The COVID-19 pandemic brought many terms into the spotlight, one of which was "non-pharmaceutical interventions" (NPIs). Used widely in academic papers, public health guidelines, and media reports, NPIs became a catch-all phrase for measures like contact tracing, quarantine, and hand hygiene; essentially anything that wasn’t a drug or vaccine. However, BMJ Editor Kamran Abbasi and I argue in our editorial it is time to end the use of this term in favour of "public health and social measures." Here’s why this shift matters.
The Problem with Defining by Negation
The term "non-pharmaceutical interventions" defines these strategies by what they aren’t rather than what they are. This framing is inherently limiting. Imagine calling surgery a "non-drug intervention"—it sounds absurd because surgery stands on its own as a complex, evidence-based practice. Similarly, public health measures like sanitation or hand hygiene aren’t just stopgaps until a drug or vaccine becomes available. They are powerful tools with scientific grounding, often critical in the early stages of a health crisis and remain valuable even after pharmaceutical options emerge. By labelling them as "non-pharmaceutical," we risk undervaluing their role and complexity.
A Misleading Hierarchy
The NPI label also subtly suggests that these interventions are second-rate compared to drugs or vaccines. This perception can lead to serious consequences: underfunding, limited evaluation and a reluctance to fully integrate them into health strategies. Yet, history shows that measures like clean water systems or contact tracing can have major impacts of public health; sometimes more effective than any medication. The implied inferiority of NPIs feeds into a biomedical bias, prioritising technological fixes over holistic approaches that address behaviour, culture, and social determinants like poverty or housing.
Missing the Social Dimension
Another flaw in the term "non-pharmaceutical" is its failure to reflect the social and behavioural core of these measures. Hand-washing campaigns do not succeed through science alone. They depend on people’s willingness to adapt, shaped by trust, norms, and socioeconomic context. Calling them "non-pharmaceutical" strips away this human element, reducing them to technical fixes rather than collective efforts. This oversight can widen health inequities, as solutions that ignore social factors often fall short for vulnerable populations.
Clarity for the Public
Communication is critical in a health crisis, and "non-pharmaceutical interventions" may not mean much to the average person. It is jargon that obscures rather than enlightens. In contrast, "public health and social measures" is straightforward. It signals that these actions protect communities and require shared effort. When people understand what is at stake and why it matters, they are more likely to follow the advice they have been given.
A Call for Change
We propose "public health and social measures" as a term that captures the full scope of these interventions; their diversity, their evidence base and their reliance on social dynamics. It aligns with the World Health Organization’s recommendations and encourages a broader view of health, one that integrates biology with environment and society. The BMJ is aiming to lead by example, committing to this terminology across its content. We urge other journals, reviewers, and health professionals to follow this example.
Why It Matters Now
As we face ongoing and future health challenges - such as pandemics, climate-related crises or an increase in chronic diseases - this shift is not just semantic. It is about ensuring these measures get the research, funding and respect they deserve. By reframing them as "public health and social measures," we elevate their status, improve public understanding, and foster interdisciplinary solutions that address public health challenges effectively.
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