Rheumatic heart disease presents a major public health challenge (particularly for children) and major determinants are poverty, malnutrition, overcrowding, poor housing and a shortage of health-care resources. Although cost effective prevention and control strategies are available, they remain underused in most developing countries. This publication contains the report of a WHO expert consultation, held in Geneva in October 2001, which reviewed the current scientific knowledge of rheumatic fever and rheumatic heart disease, as well as the medical and public health related practices. It suggests practical recommendations for an evidence-based approach to the prevention and management of the disease and for cost-effective programmes for their control.