Download Ten Great Achievements of Public Health in US, 1900

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
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Control of infectious disease
Vaccination
Motor vehicle safety
Safer workplaces
Decline in deaths from coronary heart disease,
strokes
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
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:
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risk-factor modification,
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smoking cessation
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blood pressure control
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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
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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
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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
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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
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To prevent initiation of tobacco use
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To promote cessation of use
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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?
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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.
• www.cdc.gov
• MMWR
• Previous years
• 1999 ten publications
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