Chronic and Non-Communicable Diseases

Since the late nineteenth century, influential medical and public health figures have tried to respond to apparent changes in the disease profiles of nations and social groups. Thinking has revolved around two axes: 1) acute versus chronic diseases having to do with duration; 2) infectious diseases versus non-communicable diseases relating to causation. The first axis reflects a traditional distinction going back to Antiquity and originating in the need to provide prognosis. The second became possible following the spread of the germ theory of disease in the late nineteenth century. Initially, the opposite of “infectious” was described by terms like “degenerative” and “organic.” “Non-communicable” came into common usage in the 1990s when it was taken up in the world of global health. Despite the different conceptual bases of these terms, they mostly focus on the same conditions. These conditions are not stable and vary with time and place. Mental illness and disability have at times been lumped together with cancer and cardiovascular diseases, but mostly, they follow an independent trajectory. This article discusses such conditions only if they interact directly with one of our two major categories. The issue of disability is particularly thorny because it intersects more directly with the history of chronic disease. But disability history has taken an autonomous path that has generated a huge literature that cannot be integrated into this study, as a later section discusses. A second difficulty is that the number of relevant conditions, and of works about them, has multiplied to the point where it is impossible to deal with them individually. Here too, this article discusses individual diseases only to the extent that they contribute to the development of general concern with chronic disease and non-communicable disease or that they illuminate one of the themes discussed. Since the contemporary period is awash with studies of these many diseases, this article is limited for the most part to works dealing with the subject substantively before roughly 1980. Another limitation is geographical. This article focuses on the United States, the United Kingdom, and France. However, interesting work on other countries is scattered throughout this essay. Finally, the article presents a representative selection of works on the subjects it discusses. Readers who search for other relevant research by these authors discussed will be well rewarded. The framework underlying what follows is that extensive concern with chronic disease emerged first in the United States in the early years of the twentieth century for a variety of shifting reasons. Consequently, the United States has produced a very extensive literature on chronic disease, which is reflected in its lengthy treatment in this bibliography. In Europe, chronic disease was dealt with as a collective social welfare problem or as one of several individual diseases until the 1960s, when authorities gradually began treating such conditions as parts of a single comprehensive medical problem. In the world of international and global health, chronic disease entered the World Health Organization (WHO) on a small scale in the 1960s but became a major global health concern only in the 1990s when it was reframed as non-communicable disease.