The Lancet takes on non-communicable diseases
The 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time on branding, which perhaps explains why existing classifications for the three largest groups of diseases are both outdated and counterproductive.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.
After all, “anything that begins with ‘non’ may be considered a ‘non-issue’ or a ‘non-starter’”.2 Evidence is mounting that some NCDs are partly or wholly communicable. They can be spread through social networks,3 viruses such as hepatitis and human papillomavirus, the built environment,4 cultural and economic conditions, food deserts (ie, areas short on fresh fruit, vegetables, and other healthy foods),5 and intergenerational transmission (ie, diabetes and obesity). Furthermore, the present misnomer implies that the causes are individual rather than societal.
This implication is simply not the case: NCDs have largely sociogenetic antecedents, and efforts focused on individual behaviour have little overall effect if the social and policy environments do not change in parallel.
After initiating a global debate on the subject, Luke Allen (Nuffield Department of Primary Health Care Sciences, University of Oxford, UK) and Andrea Feigl (Directorate for Employment, Labour and Social Affairs, Health Division, OECD, Paris, France) have put forward a new term:
“socially transmitted conditions” (STCs)
This label stresses the anthropogenic and socially contagious nature of the diseases: STCs are driven by urbanisation, industrialisation, and poverty, the availability of tobacco, alcohol, and processed foods, and physical inactivity. STCs also share a common set of solutions focused on addressing the complex and often unjust structure of society.
It is important not to absolve individuals of all responsibility for their own health and lifestyle choices, while highlighting the fact that our changing social environment strongly influences the set of choices available. The term “socially transmitted” shifts the implied locus of action upstream. The term also provides clarity by describing the core uniting characteristic of the disease group.
Virtually all diseases are influenced by social factors to some degree, and it is stressed that STCs are distinguished by the common constellation of social drivers that they share. The authors note that congenital and degenerative conditions are imperfectly captured by the new name. Despite these limitations, the preface “socially transmitted” is vastly more transparent, accurate, and tractable than “non-communicable”. Importantly, it also challenges the persisting misconception that individual greed and sloth are driving the global epidemiological transition.
- Murray, CJ, Lopez, AD, and Jamison, DT. The global burden of disease in 1990: summary results, sensitivity analysis and future directions. Bull World Health Organ. 1994; 72: 495–509
- Sridhar, D, Morrison, JS, and Piot, P. Getting the politics right for the September 2011 UN High-Level Meeting on Noncommunicable Diseases. Center for Strategic and International Studies, Washington, DC; 2011
- Christakis, NA and Fowler, JH. Social contagion theory: examining dynamic social networks and human behavior. Stat Med. 2013; 32: 556–577
- Hipp, JA and Chalise, N. Spatial analysis and correlates of county-level diabetes prevalence, 2009–2010. Prev Chronic Dis. 2015; 12: E08
- Ferdinand, AO, Sen, B, Rahurkar, S, Engler, S, and Menachemi, N. The relationship between built environments and physical activity: a systematic review. Am J Public Health. 2012; 102: e7–13