ABSTRACT
According to the World Health Organization (WHO 1986), significant improvements in health in the nineteenth century were brought about by what might be called "engineering methods"-the building of safe water supplies and sewers and the production of cheap food for urban areas through the use of mechanized agriculture. These methods continue to improve the health of people in underdeveloped areas of the world. The first 60 years of the twentieth century was the "medical era," in which the dominant approach to health was mass vaccination and the extensive use of antibiotics to combat infection. WHO suggests that in the present period of history, advanced societies are entering into a "postmedical era" in which physical well-being is largely undermined by social and environmental factors. These factors include certain types of individual behavior (e.g., smoking, overeating), failures of social organization (e.g., loneliness), economic factors (e.g., poverty), and the physical environment (e.g., pollution) that are not amenable to direct improvement by medicine. WHO (1986:117) concludes: "Whereas in the 'medical era' health policy has been concerned mainly with how medical care is to be provided and paid for, in the new 'post-medical' era it will focus on the attainment of good health and well-being."
