Recap — Are Distinctions Between Communicable and Non-Communicable Diseases Still Useful? Why We Should Care, with Paul McDonald

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Published on October 31, 2024

On October 9, 2024, York University Professor Emeritus and Dahdaleh Senior Fellow Paul McDonald asked seminar attendees to re-consider the traditional distinctions between communicable and non-communicable diseases (NCDs). He argued that, like many models, frameworks, nomenclature and theory, this division can limit our understanding of interventional innovations in public health. He quoted statistician George Box who wrote, "All models are wrong, but some are useful". Paul noted that the words and organizational frameworks we use can influence how we think about ourselves, other people, as well as health, disease, and the way we address them. For example, terms and concepts like “non-communicable disease” have accelerated in use over the last 60 years. They have come to represent a distinctive group of conditions which are differentiated from communicable diseases by virtue of their rate of progress, duration, pathogenic foundation (e.g., lifestyles “choices vs microorganisms), and communicability.  

Paul noted that unlocking our potential to address NCDs are important because three quarters of global deaths are attributable to NCDs with 86% of premature deaths before age 70 linked to these conditions. Moreover, NCDs are a global health issue because 77% of NCD deaths from now occur in low and middle income nations.

Paul went on to examine the distinguishing feature of communicable vs. non-communicable diseases. He presented examples of how various NCDs (some of which are highly prevalent) can progress rapidly, are not necessarily chronic, and can be caused by micro-organisms spread from person to person. Conversely, there are examples of communicable diseases which are slow to develop, and chronic in nature.  Paul also pointed out that NCDs and CDs often interact in complex ways. As might be expected from the name, arguably the most important feature of so called NCDs is that they are not contagious or spread between people. Therefore, Paul presented data suggesting that conditions such as heart disease, cancer, and certain mental health conditions are spread through social networks. Major risk and protective factors such as tobacco use, tobacco cessation, obesity, weight loss, and happiness spread through complex social, political, economic networks and institutions. Certain cancers are spread through sexual contact between people. Our failure to recognize the communicable nature of NCDs influences our focus on individual level and clinical interventions and a failure to develop and proliferate more social, commercial, environmental and developmental interventions at a network and population level.  Paul argued that theory, models and practices used to address communicable diseases could have significant utility for preventing and managing heart disease, stroke, lung disease, cancer, chronic brain disorders including dementia and mental illness. Lesson from NCDs have the potential to aid the control and treatment of traditional communicable conditions. He stressed that using common terms such as pathogen and vector may be helpful in unifying our thinking.

Paul advocated for a more integrated and systems-based approaches to public health which identify and take advantage of the complex interactions of factors influencing communicable diseases, so called non-communicable diseases, as well as injuries. He closed by urging us not to be inhibited by traditional models, nomenclature, and frameworks. Rather, science, policy and practice will ultimately only advance when we have the courage to question the status quo and  embrace broader perspectives to create innovations for improving global health.

Watch the seminar presentation below: https://www.youtube.com/watch?v=_ubyJNNXEtg

Connect with Paul McDonald.

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