Medical journals should use the term “public health and social measures”
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r409 (Published 04 March 2025) Cite this as: BMJ 2025;388:r409
The covid-19 pandemic highlighted the importance of public health interventions such as contact tracing. The expression “non-pharmaceutical interventions” (NPIs) became common, appearing in academic articles, public health guidance, and media reports as a convenient way of describing these interventions and to separate them from pharmaceutical treatments.1 However, in line with World Health Organization recommendations, it is time to replace non-pharmaceutical intervention with the more accurate and comprehensive descriptor, “public health and social measures.”2
A key limitation of the term non-pharmaceutical intervention lies in its definition by negation. It describes interventions by what they are not—pharmaceutical products such as drugs and vaccines—rather than by what they are. Framing them as simply “not drugs or vaccines” diminishes the complexity of these interventions and undermines their scientific legitimacy. No one would describe surgery, for example, as a non-drug intervention. The same applies to public health and social measures. These are not merely placeholder interventions until a drug or vaccine arrives; they are powerful tools in their own right, and often the only tools available in the early stages of a health crisis. They also often remain essential even as pharmaceutical treatments become available.3
Problem of perception
The “non-pharmaceutical” label implies a secondary or inferior status to pharmaceutical interventions, which is a misconception. Many public health measures, such as sanitation, contact tracing, and quarantine, are based on robust scientific principles and are highly effective. The implication that they are second best control measures reinforces a hierarchy where pharmaceutical solutions are prioritised, potentially leading to underinvestment, less rigorous evaluation, and a lack of use of other public health strategies.4
Using the label “non-pharmaceutical” also fails to capture the crucial social and behavioural dimensions of these interventions. Many public health interventions, such as hand hygiene, rely on both individual and collective behaviour change. Understanding the social context, cultural norms, and psychological factors that influence these behaviours is essential for their successful implementation. Calling these interventions “non-pharmaceutical” overlooks this complexity and the evidence underlying their effectiveness. Furthermore, it encourages a technology focused approach that fails to address the social determinants of health—such as poverty, education, and housing—and may have fewer benefits for populations at greater risk of health inequalities.
Public communication
Another limitation of the use of the expression non-pharmaceutical interventions is that lack of clarity about the definition can hinder public understanding and acceptance of these measures, particularly during a public health crisis when clear communication is essential.5 By contrast, “public health and social measures” is more transparent and self-explanatory. It communicates that these interventions are aimed at protecting public health and that they often involve collective action and changes in behaviour.
Using “public health and social measures” provides a more accurate and comprehensive description of these interventions, acknowledging their diversity and complexity. It also highlights the crucial social and behavioural aspects of these measures, emphasising the need for interdisciplinary approaches to their implementation.
By consistently using the term public health and social measures, medical journals can set a new standard for public health communication. The term also aligns with the need for a more holistic understanding of health. It reflects a shift away from a purely biomedical model towards an approach that considers the complex interplay between individual, social, and environmental factors. This change will not only improve public communication and understanding but also elevate the status of these interventions, ensuring that they receive the attention and resources they deserve.
To support this change in terminology, TheBMJ will now aim to use the term “public health and social measures” in all its content. We call on editors in other journals to also make this change, for peer reviewers to advocate for accurate language, and for public health professionals to use this term in their own practice. This change will put public health interventions in their rightful place and help ensure that we have the necessary research and resources to protect population health, both now and in future health emergencies.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.