Rheumatic heart disease (RHD) is a preventable, treatable form of cardiovascular disease that affects over 32 million people around the world and claims 275,000 lives annually. It affects the world’s poorest, most vulnerable populations and imposes heavy costs on the health systems that can least afford it. If left untreated, rheumatic heart disease can lead to heart valve damage, stroke, heart failure, and death. Treatment of advanced disease requires costly surgery unavailable in many parts of the world. In endemic countries, prevalence of this preventable disease is a stark measure of health system failure and inequality. RHD is the most commonly acquired heart disease in young people under the age of 25. It most often begins in childhood as strep throat. If left untreated, RHD may progress to serious heart damage that kills or debilitates adolescents and young adults, and makes pregnancy hazardous. Although virtually eliminated in Europe and North America, the disease remains common in Africa, the Middle East, Central and South Asia, the South Pacific, and in impoverished pockets of developed nations.