Chronic non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, dementia, and depression now account for nearly three-quarters of global deaths. Traditionally, these diseases have been framed as the inevitable outcomes of biological aging, genetics, and individual “lifestyle choices.” This white paper challenges that paradigm, demonstrating that the so-called “natural history” of these diseases is, in fact, largely anthropogenic — shaped by human-designed systems, policies, and environments.
Upstream determinants — including food systems, housing quality, advertising landscapes, workplace structures, and environmental exposures — create exposure fields that drive disruptions in a small set of shared biological pathways: metaflammation, insulin resistance, endothelial injury, circadian misalignment, and microbiome disruption. These pathways explain why single exposures influence multiple diseases simultaneously, and why population health cannot be restored by downstream treatments alone.
Recognizing the designable nature of disease trajectories reframes prevention, accountability, and equity. Human-made causes imply human-reversible solutions: redesigning upstream determinants through policy, regulation, and systemic advocacy can bend population risk curves earlier, faster, and more equitably than reactive healthcare ever could.
This reframing calls for a paradigm shift in medicine, public health, and governance. Clinicians must integrate determinant histories and dual-lever treatment plans. Policymakers must deploy high-leverage interventions such as regulating harmful advertising, incentivizing nutrient-rich food systems, and redesigning urban spaces. Communities must be empowered to co-create healthier defaults. Together, these strategies represent a collective opportunity to reimagine health as a design challenge — one where prevention by design becomes the foundation for population flourishing.
