This article outlines the impact of rheumatic heart disease for the individual, the international community and the Pacific region. It then appraises the three main strategies for control of rheumatic heart disease. Secondary prevention is the regular delivery of antibiotic prophylaxis to prevent further episodes of recurrent rheumatic fever and is the only prevention activity that is proven to be effective and cost effective at the individual and community level. The article explores the essential facets of a successful control program focussing upon health education and promotion, and then discusses previous experience with control programs for rheumatic heart disease. Finally it describes the current Pacific Rheumatic Heart Disease Control Program.