The emerging burdens of chronic non-communicable disease in the developing world are stubbornly resistant to prevention given the limited infrastructure, the competing priorities of com- municable diseases and trauma and limited resources. World- wide, there are approximately 55 million deaths each year, over half of which occur in people less than 60 years of age. Communicable diseases account for 31%, non-communicable diseases for 60% and injuries for 9%. 1 However, this mortality picture does not give a good indication of just how sick the population is. Disability-adjusted years provide a different lens through which to examine burdens of disease and produce rather different rank ordering of priority health problems, in particular highlighting the importance of injuries. 2 Geoffrey Rose's paper 3 deals with three major issues that and economic pressures we are under are pushing the popu- lation distribution of many risk factors—total cholesterol, blood pressure—upwards. Even more insidious is the marketing of cigarettes to people in the south and south east Asian regions. The numbers of potential smokers will more than make up for the loss of smokers in the west. These trends are likely to ensure that global inequalities of health are magnified. High-risk pre- vention strategies appeal to doctors, who tend to be major power brokers in poorer countries. Consequently, diversion of resources from primordial prevention to the identification and treatment of cardiovascular risk factors and coronary heart disease and diabetes among the emerging, relatively wealthy, urban populations of poorer countries is now evident. In poorer countries, the dominance of high-risk strategies undermines much that might be achieved through preventive efforts, and consumes resources that should be used in existing maternal and child health programmes. Rose's third theme was the prevention paradox. Few will benefit but all have to take part. In Chinese communities, most children are taught a Confucian truth at an early age: a single chopstick can be broken easily with little force, a bundle of chop- sticks are virtually impossible to break. Solidarity among people is a powerful weapon (and also, in the case of adverse health behaviours, a major barrier) in the public health medicine arsenal. The International Epidemiological Association has a role to play in creating and sustaining a united front among epidemiologists and the wider public health community in their efforts to promote public health. Such work requires real deter- mination and will to stand up to powerful vested interests.