The decline in infant mortality now occurring in the developing world assures a growing population of older persons with a chronic disease morbidity burden that is predictable and costly. The health needs and related social requirements of the elderly are not always well met even in countries where resources are substantial. In the developing world, this morbidity burden can quickly overwhelm fragile and often underfinanced health infrastructures already unable to meet fully the prevention and treatment needs of a younger population with relatively low-cost, easy-to-prevent, easy-to-treat illnesses. Inappropriate application of costly technology could easily result, accompanied by diversion of resources from existing primary-care services, and paradoxically poor service to the emerging aging population. This paper examines the dilemma, and spells out the issues by examining several chronic diseases in detail. We conclude with suggestions for a policy-oriented research agenda aimed at the development of affordable and humane approaches to the health needs of aging populations, and the prevention and care of chronic diseases in the developing world.