IS DIABETES A PUBLIC-HEALTH DISORDER

In the U.S., certain health conditions are readily accepted as ''public-health disorders,'' and others continue to be primarily viewed as ''clinical diseases.'' Reflecting on infectious conditions, it appears that disease burden, rapid change in disease incidence (suggesting preventability), and public concern about risk are three essential characteristics that define a public-health disorder. By any one of several criteria, 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 tertiary prevention strategies are effective in reducing the disease burden associated with diabetes. Yet most would still consider diabetes primarily to be a clinical disease. In part, this perception is based on the fact that, in association with aging and a possible strong family history, diabetes and its complications may appear inevitable to many. Further, much of the burden associated with diabetes is insidious, coming 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 increasing steadily. Finally, our understanding of public concern is only now 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 request ''public-health responses.'' Legitimate and important public-health dimensions associated with diabetes complement the critical role of clinical care. To effectively establish these public-health perspectives public concern must be incorporated into efforts to define the burden of diabetes and our extant ability to prevent and thereby reduce this burden.