Is the Horse Already Out of the Barn in Rural India?

The 20th century saw unparalleled1 increases in life expectancy and a major shift in the causes of illness and death throughout the world. A century ago, cardiovascular disease (CVD) accounted for fewer than 10% of all deaths; today, it accounts for approximately 30% worldwide.2,3 The increase in CVD, through a proliferation of risk factors that are heavily influenced by lifestyle choices, is the new challenge for many developing countries.Article p 1950 At the end of the last century, investigators projected the future epidemic of CVD in developing countries.1,4 Many of the projections were for regions determined by economic and geographic factors according to World Health Organization (WHO)1 and World Bank5 definitions; however, these regions are supranational and thus beyond the scope of the units of government in which decision making to combat the CVD burden occurs, either at the national or state/provincial level. A country or provincial level of information is required for planning. Both health ministers who are in the process of developing systems of primary care for chronic diseases and the financial and commercial leaders who are trying to understand the size of future labor forces or government programs (such as social security later in life) are in need of better sources of data.Furthermore, what few estimates we have of the CVD burden in developing countries are based on urban centers, where the highest concentrations of providers and healthcare facilities are found.6,7 Much less is known about rural areas of developing countries, where up to 70% of the population lives (compared with only 21% of the US population). In this issue of Circulation , Joshi and colleagues8 provide a much clearer understanding of the CVD epidemic in rural Andhra Pradesh. They report not only on the mortality data but …