a Institute of Advanced Studies, University College London , London , UK.
Glob Health Action. 2019;12(1):1641043. doi: 10.1080/16549716.2019.1641043.
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.
近年来，人们一直在争论传染病与非传染性疾病（NCD）的划分在疾病分类中是否有意义。针对 NCD 的框架提出了一些批评意见，不仅涉及到感染在 NCD 病因学中所起的重要作用，还涉及到 NCD 的许多社会决定因素的传染性，以及 NCD 个体主义的“生活方式”框架，这种框架往往侧重于健康行为，而忽略了健康的社会政治、环境和结构决定因素。在本文中，我们对 NCD 术语的使用进行了历史概述，并分析了最近关于 NCD 的命名和框架的一些争论。我们认为，对 NCD 命名和框架所依据的假设缺乏反思，可能导致收集到的流行病学数据不足，干预措施不适当，护理不足。社会流行病学、健康促进、医学人类学、人口学和其他领域的工作可以为以下方面提供一些见解：如何重新构建针对 NCD 的工作，以提高其影响和效果。此外，诸如多病共存和综合征、生态社会理论框架以及基于社会科学的方法等概念，可能为疾病的概念化提供了一种前进的方式。
