Epidemiology and public health need to change for the upcoming problems of the 21st century and beyond. We outline a four-point approach to produce this change. The first one is to take a systems approach to disease. The second approach discussed is the use of new techniques to "count" disease using capture-recapture. The third represents the application of telecommunications, especially the Internet, to public health. The fourth and final component represents the application, at the local health department level, of a total quality approach, as espoused by Deming, for the prevention of disease.