In most countries in the Americas, chronic diseases are now the leading cause of premature death and disability. Responsible for two of every three deaths among the general population, chronic diseases caused almost half of the mortality in people under 70 years old in 2002. The significant socio-economic inequities in Latin America compound the burden of chronic disease (including early death) among poorer people, locking many into a cycle of deprivation and ill-health. Cristina Escobar reports on the CARMEN network, an integrated, community-based approach to preventing and managing chronic non-communicable diseases and their risk factors – tobacco use, unhealthy diet, lack of physical activity – in Latin America and the Caribbean.