This commentary on a paper discussing the high levels of hypertension found in a tribal Indian community reflects on how the poor are affected by the hidden epidemic of non-communicable diseases. They suffer multiple burdens - of communicable and non-communicable diseases, of poverty and of ill-equipped, under-functioning and non-accountable health systems. The situation is worsened by the selective model of primary health care promoted by international financial institutions. The curious logic of this approach to public health is illustrated using hypertension.