Renaming non-communicable diseases
Authors: Michael Rigby
Journal: The Lancet Global Health (2017)

The call by Luke Allen and Andrea Feigl (February, 2017)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 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. Would we call for more non-lay people and non-retail products to address the non-static numbers of persons with non-normal mobility and physiology? However, moving from what not to call NCDs to what better to call them requires a considered and constructive approach. The objectives at a system level are to achieve better understanding of the conditions, their personal and societal impact, and the health and care actions needed, especially as numbers increase inexorably owing to medical advances and the ageing demographic. More importantly, at a personal level, any new term needs to resonate with and represent patients and their carers. The term needs to be credible, and indeed compelling, to policy makers, politicians, and donors in particular. It needs to be applicable in high-income as well as low-income countries, and in all health systems. Conceptual, academic, or high-level terms are therefore unlikely to succeed. There may also be an age issue. Conditions affecting mature adults and older people will be perceived as something broadly correlating with the ageing process, and its variation in individuals. But for children and young adults, a term that smacks of the onset of elderliness while still in youth with be demoralising and a disincentive to seeking to optimise function and performance. A suitable generic term might therefore be life-long disease (LLD). This does not imply poor prognosis, or indeed any lack of hope of remission, but almost all such diseases even if controlled or in remission will still need monitoring or check-ups, with their resource and lifestyle implications. This term does indicate an increasing occurrence in an ageing society. However, for younger people, a variant of learn-to-live-with conditions, made vernacularly attractive as L2Ls, would indicate a long-term situation but with a positive process of understanding and planning of lifestyle and health throughout a normal lifespan. For policy makers, health planners, donors, and epidemiologists, LLDs and L2Ls would be clear terms and the resource requirements, as well as societal understanding, would be seen as necessary to be supportive. Above all, the terms would be equally meaningful to all citizens as well as to global institutions, and are devoid of any stigma. I declare no competing interests. What'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 AccessRenaming non-communicable diseasesLuke Allen and Andrea Feigl issue an impassioned call to reframe non-communicable diseases (NCDs).1 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. Full-Text PDF Open AccessRenaming non-communicable diseasesThe debate opened up through the Comment by Luke Allen and Andrea Feigl1 is timely and welcomed. The framing of non-communicable diseases (NCDs) has been an ongoing challenge for those working on prevention and one that has not been fully addressed or resolved. Full-Text PDF Open AccessRenaming non-communicable diseasesReframing non-communicable diseases (NCDs) to "spur a sense of urgency" and "focus attention on effective system-wide interventions"1 makes sense. With almost three-quarters of NCD deaths now occurring in low-income and middle-income countries (LMICs), the increasing burden of NCDs already has severe economic consequences that impoverish families, jeopardise health systems, and hinder social and economic development.2 Full-Text PDF Open Access