The prevalence of rheumatic heart disease (RHD) in industrialized countries has declined dramatically over the last century, but the disease remains an important global health problem with the burden of disease shouldered by developing countries. Indeed, data from epidemiologic surveys, which used echocardiography as the primary screening tool, indicate that the prevalence of RHD in developing nations might have been substantially underestimated. Despite the high burden of disease globally, there has never been a sustained and comprehensive international strategy to control RHD. The current focus of global efforts to combat the disease is on strengthening secondary prophylaxis strategies, although very few active national programs have been implemented. RHD will continue to cause high morbidity and mortality among the world's poorest populations unless current prevention initiatives expand and new programs are established.