Nevertheless, the age-standardised death rate in Costa Rica decreased from 556 per 100 000 inhabitants in 1990 to 462 per 100 000 inhabitants in 2010. Important for this development was an improved access to primary health care services during the 1980s and 1990s, allowing for quicker detection of diseases. Ischemic heart disease ranked highest with 10.2% of all YLL in 2010, which corresponds to a 40% increase from the levels in 1990 (Table 1.1) (IHME, 2011). However, the second and third causes of YLL due to premature mortality in 2010 were road injury and interpersonal violence, with 7.3% and 4.5% of all YLL respectively (59% and 142% higher than levels in 1990 respectively), pointing out an urgent need in the prevention of injuries and violence in the country . As measured by disability adjusted life years (DALY),3 it was estimated that the leading cause of burden of disease in Costa Rica in 2010 was ischemic heart disease, followed by major depressive disorder, lower back pain, road injury and asthma. These risk factors in combination with increasing life expectancy have driven up the prevalence and mortality of NCDs.