In this issue of the Journal, Jindal and colleagues compellingly document the high disease burden for asthma and chronic bronchitis in India.1 With a comprehensive survey of 169 575 individuals from 23 sites across 12 centres, they estimate that one or more respiratory symptoms were present in 8.5% of individuals. The national burden of asthma and chronic bronchitis is estimated at 17.23 million and 14.84 million, respectively. In absolute terms, these are not small numbers. The unfortunate reality, however, is that the brunt of this disease burden is likely disproportionately borne by the economically impoverished and the socially disenfranchised. The authors suggest that most of the risk factors are preventable, yet public health efforts to combat disease burden have had limited success. Perhaps current health care remains a service delivery challenge in terms of access to both reasonable care and medication. Alternatively, it highlights the inadequate level of investment in public health to improve prevention. Nevertheless, a compelling case now exists for considering a systemic redesign of health care delivery and integrating public health efforts in more innovative ways.