By definition, chronic diseases such as heart disease, cancer, and diabetes are not infectious or transmissible. Since the early 20th century, we have witnessed a shift in developed nations, moving from infectious diseases like tuberculosis and pneumonia as the primary causes of death to noncommunicable diseases such as cardiovascular disease, cancer, and respiratory conditions.
Chronic diseases account for approximately 60% of global deaths, prompting a corresponding change in priorities for both public health and medical care. The focus has shifted towards preventive measures, including dietary practices, increased physical activity, and pharmaceutical treatments. However, this approach often overlooks the main contributors to chronic diseases and premature death.
I advocate for using proven strategies, similar to those employed to control the spread of infectious diseases, to prevent the proliferation of chronic diseases. We need to move beyond trying to convince individuals that they bear a moral responsibility to themselves and society as a whole to improve their diet and engage in regular exercise. These interventions frequently come too late and have limited impact on mitigating the severity of illnesses.
I propose strategies that target the root causes of chronic diseases, which lead to the formation of disease clusters, similar to what we observe with infectious diseases. When we examine county maps documenting diabetes cases, we find that they are concentrated in lower-income areas with limited access to healthcare services, high unemployment rates, and unfavorable neighborhood conditions.
To address this, I suggest revising zoning policies to restrict the sale of cigarettes and vaping products, as well as curbing advertising targeting the youth. While encouraging people not to desire or purchase tobacco products is important, the healthy lifestyle approach places an undue moral burden on individuals. We need to focus on the “vectors” in a similar manner to how infectious diseases are controlled. Notably, there are fewer liquor and tobacco stores in affluent neighborhoods, and when we analyze the data, it becomes evident that this is what makes chronic diseases appear contagious. People’s choices are heavily influenced by the options available to them.
I have integrated this shift in public health thinking into my curriculum and as part of an introductory public health textbook that I am co-authoring, set to be released in 2024.