Chronic and Non-Communicable Diseases

by

George Weisz

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0013

Introduction

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.

General Overviews

There have been many books about specific diseases considered chronic or non-communicable, but very few about the broader categories chronic disease and non-communicable disease. Among those works that do exist, three approaches have been used. The first, exemplified in Fox 1993, views increasing concern with chronic disease as a natural consequence of changing disease profiles. A second calls into question the simple link between the growing incidence of chronic disease and intensifying efforts to confront it. Arney and Bergen 1984 and Armstrong 2014 see it as the birth of a new kind of medicine focusing on new populations like the elderly and introducing novel methods of medical surveillance and self-care. Weisz 2014 argues that growing concern with chronic disease was a complex phenomenon, reflecting both the above elements as well as several others, notably medical specialization, better diagnostic tools and statistics, new optimism about controlling such diseases as well as fears of civilizational decline, and the transformation of senescence into a pathological process. It has also been used as a political issue, particularly in the United States. In the process, medicine has vastly extended its areas of responsibility and suppressed alternative explanatory frameworks.

• Armstrong, David. “Chronic Illness: A Revisionist Account.” Sociology of Health & Illness 36.1 (2014): 15–27.

  DOI: 10.1111/1467-9566.12037

  Inspired by Foucault, Armstrong challenges the view that the current dominance of chronic disease in Western nations is due to the decline of infectious disease and an aging population. Instead, they see it as the medicalization of what had previously been considered the natural processes of aging. Aside from being yet another example of “medicalization,” the transformation of normal life into medical problems, chronic disease has been a central element in the creation of a new kind of medicine that in earlier work Armstrong termed “surveillance medicine.”

• Arney, William Ray, and Bernard J. Bergen. Medicine and the Management of Living: Taming the Last Great Beast. Chicago: University of Chicago Press, 1984.

  Inspired by Michel Foucault, the authors argue somewhat unconvincingly that the “anomaly,” a person whose body suffered the effects of different forms of accident and deserved charitable care, was replaced in the mid-twentieth century by the “disabled,” “handicapped,” or “chronic” patient. This shift extended the medical gaze to the most intimate aspects of life and made medical power more total and powerful even as it became more humane and liberating.

• Fox, Daniel M. Power and Illness: The Failure and Future of American Health Policy. Berkeley: University of California Press, 1993.

  Seeks to make history relevant to policymakers. This may explain the simplicity of his analysis. Using deeply flawed statistics, he argues that since 1920 a growing number of people have suffered from chronic disease. Nonetheless, policymakers, medical professionals, and insurance systems continue to focus on acute illnesses and have failed to deal with the problem. Like many before him, Fox suggests that resources be redirected away from acute care services and toward those dealing with chronic disease.

• Weisz, George. Chronic Disease in the Twentieth Century: A History. Baltimore: Johns Hopkins University Press, 2014.

  DOI: 10.1353/book.29446

  Argues that “chronic disease” is a complex social construction that varies in time and place. In the United States, the site of the first chronic disease crisis, the decline in infectious diseases contributed to changing epidemiologic profiles but not nearly as dramatically as some historical and contemporary actors believe. Also, at play were the crisis of welfare institutions in growing cities, changing views of the rights of the poor sick, the expansion of the field of public health, and political ambitions and imperatives. The book then more briefly charts the very different histories of chronic disease in the United Kingdom and France.