| Abstract: | In this article an attempt is made to assess the major health problems of the second half of the twentieth century in developed countries, the methods appropriate to these problems, and the pattern of medical services necessary to deal with them. From an examination of mortality and morbidity trends it is suggested that the most important problems are likely to be the mortality, malformation and disability established before birth, mental illness, and the disease and disability associated with ageing. Reasons are given for doubting whether control of breeding, the method which has contributed greatly to the improvement of plants and other animals, can be expected to be effective in the case of man, and hence reliance must continue to be placed on modifications of the environment to which achievement hitherto has been entirely due. The methods likely to be significant are: an extension of measures already in use for control ofthe physical environment; discovery and application of knowledge concerning the social environment; and elaboration of more effective methods of preventing and treating disease in the individual. Profound changes will be needed in the pattern of services through which medical knowledge is applied, the most important being unification ofthe major classes ofhospitals - acute, mental and chronic; association ofthe preventive personal health services with curative services (rather than with environmental services); and the strengthening of domiciliary medical care, particularly through a new and more intimate relationship between general practitioner and hospital services. |
