Neglected Global Epidemics: three growing threats especially for the most advantaged members of these societies- can be just as effective in their poorer counterparts There is now abundant evidence to initiate effective actions at national and global levels to promote and protect cardiovascular health through population-based measures that focus on the main risk factors shared by all noncommunicable diseases. The population-wide ap- plication of existing knowledge has the potential to make a major, rapid and cost-effective contribution to their prevention and control and to benefit all segments of the population(3) The main issue for policy-makers, at all levels of public health in developing countries, is how to deal with the growing burden of epidemics of noncommunicable diseases in the presence of persisting communicable disease epidemics. Furthermore, this challenge must be faced even where health system resources are already inadequate. Although considerable policy gains can be made very cheaply, especially intersectorally, extra provision must be found This requires a greater share of national resources for health care, better use of existing re- sources,and new sources of funding. A special tax on tobacco products for disease preven tion programmes is a readily available source of new funds for most countries. The causes are known The good news is that an impressive body of research has identified the causes of the CVd epidemics within populations(1). Global trade and marketing developments continue to drive the nutrition transition towards diets with a high proportion of saturated fat, sugar and salt. At the same time, protective elements like fibre and phytochemicals in fresh fruit and vegetables are being progressively depleted in diets. When combined with tobacco use and low levels of physical activity, this diet leads to population-wide atherosclerosis and the wide spread distribution of CVDs. Variations in these same major risk factors explain much of the ajor difference in rates of CVDs between countries. In summary, the major CVD risk factors of tobacco use, inappropriate diet and physical inac tivity(primarily expressed through unfavourable lipid concentrations, high body-mass ir dex, and raised blood pressure)explain at least 75-85% of new cases of coronary heart disease (4 ) In the absence of elevations of these risk factors, coronary heart disease is a rare cause of death. Unfortunately, the vast majority of the populations in almost all countries are at risk of developing CVD because of higher than optimal levels of the main risk factors. Only about 5%of adult men and women in wealthy countries are at low risk with optimal risk factor levels. There are only a few very poor countries in which these factors have not yet emerged as major public health problems. Policies are available One of the most exciting possibilities to emerge in public health in recent years is the integra- tion of communicable disease and CVd prevention and control into comprehensive health systems led by primary care. Bringing this to fruition will mean reshaping the future of pri- mary health care in response to a changing world. It would see all patients being offered across their lifespan-prevention, treatment and long-term management of both sides of the double burden Achieving such integration will not be easy. Apart from other considerations, it will require cooperation between professional rivals, who each regard their side of the double burden to be more important than the other, and who compete for their share of limited resources Such competitiveness has long been entrenched across the battlefields of public health AndNeglected Global Epidemics: three growing threats 87 especially for the most advantaged members of these societies – can be just as effective in their poorer counterparts. There is now abundant evidence to initiate effective actions at national and global levels to promote and protect cardiovascular health through population-based measures that focus on the main risk factors shared by all noncommunicable diseases. The population-wide ap￾plication of existing knowledge has the potential to make a major, rapid and cost-effective contribution to their prevention and control and to benefit all segments of the population (3). The main issue for policy-makers, at all levels of public health in developing countries, is how to deal with the growing burden of epidemics of noncommunicable diseases in the presence of persisting communicable disease epidemics. Furthermore, this challenge must be faced even where health system resources are already inadequate. Although considerable policy gains can be made very cheaply, especially intersectorally, extra provision must be found. This requires a greater share of national resources for health care, better use of existing re￾sources, and new sources of funding. A special tax on tobacco products for disease preven￾tion programmes is a readily available source of new funds for most countries. The causes are known The good news is that an impressive body of research has identified the causes of the CVD epidemics within populations (1). Global trade and marketing developments continue to drive the nutrition transition towards diets with a high proportion of saturated fat, sugar and salt. At the same time, protective elements like fibre and phytochemicals in fresh fruit and vegetables are being progressively depleted in diets. When combined with tobacco use and low levels of physical activity, this diet leads to population-wide atherosclerosis and the wide￾spread distribution of CVDs. Variations in these same major risk factors explain much of the major difference in rates of CVDs between countries. In summary, the major CVD risk factors of tobacco use, inappropriate diet and physical inac￾tivity (primarily expressed through unfavourable lipid concentrations, high body-mass in￾dex, and raised blood pressure) explain at least 75–85% of new cases of coronary heart disease (4). In the absence of elevations of these risk factors, coronary heart disease is a rare cause of death. Unfortunately, the vast majority of the populations in almost all countries are at risk of developing CVD because of higher than optimal levels of the main risk factors. Only about 5% of adult men and women in wealthy countries are at low risk with optimal risk factor levels. There are only a few very poor countries in which these factors have not yet emerged as major public health problems. Policies are available One of the most exciting possibilities to emerge in public health in recent years is the integra￾tion of communicable disease and CVD prevention and control into comprehensive health systems led by primary care. Bringing this to fruition will mean reshaping the future of pri￾mary health care in response to a changing world. It would see all patients being offered – across their lifespan – prevention, treatment and long-term management of both sides of the double burden. Achieving such integration will not be easy. Apart from other considerations, it will require cooperation between professional rivals, who each regard their side of the double burden to be more important than the other, and who compete for their share of limited resources. Such competitiveness has long been entrenched across the battlefields of public health. And