Economic thought regarding the link between poverty and disease has also evolved. Sen's 2 landmark treatise, Development as Freedom, exposed the false dichotomy between political and social and economic rights. Sen 2 posited that development was broader than income: an affluent, stable democracy could not be achieved without an educated and healthy populace. "There is a deep complementary between individual agency and social arrangements," Sen 2 wrote. And more pointedly: "Development requires the removal of major sources of unfreedom: poverty as well as tyranny, poor economic opportunities as well as systematic social deprivation, neglect of public facilities as well as intolerance or overactivity of the repressive states." Such insight paved the way for the creation of the Human Development Index (HDI) 20 years ago. The HDI is a composite measure of health, education, and income and was designed by Mahbub ul Haq to counter the inordinate reliance on income alone as a measure of well-being. Building on the conceptual framework created by Sen and parameterized (albeit imperfectly) by ul Haq, Jeff Sachs became the next economist to make a broader concept of development operational by promoting the Millennium Development Goals (MDGs). The 8 MDGs, endorsed by 189 countries, are timelimited commitments to reduce poverty, expand educational opportunities, promote gender equality, and safeguard population and environmental health. 3 This article discusses the complex relationship between poverty and communicable disease, and draws on experience gleaned from working in solidarity with the destitute sick in Haiti, Peru, Rwanda, and elsewhere, as well as from anthropologic and economic theory and evidence. We conclude that the twin afflictions of poverty and disease cannot be treated in isolation and require a biosocial understanding to achieve lasting health gains.