It would be a travesty if the available evidence from high-income countries about strategies for the prevention of cardiovascular disease and the control of diabetes were not translated into practicable solutions for developing countries at a time when their need is great and when safe and effective interventions that were once very expensive are now available for a few cents a day. However, resources to provide such solutions for low- and middle-income regions remain surprisingly scarce, in contrast with the enormous resources devoted to cardiovascular disease prevention and diabetes control in other regions such as the North America and Western Europe.

A particular challenge is to make affordable preventive interventions available to the most disadvantaged groups in low- and middle-income countries. In settings in which access to cardiovascular and diabetic health care is largely dependent upon the ability of patients to pay, the poor would stand to benefit most from the availability of low-cost intervention packages. In countries such as China, the poor are emerging as the socioeconomic group with the highest prevalence of diabetes and other risk factors, and the highest incidence of stroke and heart attack.

However, experience in high-income countries demonstrates that even well-resourced health services face substantial difficulties in delivering effective preventive care to disadvantaged groups in both urban and rural settings. Research is therefore needed to evaluate the barriers to health care delivery in a variety of economic and cultural settings, and to develop and test strategies to maximize the penetration of preventive programs targeted to disadvantaged groups.

View global distribution of burden of disease