Sub-Saharan Africa (SSA) has huge amounts of natural resources and a source of strategic minerals. It is not overpopulated compared to the Asian continent, yet the economic conditions have deteriorated alarmingly in recent years. It is the poorest continent and has the lowest per capita income in the world. An analysis of the causes of poverty and its impact on health, particularly cardiovascular diseases (CVD) and hypertension, was carried out and is reported on here. A 'second-wave epidemic' is currently sweeping through SSA, other developing countries and Eastern Europe, making a comprehensive CVD programme necessary. Social, economic and cultural factors impair the control of hypertension, diabetes, obesity, tobacco use and other risk factors for CVD in SSA. Primary prevention through a population-based, lifestyle-linked programme, as well as cost-effective methods for detection and management are synergistically linked. The existing healthcare infrastructure needs to be orientated to meet the challenge of CVD, while empowering the community through health education.