From both a social and political standpoint, a very strong case can be made that action is warranted. As noted in Chapter 1, South Asians are 6 years younger than those in the rest of the world at their first heart attack.
This burden is especially hard on the poor, who after a heart attack, face a lifelong major illness, the need to finance substantial portions of their care out of pocket,
and live at great risk for catastrophic spending and worsened impoverishment. Even for those who have escaped severe poverty, faced with large, lifelong out-of-pocket expenses, impoverishment can reoccur.
and live at great risk for catastrophic spending and worsened impoverishment. Even for those who have escaped severe poverty, faced with large, lifelong out-of-pocket expenses, impoverishment can reoccur.
Social determinants also play an important role. Dramatic differences in health are closely linked with the degree of social disadvantage and poverty within countries (CSDH 2008). These inequities arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with health and illness.
The conditions in which people live and die are, in turn, shaped by political, social, and economic forces. In addition, the relationship between NCDs and poverty is bidirectional via social determinant forces (Figure 3.1).
Figure 3.1 Social determinants, NCDs, and their relationship to poverty
Source: Authors.
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