Medical practice and community health care in the 21st century: a time of change

Public Health. 2008 Jul;122(7):671-80. doi: 10.1016/j.puhe.2008.04.002. Epub 2008 Jun 4.


The contemporary model of evidence-based medicine has not effectively addressed the ubiquitous public health dilemma of escalating chronic illness, and is being challenged by pervasive dissatisfaction among both patients and caregivers. Several recent reports highlight the disturbing problem of deteriorating morale within the medical community, while unprecedented numbers of discontented patients are turning to assorted unconventional therapies in search of help. Although doctor shortages, overwork, increasing regulation and myriad other challenges add to ever-increasing stress, many medical professionals no longer find medicine to be a rewarding vocation and feel ineffective in their work. Recent research, however, highlights innovative clinical strategies using principles from emerging fields, such as molecular medicine and epigenetics, which offer promising outcomes for many chronically ill patients. In this paper, an investigative and aetiologically based approach to clinical practice is presented; a strategy that has resulted in physical and mental health restoration for many patients. Community health applications incorporating disease prevention and health promotion are also discussed.

Publication types

  • Historical Article

MeSH terms

  • Chronic Disease / prevention & control
  • Community Health Services / trends*
  • Epigenesis, Genetic
  • Evidence-Based Medicine
  • History, 21st Century
  • Humans
  • Public Health Practice*