Reframing NCDs? An analysis of current debates

ABSTRACT

There have been many debates in recent years as to whether the communicable disease versus non-communicable disease (NCD) division is a meaningful one in disease classification. Several critiques have been raised about the framing of NCDs, regarding not only the prominent role that infections play in the aetiology of NCDs, but also the communicability of many social determinants of NCDs and the individualistic, ‘lifestyle’ framing of NCDs that tends to focus on health behaviours to the neglect of socio-political, environmental, and structural determinants of health. In this paper, we give a historical overview of the usage of the NCD terminology and analyse some of the recent debates regarding the naming and framing of NCDs. We argue that a lack of reflection on the assumptions underlying the naming and framing of NCDs may lead to the collection of insufficient epidemiological data, the development of inappropriate interventions and the provision of inadequate care. Work in social epidemiology, health promotion, medical anthropology, demography, and other fields may provide insights into the ways in which efforts targeting NCDs may be reframed to improve impact and efficacy. In addition, concepts such as multimorbidity and syndemics, frameworks such as ecosocial theory and approaches based in the social sciences may provide a way forward in the conceptualization of disease.

KEYWORDS:

• Non-communicable diseases
• social determinants of health
• epidemiology
• health transitions

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

The authors would like to acknowledge Marissa Mika, Olutobi Sanuade, the research fellows and directors of the Institute of Advanced Studies at University College London, and members of the Centre for Global Non-Communicable Diseases at University College London for their comments and suggestions on the paper.

Authors’ contributions

MV conceived of the paper. KA drafted the manuscript. Both authors reviewed and revised the manuscript and approved of the final version.

Disclosure statement

No potential conflict of interest was reported by the authors.

Paper context

Health professionals and scholars from various fields have expressed dissatisfaction with the framing and terminology of non-communicable diseases (NCDs). This paper synthesizes these debates, analysing themes that emerge. The implications are that health professionals may need to be more reflexive about how we classify and discuss diseases and may benefit from other disciplines in addressing the NCD burden. Concepts such as multimorbidity, syndemics, ecosocial theory and health promotion may be particularly useful in this endeavor.

Additional information

Funding

The authors were funded by a Wellcome Trust Investigator Award in Humanities and Social Science held by Megan Vaughan (Grant number: 106534/Z/14/Z). The funders did not play any role in the design and interpretation of this analysis, nor in the writing of the manuscript.