Reframing non-communicable diseases – Authors' reply
Authors: Luke N Allen, Andrea B Feigl
Journal: The Lancet Global Health (2017)

Lavanya Vijayasingham and Pascale Allotey suggest a conceptual extension of the socially transmitted condition (STC) framework to emphasise the role of social factors not only in predisposing individuals to the development of these diseases, but also in shaping the disease course and lived experience. Their reasoning is borne by evidence that socioeconomic factors correlate with STC behavioural risk factors,1Allen L Williams J Townsend N et al.Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review.Lancet Glob Health. 2017; 5: e277-e289Summary Full Text Full Text PDF PubMed Scopus (281) Google Scholar prevalence rates,2Sommer I Griebler U Mahlknecht P et al.Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews.BMC Pub Health. 2015; 15: 914Crossref PubMed Scopus (186) Google Scholar and risk of premature death.3Allen L Cobiac L Townsend N Quantifying the global distribution of premature mortality from non-communicable diseases.J Pub Health. 2017; (published online Feb 10.)DOI:10.1093/pubmed/fdx008Google Scholar Although the insight that social architecture and processes shape the causes and courses of STCs is true, it is neither novel, nor a phenomenon restricted to these conditions. In our original Comment,4Allen LN Feigl AB What's in a name? A call to reframe non-communicable diseases.Lancet. 2017; 5: e129-e130PubMed Scopus (42) Google Scholar we stated that “virtually all diseases are influenced by social factors to some degree”, and Catherine Cavalin and Alain Lescoat caution that an emphasis on the role of social factors in STCs might downplay their role in traditional communicable diseases. We reiterate that STCs are distinguished from other conditions by their distinct constellation of social drivers. We use framing and naming as nosological synonyms, and purposively project beyond the cognitive function of nomenclature towards effecting political change. A helpful philosophical reference point is Wittgenstein's observation that words can act as tools, with meaning derived from use.5Wittgenstein L Hacker PMS Schulte J Philosophical investigations. 4th edn. Wiley-Blackwell, Oxford2009: 43Google Scholar Although an examination of underlying values and assumptions can be helpful, our purpose in reframing NCDs is to effect real-world change. Although Cavalin and Lescoat advocate that social drivers should be tackled as a continuum across all diseases, STCs are a decent place to start, and might help to spread upstream thinking to other areas. What does this mean in practice? Let's consider the UN's Sustainable Development Goals, in which NCDs have been specifically targeted but have not been apportioned any additional funding (nationally or internationally). NCDs suffer a dearth of appropriate measurement indicators and have been side-lined in WHO health system strengthening and universal health coverage planning and financing tools. All 191 WHO country delegations are aware of NCDs but most are not meaningfully addressing them. There is no guarantee that reframing NCDs as STCs will change anything, but we hope to spur reconceptulisation that directly leads policymakers to multisectoral and population-level interventions, such as investment in active transport, early years education, gender equality laws, trans fat bans, and smoke-free legislation. Policy coherence for sustainable development is a hot topic, and policymakers are keen to show that they have more to offer than soundbites. STCs are an open invitation for different sectors to collaborate; for example, at the nexus of environment, agriculture, food, trade, and health. The renaming of NCDs has nothing to do with semantics, and everything to do with the stimulation of action related to the world's leading cause of death and disability. We declare no competing interests. The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of the Organisation for Economic Co-operation and Development or of its member countries. 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 AccessReframing non-communicable diseasesThe collective dynamic initiated by Luke Allen and Andrea Feigl1 is remarkable, and explains why they felt the need to formulate a new proposal,2 which involves renaming and reframing non-communicable diseases (NCDs) as socially transmitted conditions (STCs). Full-Text PDF Open Access