Over the last year, Healthwatch Essex have been supporting the Coastal Gap Equality Management for Stroke Care (CoastGEM) research project – a collaboration between the University of Essex and East Suffolk and North East Essex NHS Foundation Trust (ESNEFT). In this blog to commemorate World Stroke Day 2025, postgraduate researcher Rebecca Dau highlights why it’s important to highlight the effects on health inequalities on stroke care in coastal communities.
Stroke is a major cause of death and disability, with approximately 90,000 new cases annually, and 1 million stroke survivors in the UK currently. While most strokes occur in people aged above 65 years, researchers are finding a disturbing trend where cases in people less than 55 years are increasing. This will have implications on health and social care costs, unpaid care costs and lost productivity. Stroke is however highly preventable, with 10 modifiable risk factors responsible for over 80% of stroke. A modifiable risk factor is a condition or behaviour that increases your chances of getting a disease, but can be altered or changed through lifestyle and behaviour changes or early management of conditions to prevent the disease. Some significant modifiable risk factors include high blood pressure, high blood cholesterol, high blood sugar (diabetes), high salt intake (sodium salts), physical inactivity, low diet in fruit and vegetables, smoking and alcohol intake. Additionally, investing in stroke prevention is cost-saving with every $1 invested in stroke prevention having a return on investment of $10.
The number of strokes and the presence of risk factors is unevenly distributed in society with particular communities such as deprived communities bearing the burden disproportionately. This is because they may experience additional challenges (financial, geographical due to distance) in accessing health services on time to get an early diagnosis, accessing healthy diet due to costs, or lack spaces within their community for physical activity. This results in inequalities in stroke. The CoastGEM project is a joint project between the University of Essex and East Suffolk and North Essex NHS Foundation Trust (ESNEFT). It investigates factors in the health system that result in these inequalities across the stroke pathway (prevention, pre-hospital care, hyperacute and acute care and transient ischaemic attack (TIA) management, rehabilitation and life after stroke). I particularly investigated system factors resulting in inequalities in the prevention of stroke. The study area covered by ESNEFT (East Suffolk and North East Essex) serves coastal communities (in Tendring- Jaywick and Clacton-on-Sea) which have among the highest levels of deprivation in England, and experience worse health outcomes for stroke and other health conditions. Understanding these factors will allow us to come up with recommendations specifically targeting to reduce stroke burden in these marginalised communities.
The team conducted a workshop and individual interviews involving service providers, policy makers and community organisations working in stroke to understand their perspectives on barriers in stroke prevention resulting in inequalities. Stroke survivors were also included in the workshop, to capture their lived experiences with stroke prevention.
Lack of awareness of stroke and its risk factors is a significant hinderance to equitable stroke prevention. As such, a major finding from project was the low awareness about stroke and its risk factors arising due to limited education and awareness campaigns manifesting in various ways. First, risk factor campaigns (anti-smoking, anti-obesity, anti-hypertension, physical activity campaigns) were highlighted to be non-comprehensive and occur in siloes, with some risk factors like smoking getting disproportionate attention. Additionally, limited direct association was usually made between the risk factors and stroke in these campaigns. Participants further highlighted that current awareness campaigns focused on early identification of stroke symptoms (BE FAST and FAST campaigns) but did not highlight risk factors. Patient education was also pointed out to be inconsistent and confined to a few places (some GP practices, bus stops) or seasons (Stoptober antismoking campaign) thus having low visibility and accessibility. One of the general practitioners interviewed noted that it was expected that patients already knew which is concerning given that health literacy levels may be low especially in deprived communities. They use traditional methods of raising awareness such as posters and television advertisements and the limited integration of social media to raise awareness excluded younger demographics. Also, patient education and campaigns predominantly in English with limited cultural diversity limit engagement by ethnic minorities.
Based on existing global and local evidence that was presented to participants, we also asked participants to propose solutions to overcome these identified barriers best suited to the context of East Suffolk and North East Essex. Multilingual and culturally appropriate public health education and awareness campaigns was proposed to increase engagement among ethnic minorities and immigrants with limited English proficiency. Including trusted community members (community leaders or medical practitioners who are from the same communities) in designing patient education and campaigns, and in advocacy efforts was recommended to ensure cultural compatibility and correct translations and inferences are made. This is because they are trusted sources of health-related information in those communities.
Taking awareness campaigns and patient education down to community level by utilizing community spaces such as religious spaces (churches, mosques, temples), supermarkets, football matches and county fairs, was noted as a mechanism to increase engagement. These are spaces where they are comfortable and are free to ask questions. This also overcomes barriers associated with time constraints and short appointments in more formal settings such as the GP practices that do not allow for extensive patient education to occur, arising due to staff shortages. Through the Making Every Contact Count (MECC) national public health strategy, staff working across health and care, local authority and voluntary sectors can be trained and leveraged to raise awareness on health and wellbeing, and encourage positive lifestyle changes during routine contacts in disadvantaged communities.
Ensuring that integrated campaigns are designed to deliver consistent stroke and stroke prevention messaging across risk factors was proposed to overcome disjointed short-term risk factor campaigns. Additionally, participants highlighted running year-round stroke awareness campaigns contrary to current campaigns limited to particular days (World Stroke day), and incorporating digital platforms like social media to increase their visibility and public engagement, similar to COVID-19 awareness campaigns.
As we mark World Stroke Day, the reminder that stroke prevention is indeed better than cure is pertinent and everyone has a role to play. Individuals should, to the best of their ability, address modifiable risk factors by making the necessary lifestyle behaviour changes, and working collaboratively with health providers to monitor and manage conditions such as hypertension and diabetes that increase stroke risk. Prevention is acknowledged as an important aspect in reducing inequalities in England’s current and previous 10-year Health Strategy (Fit for the Future Strategy and NHS Long Term Plan respectively). Therefore, more dedicated efforts from policymakers to ensure that they create an environment that allows individuals to make healthy lifestyle and behaviour choices, and maintain health and wellbeing is important.
You can find out more about the CoastGEM project and how to get in touch with their team here.