In the U.S., certain health conditions are readily accepted as ''publi
c-health disorders,'' and others continue to be primarily viewed as ''
clinical diseases.'' Reflecting on infectious conditions, it appears t
hat disease burden, rapid change in disease incidence (suggesting prev
entability), and public concern about risk are three essential charact
eristics that define a public-health disorder. By any one of several c
riteria, diabetes is associated with a very high burden to individuals
with the disease, as well as to society in general. Further, there is
convincing and increasing evidence that primary, secondary, and terti
ary prevention strategies are effective in reducing the disease burden
associated with diabetes. Yet most would still consider diabetes prim
arily to be a clinical disease. In part, this perception is based on t
he fact that, in association with aging and a possible strong family h
istory, diabetes and its complications may appear inevitable to many.
Further, much of the burden associated with diabetes is insidious, com
ing on gradually only after a considerable number of years. Thus, the
burden associated with diabetes has not dramatically increased in the
past few months or years; it has been here for some time and is increa
sing steadily. Finally, our understanding of public concern is only no
w being systematically investigated. Factors that galvanize the public
to demand societal or governmental action are quite complex and very
different from those elements that convince the scientist/expert to re
quest ''public-health responses.'' Legitimate and important public-hea
lth dimensions associated with diabetes complement the critical role o
f clinical care. To effectively establish these public-health perspect
ives public concern must be incorporated into efforts to define the bu
rden of diabetes and our extant ability to prevent and thereby reduce
this burden.