When we are sick, working is hard and learning is harder still. Illness blunts our creativity, cuts out opportunities. Unless the consequences of illness are prevented, or at least minimized, illness undermines people, and leads them into suffering, despair and poverty.

Kofi Annan, Secretary-General of the United Nations on the occasion of the release of the Report of the Commission on Macroeconomics and Health, in London, 20 December 2001.

There is a two-way interdependent relationship between economic poverty and chronic disease. Many of the world's poor, despite regional differences in geography, culture and commerce, experience the same discouraging cycle: being healthy requires money for food, sanitation and medical care, but to earn money, one must be healthy. The lack of adequate care for chronic conditions forces poor families to face a particularly heavy burden of caring for their loved ones that undermines the development of their most basic roles. Women are particularly "taxed" by the lack of a health care system that deals effectively with chronic diseases (15-17). Competing needs in populations suffering from chronic poverty undermine efforts to address the needs of patients requiring long-term care, including the problem of adherence to medications and therapies.

Poor adherence compounds the challenges of improving health in poor populations, and results in waste and underutilization of already limited treatment resources.