Chronic diseases like heart disease, cancer, and diabetes are defined as non-infectious and non-transmissible. Since the early 20th century, developed nations have experienced a significant shift in the primary causes of death, moving from infectious diseases such as tuberculosis and pneumonia to noncommunicable conditions like cardiovascular disease, cancer, and respiratory illnesses.
These chronic diseases now account for roughly 60% of global deaths, forcing public health and medical care to prioritize preventive measures such as healthier diets, increased physical activity, and pharmaceutical treatments. However, this approach often fails to address the core drivers of chronic diseases and premature mortality.
Instead of focusing solely on individual responsibility, I propose adopting strategies modeled on those used to combat infectious diseases. This means moving beyond the narrative that individuals have a moral duty to improve their lifestyle for the greater good. Efforts to encourage better diets and regular exercise often come too late and have a limited effect on disease progression.
We need solutions that address the systemic root causes of chronic diseases, which frequently manifest as clusters influenced by socio-economic and environmental factors. For instance, county maps showing diabetes prevalence often highlight concentrations in low-income areas where access to healthcare is limited, unemployment rates are high, and neighborhood conditions are poor.
One way to tackle this is through policy changes, such as revising zoning laws to restrict the sale of cigarettes and vaping products and limiting youth-targeted advertising. While individual education remains valuable, emphasizing a “healthy lifestyle” approach can place an unfair moral burden on people. Instead, public health efforts should focus on controlling the “vectors” of chronic diseases, similar to strategies for infectious disease containment. Data shows that affluent neighborhoods typically have fewer tobacco and liquor stores, and this disparity contributes to the perception of chronic diseases spreading like contagions. People’s choices are largely dictated by the options available to them.
This new perspective on public health has been integrated into my teaching and will be a key theme in an introductory public health textbook I am co-authoring, scheduled for release in 2024.