As a result of the rapid wave of urbanisation, demo-graphic and nutritional transitions, economic growth, and technological change, the epidemiological profile of most countries has been moving from communicable diseases to non-communicable diseases and injuries. However, while the global burden of injuries has decreased by 31% in the past 20 years, the injury burden due to road injuries and falls in sub-Saharan Africa and southeast Asia has increased by 10–50%, showing how improvements in the injury burden have not been equitably distributed. 

The burden from non-communicable diseases and injuries (NCDI) in India is increasing rapidly. With low public sector investment in the health sector generally, and a high financial burden on households for treatment, it is important that economic evidence is used to set priorities in the context of NCDI.

The poorest billion people are distributed throughout the world, though most are concentrated in rural sub-Saharan Africa and South Asia. Cardiovascular disease (CVD) data can be sparse in low- and middle-income countries beyond urban centers. Despite this urban bias, CVD registries from the poorest countries have long revealed a predominance of nonatherosclerotic stroke, hypertensive heart disease, nonischemic and Chagas cardiomyopathies, rheumatic heart disease, and congenital heart anomalies, among others. Ischemic heart disease has been relatively uncommon. Here, we summarize what is known about the epidemiology of CVDs among the world’s poorest people and evaluate the relevance of global targets for CVD control in this population. 

In the post-2015 era, the Sustainable Development Goals have come to include non-communicable diseases (NCDs). And yet the world's poorest people are still unlikely to benefit from this expanded focus. Despite efforts by WHO and many others, the development community has mainly understood NCDs as a problem linked to aging, urbanisation, affluence, and lifestyle choices. This perspective is also reflected in some of the agreed global targets for NCD control.

In this commentary, investigators from Partners In Health, including NCD Synergies’ Dr. Gene Bukhman, University of Rwanda, Rwanda Diabetes Association, Boston University, and University of Geneva, outlines the importance of researching and addressing the burden of diabetes specific to the world’s poorest populations in low-income countries.

“80 under 40 by 2020: an equity agenda for NCDs and injuries” is a commentary published in The Lancet in 2014, written by Hon. Min. Agnes Binagwaho and Dr. Marie Aimee Muhimpindu of the Rwandan Ministry of Health and Dr. Gene Bukhman for the NCD Synergies group. The 80x40x20 paper was written as an outcome of the NCD Synergies conference held in Kigali, Rwanda in July 2013. The conference hosted by the Rwandan Ministry of Health and attended by representatives from 18 countries, including policy makers from 13 African health ministries.

In the advocacy piece, the authors call for an expanded international agenda on noncommunicable diseases and injuries, focusing particularly on the very poorest populations and individuals younger than 40.