US public health and the 21st century: diabetes mellitus

Lancet. 2000 Aug 26;356(9231):757-61. doi: 10.1016/S0140-6736(00)02641-6.


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.

Publication types

  • Review

MeSH terms

  • Blood Glucose*
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / epidemiology
  • Diabetes Mellitus, Type 2* / mortality
  • Humans
  • Public Health / trends*
  • Quality of Life
  • Risk Factors
  • United States / epidemiology


  • Blood Glucose