Allen and Feigl1 fail to emphasize that non-communicable diseases (NCD) were framed and not named in global health discourse. NCDs from a global health perspective are currently thought of as four diseases and four associated risk factors.2 This framing does not include many NCDs, such as genetic defects, mental health and injuries, which by definition are included in the categorization as they are not transmitted from person to person. Within the 4 prioritized NCDs there are conflicts with what Allen and Feigl1 and others propose3,4. Some cancers are caused by a virus and are curable. Type 1 diabetes is of unknown etiology compared to type 2 diabetes which is mainly driven by changes in the environment.
Allen and Feigl5 state that the “global health community does not spend much time on branding”. We agree with this statement, but highlight that three communicable diseases which receive significant funding, namely HIV/AIDS, tuberculosis and malaria did not rename themselves. Two stuck to the causative pathogens and the third with its original name linked to the notion that it was caused by “bad air”. Advocates reframed these health issues, beyond a purely health based discourse and the specialist and academic spheres, as wider concerns impacting global security, economies and development.6,7
The inclusion of NCDs in the Sustainable Development Goals (SDG) is a unique opportunity. We suggest linking NCDs with each SDG in order to highlight that development cannot succeed without the inclusion of NCDs.8 One could call this the COHESION approach in that the focus of our work on NCDs and NTDs are the tools that allow us to address the SDGs versus a disease centric approach. For example SDG 1 and NCDs as caused and causes of poverty; SDG 2 and malnutrition as a risk factor for NCDs and that the double burden of malnutrition needs to be addressed; SDG 3 and how NCDs need to be included in Universal Health Coverage; Gender issues (SDG 5) as NCDs impact women and men in different ways; SDG 11 and in making cities safe this needs to include NCDs with regards to road traffic accidents and providing safe spaces for exercise and access to healthy food; and SDG 17 that national and global partnerships across sectors will be necessary to solve this challenge.
“What’s in a name? That which we call a rose; By any other name would smell as sweet. As stated by Romeo and Juliet names do not have an impact and the rose remains a rose no matter what we call it. NCDs will not be solved purely by being renamed, they need to be reframed politically.
References
1. Allen LN, Feigl AB. Reframing non-communicable diseases as socially transmitted conditions. The Lancet Global health 2017; 5(7): e644-e6.
2. WHO. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: World Health Organization, 2013.
3. Lincoln P. Renaming non-communicable diseases. The Lancet Global Health 2017; 5(7): e654.
4. Rigby M. Renaming non-communicable diseases. The Lancet Global health 2017; 5(7): e653.
5. Allen LN, Feigl AB. What’s in a name? A call to reframe non-communicable diseases. The Lancet Global health 2017; 5(2): e129-e30.
6. Stabinski L, Pelley K, Jacob ST, Long JM, Leaning J. Reframing HIV and AIDS. BMJ 2003; 327(7423): 1101-3.
7. de Waal A. Reframing governance, security and conflict in the light of HIV/AIDS: a synthesis of findings from the AIDS, Security and Conflict Initiative. Soc Sci Med 2010; 70(1): 114-20.
8. Beran D, Chappuis F, Cattacin S, et al. The need to focus on primary health care for chronic diseases. The lancet Diabetes & endocrinology 2016; 4(9): 731-2.