Diabetes and Disease Surveillance

All public health practitioners should read the policy forum in this week's journal, Science. The forum discusses New York City's public health plan to test all its residents for diabetes, using the hemoglobin A1C levels. If abnormal, the individual would be counseled about diabetes and referred to a source of care. If already under care both the individual and medical practitioner would be counseled. While this seems, hypothetically, a reasonable plan, the forum questions how much intrusion into our personal lives, in the name of disease prevention/modification, is acceptable. Further it questions how closely public health should be linked into the treatment system. We have good examples for infectious diseases, where public health programs limit the spread of communicable diseases. The question about a chronic disease with a large behavioral component (overeating, lack of exercise) such as diabetes may require more careful thought. Are we approaching Huxley's Brave New World too quickly? What will the health department do about those who have no access to medical care? What will they do about those who take no notice of their probably heavy handed education?