The history of clinical preventive medicine has been shaped by the interactions of biomedical knowledge and sociopolitical forces. In the late nineteenth century, medical thinking shifted from the belief that diseases were caused by general bodily imbalances to the belief that diseases were caused by specific agents, and that they might be amenable to specific preventive and therapeutic approaches. During the twentieth century, preventive medicine moved from advocating a public health, community-based approach toward preventing specific diseases in individual patients. The establishment of preventive medicine as a discipline has been fostered both by recent concerns that medical care emphasizes cure, rather than care, and by efforts to reduce health care costs.