US public health and the 21st century: diabetes mellitus

No one can question the remarkable contribution of US public health to unde rstanding the causes and consequences of illness, disability, and death. Ho wever, some commentators question the agenda: the endless pursuit of indivi dual risk factors and the cursory attention to social determinants of disea se. We attempt to illustrate some limitations of US public health by focusi ng on type-2 diabetes (adult-onset non-insulin-dependent diabetes)-an incre asingly prevalent but still poorly understood medical condition with devast ating complications and implications for quality of life. A more theoretica lly based multilevel approach to diabetes, outlined for the 21st century, h as an almost exclusive downstream curative focus, that ranges from midstrea m preventive programmes to upstream healthy public policy.