Communicating the Noncommunicable

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Author:  Zsuzsanna Jakab
Zsuzsanna Jakab is the WHO Regional Director for Europe. A native of Hungary, she was the founding Director of the European Union’s European Centre for Disease Prevention and Control (ECDC) in Stockholm, Sweden, and has served as State Secretary at the Hungarian Ministry of Health, Social and Family Affairs.

Growing evidence is showing that the ‘noncommunicable diseases’ (NCDs) epidemic currently sweeping the world is in fact very communicable and socially determined. These diseases (including heart disease, cancer, diabetes, chronic obstructive pulmonary disorder, and other chronic conditions such as mental illness), which now represent approximately 60% of the global burden of disease and nearly half of all deaths (WHO, 2010), are largely attributable to tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity modified by a number of diverse factors, including environmental components and genetic predisposition as well as health system performance and effectiveness.

On the surface, behavioural choices appear to be individual, yet a wide range of epidemiological evidence conclusively shows that these unhealthy behaviours are predictable and inextricable from the socioeconomic contexts in which they are most commonly found (Kanjilal et al., 2006). Moreover, the World Health Organization (WHO) and other health advocacy groups cite the aggressive global marketing of risky products and behaviours, particularly those targeting children and youth, as key factors in bringing tobacco, alcohol and unhealthy processed foods into households worldwide (WHO, 2010).   Of particular concern is the fact that the NCD burden disproportionately affects the most vulnerable communities on the socio-economic ladder, making it a major contributor to growing health inequity worldwide.

As world leaders gear up for the United Nations High-Level Meeting on NCDs, to take place in September 2011, the time is propitious to intensify the debate on strategies for tackling these diseases. Given that chronic diseases are profoundly rooted in social and community ties, a modern communication strategy which unites a wide array of stakeholders will be a linchpin of any successful action to address these public health threats.

Human beings are intensely social animals, and activities such as smoking, drinking, eating, and exercising are often closely associated with group contact. A group of researchers led by Fowler, Christakis, and Rosenquist ( 2008; 2010) have documented this phenomenon using data from the Framingham Heart Study (, shedding light on how social networks help to determine many health-related behaviours such as tobacco use and alcohol intake and how they disseminate supposedly noncommunicable conditions, including obesity depression, loneliness, happiness and even cooperative social behaviour). Their conclusions indicate that both physical and mental health are strongly influenced by social forces, and that both healthy and unhealthy behaviours spread contagiously in large social groups.

Communication in all its forms – including, education, advocacy, social networking, behavioural counselling and awareness raising – has an unparalleled role in determining population attitudes and beliefs. Communication can influence the public agenda, advocate for policies and programmes, promote positive changes in the social, economic and physical environment, catalyze behavioral changes, stimulate debate and dialogue for health as a priority, and encourage social norms that benefit health and quality of life (UN-ECOSOC, 2010; Wakefield, et al, 2010).  A central goal of these strategies must be not only to modify behaviors, but to change the way communities perceive unhealthy behavioral choices, increasing their support for a full range of healthy public policy.

New communication technologies and approaches, when integrated into comprehensive public health strategies, bring this objective within reach; they can effectively disseminate accurate information to virtually everyone; enhance people’s and policy makers’ health literacy related to the four key chronic disease risk factors; and advocate for strong regulations to both enhance access to reliable information as well as counteract the negative influences of the marketing of hazards such as tobacco, alcohol and highly energy-dense foods.

To this end, communication capacity building should include training, twinning, networking and development of tools and guides.  Participation should be actively sought from all relevant stakeholders, and the use of information and communication technologies (ICT) and approaches including the use of mobile communications and other social media should be explored to gather evidence on effectiveness. These new approaches are ideal ways for targeting children and adolescents—the generation whose uptake of new media technologies is highest, and also the population group which is arguably most vulnerable to acquiring poor habits. Their choices will have a great impact on development of obesity, diabetes and cardiovascular disease later in life, and thus should be a major objective of health literacy research initiatives and pilot programs which utilize innovative communication tools (UN-ECOSOC, 2010).

Useful approaches need to be shared and adapted. All of these activities could potentially be used to promote and advocate for population and policy maker chronic disease health literacy and enhance the “health literacy friendliness” of the systems in which people obtain and use information. Many sectors and actors can make a substantial contribution to developing health literacy, including education , community-based organizations, scientific societies, and the corporate sector (UN-ECOSOC, 2010). New communication  partnerships could provide training at all levels and build sustainable public health communication capacities which could be adapted to the unique needs of different settings.

Communication is one medium by which social norms (and thus many social behaviours) are transmitted; it is also a preeminent tool for fostering wide societal support for comprehensive public health initiatives. In the context of the ongoing technological and communication revolution, health policymakers cannot afford to fall behind in this rapidly evolving field.


Christakis NA & Fowler JH (2008). The collective dynamics of smoking in a large social network. New England Journal of Medicine, 358, 2249–2258.

Fowler JH & Christakis NA (2010). Cooperative behavior cascades in human social networks. Proceedings of the National Academy of Sciences USA, 107, 5334–5338.

Kanjilal S, Gregg EW, Cheng YJ, Zhang P, Nelson DE, Mensah G & Beckles GL (2006). Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971–2002. Archives of Internal Medicine, 166, 2348–2355.

United Nations Economic and Social Council (UN-ECOSOC) (2010). Health Literacy and the Millennium Development Goals: United Nations Economic and Social Council (ECOSOC) Regional Meeting Background Paper (Abstracted). Journal of Health Communication, 15, 211–223. Retrieved from:

Wakefield M, Loken B & Hornik R (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376, 1261–1271.

World Health Organization (2009). Public Health Campaigns: getting the message across. Geneva: World Health Organization.

World Health Organization (2010). Background Document Informal Dialogue with the Private Sector in the preparation of the UN High-Level Meeting of the General Assembly on Noncommunicable Diseases. Geneva: World Health Organization.

Written by jhcadmin

April 21, 2011 at 4:48 pm

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