As we approach the end of a millennium, it is appropriate that neurologists and other physicians link forces with the public in asking what improvements we want to achieve in health care, and how this can be done. Early in the 20th century, the population of the United States consisted mainly of children and young adults. In 1900, life expectancy at birth was 46.6 years and 48.7 years for white males and females, compared with only 32.5 years and 33.5 years for black males and females. Medical care of that period focused on acute, life-threatening illnesses, was usually ineffective, and was relatively inexpensive. Priority setting and resource allocation were not relevant issues. During the first half of this century, death rates from such disorders as diphtheria, scarlet fever, tuberculosis, pertussis, and rubeola plummeted, continuing a downward trend that started during the second half of the 19th century. This trend was
Menken M. Grappling With the Enigma of Violence: An Educational Approach. Arch Neurol. 1992;49(6):592–594. doi:10.1001/archneur.1992.00530300024005
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