Cardiovascular diseases and diabetes are now leading causes of death and chronic illness in most middle-income countries and many low income countries. Over the next few decades, the burden of disease faced by these countries will double. All sections of society will be affected, but the poor will suffer most, primarily as a consequence of their limited access to health care. A large proportion of the victims will be middle-aged and in the prime of their working lives. The financial and social costs of these epidemics will be profound and are likely to adversely affect development and the alleviation of poverty.