Although the past twenty years have seen a remarkable decline in the death rates of heart disease and stroke in the United States and several countries of western Europe, a reverse trend is occurring in other parts of the world. This is especially true in sub-Saharan Africa, India, China and Russia. World-wide, deaths from cardiovascular disease exceed those caused by cancer, infectious disease and trauma, constituting a deadly epidemic. Yet, in 1996 the Victoria Declaration stated that the world has the knowledge to eliminate cardiovascular disease as a major illness. Defeating such an initiative are other priorities such as education, housing, transportation, defense, as well as ignorance. The Earth Institute has labeled the needed effort, "A Race Against Time".