcome
• Table of Contents
• Title Page
• BENTHAM SCIENCE PUBLISHERS LTD.
• PREFACE
• List of Contributors
• Stroke: Causes, Symptoms, Signs and Consequences
• Stroke, Politics, Global Health and Development
• Global Stroke Burden and Stroke Prevention
• Medical and Surgical Treatment of Stroke
• Stroke Care: Stroke Units, New Therapies, Advances and the Future
• Sustainable Development Goals and Stroke
• Economic and Societal Costs of Stroke
• Understanding Stroke in a Global Context – Key Points in Plain Language