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Lancet. 2000 Aug 26;356(9231):757-61.

US public health and the 21st century: diabetes mellitus.

Author information

  • 1New England Research Institutes, Boston, MA, USA. johnm@neri.org


No one can question the remarkable contribution of US public health to understanding the causes and consequences of illness, disability, and death. However, some commentators question the agenda: the endless pursuit of individual risk factors and the cursory attention to social determinants of disease. We attempt to illustrate some limitations of US public health by focusing on type-2 diabetes (adult-onset non-insulin-dependent diabetes)--an increasingly prevalent but still poorly understood medical condition with devastating complications and implications for quality of life. A more theoretically based multilevel approach to diabetes, outlined for the 21st century, has an almost exclusive downstream curative focus, that ranges from midstream preventive programmes to upstream healthy public policy.

[PubMed - indexed for MEDLINE]
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