The scale of the cardiovascular disease and diabetes epidemics and the speed with which they have evolved poses major unresolved challenges to governments, multilateral organizations, bilateral donors and all others concerned with the health and development of low- and middle-income countries. Both the World Health Organization and the World Heart Federation are working with governments and other health care providers worldwide in an effort to support the development of policies and strategies by which to manage these epidemics. However, in most developing countries, public health and primary health care services for cardiovascular disease prevention or diabetes control still remain minimal or non-existent, while services for acute care are usually only available to a small fraction of the population.

There are, however, exceptions. China, for example, has made exemplary efforts to institute primary health care programs for cardiovascular disease control – in particular, programs for stroke prevention. Nevertheless, outside the main cities, particularly in the populous regions of western China, there remains limited access to effective preventive care. Other countries, such as Thailand, have developed sophisticated health promotion programs for disease prevention, focused mainly on tobacco control, and are now seeking to develop primary care programs that could be delivered through government-funded primary care centers. Non-governmental organizations, such as the Byrraju Foundation in India, are making similar plans for charitably-funded primary care services. All require evidence about how best to deliver such services using limited resources and while continuing to maintain other services, such as maternal and child health programs.

Ultimately, health development requires the implementation of comprehensive systems to manage all the common serious conditions affecting populations. Continued support for efforts to control conditions such as HIV/AIDS, malaria and tuberculosis need not preclude support for efforts to control cardiovascular diseases and diabetes. Indeed these should be complementary and mutually reinforcing. For example, the control of cardiovascular disease and diabetes requires the reorganization of primary health care services to deliver sustainable chronic care, which is also essential for the care of patients with HIV/AIDS, tuberculosis and drug-resistant malaria. Evidence about how best to provide integrated primary health care solutions is needed worldwide for many diseases, not least among them the cardiovascular disorders and diabetes.