Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death in the UK but is an even greater problem in low income countries. It is assumed by many to be almost entirely attributed to smoking. However, smoking alone cannot account for the distribution of the disease in the world and there is accumulating evidence that the disease is overwhelmingly a disease of poverty. The size of the problem and the failure of current hypotheses to explain the distribution of chronic lung disease make the lack of funding in this area surprising. The failure of science funders to respond to the analysis of the Cooksey report, which pointed out the extreme discrepancy between the size of the problem and the paucity of research funding, represents a serious failure in science policy. The lack of urgency in the face of such a large burden of illness suggests a degree of complacency in the face of a disease that is overwhelmingly a disease of the poor.