making, and global networking and partnering. These characteristics are hallmarks of the Special Programme for Research and Training in Tropical Diseases and led to its selection as the model for the proposed steering committee.

The control of communicable, childhood, and maternal diseases worldwide has benefited from several decades of major international efforts. Such large-scale efforts are lacking for CVD. Yet the evidence that premature death can be avoided and quality of life improved in later years includes dramatic declines in CVD mortality in Western countries, geographic variation in CVD mortality, and established associations of adult mortality with modifiable risk factors, such as tobacco use and obesity. Reducing the prevalence of these risk factors has been shown to decrease mortality in both middle-aged and older persons and to lead to less disability and a better quality of life in later years. Programs for risk factor prevention and low-cost case management of CVD offer feasible, cost-effective ways to reduce CVD mortality and disability in developing countries. They should yield high payoffs in health status and in economic productivity.

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