Self monitoring of blood glucose concentrations by non-insulin dependent diabetic patients.

effective. Some health campaigners have called for a national food and nutrition policy as the top priority for preventing and controlling cardiovascular disease in developing countriesjust as in Western ones.'2 In practice, however, undernutrition remains a major public health issue in many developing countries, and it may be unrealistic to expect a policy that encourages a low fat, low salt diet to become a top priority. Instead emphasis should be given to controlling the tobacco industry. The required policy instruments are well known, and tobacco taxation seems to be a particularly powerful means of reducing consumption in developing countries.'3 A few countries rely economically on growing tobacco, and the development and implementation of a national tobacco control policy, including bans on advertising and promotion, will be strenuously resisted by the international tobacco industry and other vested interests. Fortunately, considerable international experience and support are available to assist in the introduction of comprehensive tobacco control policies. The high risk strategy focuses on individual people at high risk of disease. It can deal cost effectively only with the later stages of the diseases and will not by itself prevent the epidemic. Cost effective interventions should supplement, not replace, the essential population strategy.'4 Treatments, such as aspirin for the management of acute myocardial infarction, should be used only for people at high absolute risk. The management, either pharmacologically or nonpharmacologically, of people at low absolute risk of disease is not indicated despite the popularity of this approach in developed countries. Prevention of cardiovascular disease can be remarkably successful, but the part played by supranational determinants, including multinational companies and trade agreements, makes international leadership essential. The problem must be high on the agenda of international agencies, especially the World Health Organisation. A strategic plan is required to build sustained international support and action; the development of epidemiological expertise in developing countries is an essential starting point. ROBERT BEAGLEHOLE Professor of Community Health, Department ofCommunity Health, School of Medicine, University of Auckland, Auckland, New Zealand