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Abstract. One hundred fifty survivors of the 11 March 2011 Great East Japan Earthquake (Tohoku-oki earthquake) (Mw = 9.0) were interviewed to study the causes of deaths from the associated tsunami in coastal areas of Tohoku. The first official tsunami warning underestimated the height of the tsunami and 40% of the interviewees did not obtain this warning due to immediate blackouts and a lack of communication after the earthquake. Many chose to remain in dangerous locations based on the underestimated warning and their experiences with previous smaller tsunamis and/or due to misunderstanding the mitigating effects of nearby breakwaters in blocking incoming tsunamis. Some delayed their evacuation to perform family safety checks, and in many situations, the people affected misunderstood the risks involved in tsunamis. In this area, three large tsunamis have struck in the 115 yr preceding the 2011 tsunami. These tsunamis remained in the collective memory of communities, and numerous measures against future tsunami damage, such as breakwaters and tsunami evacuation drills, had been implemented. Despite these preparedness efforts, approximately 18 500 deaths and cases of missing persons occurred. The death rate with the age of 65 and above was particularly high, four times higher than that with other age groups. These interviews indicate that deaths resulted from a variety of reasons, but if residents had taken immediate action after the major ground motion stopped, most residents might have been saved. Education about the science behind earthquakes and tsunamis could help save more lives in the future.

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.