Over the past few decades, many low- and middle-income countries throughout the world have experienced profound changes in population structure and disease patterns that have fundamentally changed their burden of ill health. Now, in all but the very poorest nations of the world, non-communicable diseases such as coronary heart disease, stroke and other cardiovascular diseases are leading causes of death and life years lost to ill health. Moreover, projections over the next few decades suggest that the number of people dying from cardiovascular disease or living with diabetes in these regions will double.

Unchecked, these epidemics will result in the deaths of several million middle-aged men and women annually, for in developing countries about half of all cardiovascular deaths occur between the ages of 30 and 69 years. Those who survive strokes or myocardial infarctions will frequently be disabled, often in the prime of their working lives. The hidden costs of disability are generally borne by families, resulting in diminished opportunity for other family members to engage in paid employment outside the home. The economic hardships brought about by the death or disability of family wage earners in mid life has far reaching consequences for young and old. Moreover, the expanding need for expensive acute medical care for patients with myocardial infarction or stroke diverts scarce health care resources from other critical areas such as vaccination programs and HIV/AIDS programs, with adverse consequences for the health of children and young adults.

None of the major developing regions of the world are immune from these trends – the populations of India, China, South East Asia, the Middle East, South America and Africa will all experience large increases in the numbers suffering from cardiovascular diseases and diabetes. Few countries in these regions have the capacity to deal with the existing burden of these diseases, let alone the projected increases.

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