Commentary: Poverty and cardiovascular disease in India: Do we need more evidence for action?

It appears that some Western academics are still caught in a time warp, like Rip van Winkle. An argument was advanced by a World Bank team in 1999, that any action to control non-communicable diseases (NCDs) would only help the rich and hurt the global poor by increasing health inequity.1 This has subsequently been refuted by many.2,3 Even the World Bank changed its stance in 2007, declaring that in ‘all countries and by any metric, NCDs account for a large enough share of the disease burden of the poor to merit serious policy response’.4 The United Nations political resolution on NCDs, in September 2011, also acknowledged that NCDs are imposing health and developmental burdens on the poor in low- and low-middle income countries.5 Despite this, Subramanian et al. have chosen to rehash the same argument with regard to cardiovascular disease (CVD) in India.6 In brief, they reviewed the available published literature from India on the association between socio-economic status (SES) and cardiovascular (CV) risk factors or acute events or mortality outcome. They demonstrated a positive gradient in socio-economic status (SES) in the prevalence of one of the CV risk factors, obesity or overweight in Indians, and postulated that CVD is a concern for only the rich in India. In effect their stated position was similar to the Gwatkin thesis and it is disheartening that we have not moved beyond in the past 14 years. We recognize and respect the commitment of Gwatkin and Subramanian et al. to maintaining prioritized global attention to communicable diseases and malnutrition. While sharing these commitments, we believe and argue that action is also needed on chronic NCDs and that these are not mutually competitive.