Heart disease, stroke, cancer and other chronic non communicable diseases (NCDs) contributed to 35 of the 58 million deaths (60.3%) in the world in 2005 (1). Eighty per cent of these deaths occurred in low and middle income countries. In India, NCDs were responsible for 53 per cent of deaths and 44 per cent of disability adjusted life years lost (2). India is experiencing a rapid health transition. Within India, the State of Kerala, well known for health at low cost (3), is the most advanced State in this transition, and a harbinger of what will happen to the rest of India in the future. NCDs have common risk factors such as tobacco use, unhealthy diet, physical inactivity and excess adiposity. Policies and programmes focusing on reducing the burden of these common risk factors are likely to make a substantial impact on mitigating the mortality and morbidity due to NCDs (4). The World Health Organization (WHO) has recommended surveillance of common risk factors with the “STEPwise” approach, which uses standardized instruments and protocols for collecting, analyzing and monitoring trends for risk factors within and across countries (5). Thus, STEPS approach focuses on the collection of data on key risk factors of major NCDs at regular intervals in order to design community-based interventions targeted at the reduction of these risk factors and monitoring the results of such interventions. STEPS includes the following sequential phases: collection of information on socio-demographic variables, and behavioural risk factors, i.e., tobacco use, alcohol use, physical inactivity, diet and related factors using a questionnaire (STEP 1); obtaining clinical measurements such as weight, height, waist circumference, and blood pressure using standardized protocols and instruments (STEP 2); acquiring biochemical measurements such as serum total cholesterol, high density lipoprotein (HDL) cholesterol, blood glucose and triglycerides using fasting blood samples (STEP 3). All these three steps have core, expanded, and optional elements. Depending on the need of a specific country/province and the availability of resources, data collection may be limited only to the core items or extended to gather additional data from the list of expanded and optional items.