NCDs including diabetes, heart disease and stroke are global epidemics of the 21st century. The greatest burden on health will be in developing countries and sub-Saharan Africa is an area of major challenge: We are concerned with planning for the adult victims of the new epidemic and this includes the development of appropriate treatment. Therapy should be cost effective and evidence on the economics of treating chronic conditions in Africa is urgently required. Finally, health promotion, primary prevention and health screening strategies for chronic diseases such as diabetes, stroke and coronary heart disease are required.