While the determinants of health transition in the developing countries are similar to those that charted the course of the epidemics in the developed countries, their dynamics are different.

The epidemiologic transition in Asia is very different from the classic transition that occurred in the West. First, the transition in the West was essentially reciprocal--communicable diseases went down and were replaced by a rising burden of noncommunicable diseases. In the developing countries of Asia, however, there is an overlap, with countries having to face fairly significant burdens of communicable and noncommunicable disease simultaneously.

Second, the transition is occurring much faster in Asia's developing countries than it did for countries in the industrialized West. One reason may be the rapid economic growth and improvements in health care infrastructure that have paralleled the shift in the causes of ill-health.

The compressed time frame of transition in the developing countries imposes a large, double burden of communicable and non-communicable diseases. Unlike in the developed countries where urbanization occurred in prospering economies, urbanization in developing countries occurs in settings of high poverty levels and international debt, restricting resources for public health responses. Organized efforts at prevention began in developed countries when the epidemic had peaked, and often accelerated a secular downswing, while the efforts in the developing countries are commencing when the epidemic is on the upswing. Strategies to control CVD in the developing countries must be based on recognition of these similarities and differences. Principles of prevention must be based on the evidence gathered in developed countries, but interventions must be context-specific and resource-sensitive.