All Health Afflictions Are Disease? WHO May Be Undermining Health Literacy in the Title of the New ICD-11

The International Classification of Diseases is dropping and Health Related Problems from its title in the new ICD-11 — thus calling all ailments diseases. Isn’t this misleading? Aren’t there more proper names for the diversity of mortality and morbidity causes?whoicd11

Many ailments are better referred to as health afflictions, or injuries, or intoxications, or vascular events, etc… The generic name disease especially bothers me regarding mental health problems. To call them all ‘disease’ is not only imprecise: it encourages stygma.

It is true that disease can be used as a generic term. Disease can be applied to any deviation from normal bio-organic form and function. Indeed, two subtly differring definitions for disease can be found in general use and in dictionaries, including Wikipedia: a restricted definition, and the broader definition as a deviation from normality. By including the phrase …and Health Related Problems, the original title of the ICD appertained to both the restricted and the broader definitions. But now that this phrase has been dropped, only the broader definition applies, and it is more vague and less pertinent in specific situations.

Consider a statement that starts You have a disease called… Without sounding odd, this could be said of cancer, lupus, respiratory infections, transmittable (contagious) diseases, etc. Whereas You have a disease called a vascular event would definitely sound odd. In any case it would be better to say You suffered a vascular event and now have a post-vascular event condition, for example.

A second example: You have a disease called insolation (or heatstroke) sounds odd and misleading. In any case, this can be more properly stated as You suffered an insolation. Same applies to dehydration, intoxications, intestinal (or bowel) occlusions, and other such health afflictions.

The first version of the so-called ICD was published in 1949. Before this, it was simply called the International List of Causes of Death. Nowadays a more suitable name for this classiffication could be simply International Standard of Mortality and Morbidity Causes, which is exactly what it is meant to be. Or International Classification of Diseases and Other Health Afflictions, for example. Or, eventually, International Classification of Health Afflictions.

Another noticeable instance of this broad use of the term is the name Non-Communicable Diseases (or NCDs, or Non-Transmissible Diseases). NCDs include cancer, emphysema, and other health afflictions which comply with being non-communicable, and which are classically and unarguably called diseases. But NCDs also include vascular events and mental health disorders. In both of these cases, only the broader definition of ‘disease’ applies. Much has been invested by the WHO and by governments worldwide to raise awareness on NCDs as the leading cause of death, and of a group of risk and protective factors which seem to be common to all NCDs. The purpose may be well-intentioned. But, at least in the case of mental illness, in addition to being imprecise, calling all of these non-communicable health afflictions disease encourages stygma. For example, Mental Illness is commonly but arguably translated into Spanish as Enfermedad Mental. ‘Enfermo mental‘ is widely used as a derogatory term. In English at least, the use of the term mental illness has raised no significant concern: it seems to be more proper to common sense than mental disease.

Doctors know that the ICD and also the NCDs health awareness campaigns have been using the term disease in the broader sense. But the term is misleading for the general population. Language is important because it defines how we deal with reality. Regarding health policies, calling each ailment what it is, instead of sticking with broad oversimplified generalizations, should improve health literacy, population involvement, and prevention practices.

No matter if you are conservative, or liberal, or libertarian. If you really care for health, you will agree people’s involvement is crucial: not only does it improve social and environmental health, it can drastically reduce bureaucracy and public costs.

#MentalHealthLiteracy

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