The changing pattern of disease in the developing world calls for a change in the structure, goals, and personnel of global health assistance. Chronic diseases are now the dominant threat to health and are becoming a challenge to economic advancement in developing economies. Because confronting these diseases, heart disease and diabetes mellitus in particular, requires long-tem, ongoing programs, the support and funding must come from within and therefore must reflect a nation's commitment to combat them. One model for this change is a 3-legged stool or platform upon which an assault on chronic disease can be built. The 3 legs are (1) an effective primary health care delivery system, (2) effective health promotion, and (3) a macroeconomic repositioning of health within the government bureaucracy and the world of commerce. To construct each of these legs requires changes in the structure and roles of global health assistance organizations.