Renaming non-communicable diseases

Abstract

Luke Allen and Andrea Feigl issue an impassioned call to reframe non-communicable diseases (NCDs).1Allen LN Feigl AB What's in a name? A call to reframe non-communicable diseases.Lancet Glob Health. 2017; 5: e129-e130Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar They argue that “non-communicable” insinuates “less important” relative to infectious diseases, producing a dearth of NCD attention and funding. Granting a priori precedence to infectious diseases as the primary concerns for mortality and biosecurity risks undermining broader collaborative contributions aimed at promoting health equity. Reframing NCDs requires a biosocial approach for both understanding and treatment. Linking population disease occurrence and individual experience to sociopolitical, economic, and cultural forces would illuminate the role that past and present political actors have on current health inequities, obliging policy makers to consider the impact their decisions have on health for their constituents and the increasingly connected world. To link current NCD epidemics to contemporary and past political-economic decisions and sociocultural conceptions, we suggest renaming NCDs interactional diseases (ItDs). Health scholars are already producing research through this biosocial lens. For example, Livingston2Livingston J Improvising medicine: an African oncology ward in an emerging cancer epidemic. Duke University Press, Durham2012Crossref Google Scholar links cervical cancer to the lack of human papillomavirus vaccines in Botswana. Barry and Huskamp3Barry CLH Huskamp HA Moving beyond parity: mental health and addiction care under the ACA.N Engl J Med. 2011; 365: 973-975Crossref PubMed Scopus (156) Google Scholar critique “behavioural health” as too often associated with choice—an aetiological assumption that implies individuals who suffer from these conditions can simply change their behaviour to improve their condition. This is often not the case; many epigenetic factors influence course and outcome for ItDs. Jenkins4Jenkins JH Extraordinary conditions: culture and experience in mental illness. University of California Press, Oakland2015Google Scholar demonstrates the necessity for researchers and physicians to (re)assess how their treatment expectations, especially in psychopharmacology, shape both patients' experience and adherence. We recognise the conceptual danger of prioritising certain aetiologies or conflating social communication with biological contagion. All diseases are interactional in some sense; infectious diseases are also contracted and treated in particular social worlds. However, the interactional nature of diseases formerly clustered as NCDs must be considered for researchers, clinicians, and policy makers to understand the complex context of ItD course and outcome. We intend this reframing as a catalyst for changing research priorities, funding, and interventions, so global health can further WHO's call for health to be “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” for all.5World Health OrganizationPreamble to the Constitution of the World Health Organization.Official Records of the World Health Organization. 1948; no. 2: 1Google Scholar The Center for Global Mental Health at the University of California, San Diego, seeks to use interdisciplinary collaboration to address the commonality of struggle among people everywhere to feel better and live well despite inequities. This applies across ItDs and underscores the urgency of ethical, empirical work aimed at advancing health for all as shared value and vocation. We declare no competing interests. We contributed equally to this response. Renaming non-communicable diseasesThe call by Luke Allen and Andrea Feigl (February, 2017)1 to reframe non-communicable diseases (NCDs) is welcome. The lack of focus on these increasingly important causes of morbidity, impairment, and mortality, with their commensurate increasing consumption of health and societal resources and reduced economic contribution, is inappropriate and damaging for all the reasons Allen and Feigl cogently argue. Few things that are described in the negative as what they are not obtain the understanding or action they deserve. Full-Text PDF Open AccessWhat's in a name? A call to reframe non-communicable diseasesThe global health community does not spend much time on branding, which perhaps explains why existing classifications for the three largest groups of diseases are both outdated and counterproductive. The first Global Burden of Disease study1 described infectious diseases, non-communicable diseases (NCDs), and injuries. This grouping reflected a predominantly infectious disease burden in low-income and middle-income countries, which has since tilted towards NCDs. A name that is a longwinded non-definition, and that only tells us what this group of diseases is not, is not befitting of a group of diseases that now constitute the world's largest killer. Full-Text PDF Open Access

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