During the past two decades, observers have noted that the U.S. system is in a state of disarray (Institute of Medicine [IOM], 1988). A 1988 report by the IOM described as a system in shattered vision. The IOM noted that society had contributed to the problem by its failure to reach consensus on the mission of heath and the role government should play in meeting public objectives (IOM, 1988, pp. 6-7). Recent studies also warn that our system is in a state of crisis. According to Garrett (2000), although [o]nce the envy of the world, America's infrastructure is now in a state of shambles (p. 280). The authors of Health and Health Care 2010, a report prepared by the Institute for the Future (2000), predict that during the next decade, will be insufficiently funded and to address ... underlying problems...largely incremental (p. 9). column examines the crisis in and considers prospects for the future, briefly reviewing the development of in the United States and examining the curative model of health, which grew out of the separation of from clinical medicine. Finally, the column addresses the rise and limits of what many call the new and concludes with thoughts about how social workers might participate in efforts to create a new health. THE RISE AND FALL OF PUBLIC HEALTH The period between 1900 and 1930 was a age for health (Starr, 1982, p. 197). Although New York City had enacted legislation as early as 1796, and some states and created boards of during the 1840s and 1850s, opposition from business and other groups stymied these efforts. This theme--of tension between business and sectors--would repeat itself so frequently in coming decades as to constitute a primary motif of the nation's struggle for population health (Garrett, 2000, pp. 282-283). The rise of urbanization and industrialization created problems that became impossible to ignore (Haines, 1991). Although members of the upper class could escape the overcrowded cities, by moving to rural areas, members of the emerging urban middle class did not enjoy this luxury (Baltzell, 1964). They paid taxes, supported cleanliness and education, recognized and abhorred corruption, and, as home owners, had an investment in their cities (Garrett, 2000, p. 284). The middle class took the lead in advocating a wide range of reforms, including the enactment of and safety regulations (Garrett). During the 1890s many instituted new works sanitation projects (such as piped water, sewer systems, filtration and chlorination of water) and administration (Haines, p. 105). By the turn of the century, it had become increasingly clear that many diseases were communicable in nature. With the development of vaccines against rabies and diphtheria, many communities, particularly in the east, required their citizens to become immunized (Garrett, 2000). In New York City, Hermann Biggs, a leading figure, asserted that authorities could resort to any measure that was 'designed for the good' and 'beneficent' in its 'effects' (cited in Garrett, p. 297). Authorities routinely deployed police officers and zealous nurses or physicians to the homes of those suspected of carrying disease....In some cases, police officers pinned the arm of those who refused while a city nurse jabbed it with a vaccination needle (Garrett, p. 299). These efforts seemed to pay off. Between 1900 and 1915, death rates (among children) from measles, whooping cough, scarlet fever, and diphtheria fell (Garrett). The golden age of did not last long, however. In 1920 a prominent theorist defined as the science and art of preventing disease, prolonging life, and promoting and efficiency through organized community effort (cited in Starr, 1982, p. …