 Here is the central fact that I want to leave with you in these few minutes. The central fact is that the burden of disease in poor countries simply because it is greater for communicable disease does not mean it is not also greater for non-communicable disease and the facts of the matter are that non-communicable diseases as a global burden looking at the health of people's everywhere are predominantly not just largely predominantly problems of low and middle income countries if you look at the total number of deaths from non-communicable diseases in the world approximately 80 percent of those deaths occur in low and middle income countries and these diseases are very costly to the economies and to the well-being of those countries for example between the years 2005 and 2015 it's been estimated that the three countries of china india and russia may lose between 200 and 550 billion dollars of national income just because of the three conditions of heart disease stroke and diabetes but by and large when we think about the problem and the burden of non-communicable diseases we are talking about conditions that have the attribute of chronicity that linger that affect people for year after year after year that produce morbidity reduction in productivity as well as illness and premature mortality you can deal with these problems after they occur or you can deal with these problems before they occur you can adopt strategies that are predominantly about treatment and rehabilitation and management of disease or you can adopt strategies that are about preventing disease forestalling their development diminishing their secondary impacts of the two they both have a place but the preventive strategy has the great advantage of when it works producing so much better results because you avoid disease altogether and the third point that is very important is that the interventions that are effective in preventing one chronic disease often will have benefit to prevent other chronic disease the prime example of that of course is tobacco and smoking where when you reduce the burden of tobacco you not only reduce the burden of cancer you reduce the burden of heart disease it is in the vital self-interest of the united states to be actively engaged in the global efforts to reduce non-communicable disease burden it's true across all diseases but it's especially true for those conditions where we in the u.s. also have a disproportionate burden from these same diseases so that advances that are made anywhere can be transferred and taken advantage of elsewhere lessons that can be learned about prevention and treatment including the testing of interventions for disease at different stages that can be done anywhere in the world can be adapted and used everywhere including in the united states