Factors contributing to the establishment of the earliest college health programs are reviewed. The author considers the evolution of these programs for two periods: the first 100 years (1860-1960) and the next 30 years (1960-1990). The changing emphases in college health programs during these two periods are seen as responses to contemporaneous events, including the development of vaccines and other advances in science and medicine, the emergence of intercollegiate athletics--first as a significant element in the college experience and subsequently as a major business--and the expansion of higher education in response to the arrival of the baby boomers in the mid-1960s. Contemporary healthcare reform is briefly reviewed, and the author concludes with an assessment of the probable impact of current healthcare reform proposals on the future of college health programs and on campus-controlled health centers.