In reply: Jayasuriya draws attention to the increasing problem of non-communicable diseases (NCDs) among countries in our region, and we agree that this contributes to health inequity. Prevention of NCDs requires action across many sectors, public and private, and at state, subnational, community and individual levels. Managing NCDs creates additional challenges for effective and equitable health service delivery. However, NCD-related services are only one example of currently ineffective primary health care in developing countries. We maintain that — across the disease spectrum — inadequate health reform and the lack of attention to health across sectors, the lack of public finance to provide equal access to services (including community-level preventive screening for and management of chronic NCDs), and inadequate attention to social determinants of health remain key to improving health equity.