One in four people worldwide will experience a stroke within their lifetime, but less than one in five people at risk of stroke are on any preventive medications. Even fewer people have access to stroke treatments. The ongoing inability of health systems to implement evidence-based stroke interventions could threaten progress on global health goals. To this end, in the World Stroke Organization–Lancet Neurology Commission,1 Valery L Feigin, Mayowa O Owolabi, and colleagues outline several options for national and international policy stakeholders and emphasise solutions for low-income and middle-income countries.