A child born today in the rich countries of the world will inherit the expectation of living into the mid-70s. In Africa, of those surviving to the age of 5 years, the expectation of reaching the mid-50s remains in doubt. Inequality in the opportunity to experience life itself remains the cruelest inequality of all. As in many other fields, the technological experience accumulated by the economically wealthy countries can be put to useful purposes in underdeveloped regions. Given the longer history of chronic disease epidemiology in wealthy societies, much has been learned and many successes have been achieved. These lessons are, to a large extent, exportable. An opportunity to avoid the transition to high rates of CVDs and cancer therefore exists through implementation of primary prevention programs. Despite the competing priorities, a coordinated and sustained effort to achieve this goal should be initiated without further delay.