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Ten Great Achievements of Public Health in US, 1900-1999

MMWR 1999

TH Tulchinsky MD MPH

Braun School Public Health

October 2010

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Ten Achievements of Public Health, MMWR, 1999

During the 20th century, the health and life expectancy in the US improved dramatically

Since 1900, average lifespan lengthened by >30 years; 25 years of this gain are attributable to advances in public health

MMWR profiled 10 public health achievements in a series of reports published through December 1999

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Ten Great Achievements of Public Health in the US in the 20th Century

1. Control of infectious disease 2. Vaccination3. Motor vehicle safety4. Safer workplaces5. Decline in deaths from coronary heart disease,

strokes6. Safer and healthier foods7. Healthier mothers and babies8. Family planning9. Fluoridation of drinking water10. Recognition of tobacco as a health hazard

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Control of Infectious Diseases

Clean water - filtered, chlorinated, monitored Safe foods Sanitation - waste collection, treatment,

disposal Immunization and vaccines Measures to control TB, STDs, AIDS Anti-microbial therapy Access to medical care New and resurgent infectious diseases

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Vaccination

Control of pertussis, diphtheria, tetanus, measles, mumps, rubella

Global eradication of smallpox Global eradication of poliomyelitis (by 2005?) Measles control but not eradication New vaccines - Haemophilus influenzae type b,

hepatitis A and B, varicella, influenza, and pneumococcal pneumonia

New technology Combination cocktails No vaccines for AIDS, malaria and TB

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Coronary Heart Disease and Strokes

Decline in deaths from coronary heart disease and stroke have resulted from:

risk-factor modification, smoking cessation blood pressure control access to early detection and better

treatment. Since 1972, death rates for coronary heart disease

have decreased 51%

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Safer and Healthier Foods

Decreased contamination and food-borne disease Improved food handling methods - refrigeration Improved nutritional value of foods, crops Food fortification Identifying essential micronutrients and deficiency

conditions Food-fortification programs eliminated major

micronutrient deficiency diseases: rickets, goiter, pellagra

Folic acid and other new disease- preventing functional food elements

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Healthier Mothers and Babies

Better hygiene and nutrition Spacing of pregnancies Safe delivery in general hospitals Antibiotics, vaccines, blood transfusions, Rh Management of pregnancies Social benefits, maternity leave, standards of living Greater access to health care Advances in maternal and neonatal medicine Since 1900, infant mortality decreased by 90%,

maternal mortality by 99%.

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Family Planning

Safe and effective methods Access to family planning and contraceptive

services Altered social and economic roles of women Health benefits e.g. smaller family size, longer

interval between childbirth, less abortion Pre-conceptional counseling and screening Fewer infant, child, and maternal deaths Barrier contraceptives to prevent pregnancy and

transmission of HIV and other STDs

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Fluoridation of Drinking Water

Began in 1945 to prevent tooth decay By 1999 reaches estimated 144 million in US Controversial but safe and inexpensive Strong professional support Benefits for children and adults Reaches all regardless of SES or access to care Reduced decay by40%-70% in children Reduced tooth loss in adults (40%- 60%) Effects in preventing osteoporosis (with exercise, Vit

D and calcium)

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Recognition of Tobacco Use as a Health Hazard

1964 Surgeon-General's report on health risks of smoking

Public anti-smoking campaigns Changes in social norms Goals To prevent initiation of tobacco use To promote cessation of use To reduce secondary environmental exposure Prevalence of smoking among adults decreased Millions of smoking-related deaths prevented Still enormous public health problem among poor

and adolescents

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Workplace Safety

• Work-related health problems, e.g. coal workers' pneumoconiosis (black lung), and silicosis -- common at the beginning of the century -- have come under better control

• Severe injuries and deaths related to mining, manufacturing, construction, and transportation also decreased

• Since 1980, safer workplaces have resulted in a reduction of approximately 40% in the rate of fatal occupational injuries

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Motor Vehicle Safety

Improved motor-vehicle safety from engineering efforts to make both vehicles and highways safer.

Successful efforts to change personal behavior (e.g., use of safety belts, child safety seats, and motorcycle helmets and decreased drinking and driving).

These efforts have contributed to large reductions in motor-vehicle-related deaths.

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How Was This All Accomplished?

National public health systems Local and state health departments Academic institutions - training, research, service Increased professional public health manpower Research, epidemiology, health education, and

program implementation Professional and advocacy groups Public awareness Professional awareness problematic Public health works !!

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Source

• Source: CDC. Ten Great Public Health Achievements - United States, 1900-1999. MMWR. 1999;48(12);241- 243.

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