The coverage has started of the big UN focus on non-communicable diseases (NCDs).Â BBC leads with a headline that states, “WHO targets non-communicable ‘lifestyle’ diseases.” Lifestyle is a facile term that may lead one to think that people have certain diseases because of choices in their lifestyle.
Is poverty a lifestyle? We doubt whether people chose poverty.
NCDs, like almost all diseases, have a ‘behavioral component’ in their etiology, but we need to be careful not to blame the victim whose health related behavior may be confined by culture, poverty or a political system.Â Behavior also therefore is not a simple matter of ‘lifestyle.’
So, if we are getting into the issue of behavior as a factor in the spread of disease, we need to be careful about making black and white distinctions between communicable and non-communicable.Â Malaria, a communicable disease (with a vector) arises not from simple lifestyle choices to avoid sleeping under an insecticide treated – the factors influencing behavior are complex. Furthermore, communicable diseases have non-communicable consequences – witness the challenges of chronic anemia and neurological consequences of malaria.
In the push for a new theme for the decade we need to avoid compartmentalization and remember the universal goals that launched primary health care in 1978.Â Our goal should not be to focus on or un-neglect a class of diseases, but to ensure all people, especially those living in poverty, have equitable access to whatever care and prevention they need.