During the 20th century, the health and life expectancy of
persons
residing in the United States improved dramatically. Since 1900,
the
average lifespan of persons in the United States has lengthened by
greater
than 30 years; 25 years of this gain are attributable to advances
in public
health (1). To highlight these advances, MMWR will profile 10
public health
achievements (see box) in a series of reports published through
December
1999.
Many notable public health achievements have occurred during
the
1900s, and other accomplishments could have been selected for the
list. The
choices for topics for this list were based on the opportunity for
prevention and the impact on death, illness, and disability in the
United
States and are not ranked by order of importance.
The first report in this series focuses on vaccination, which
has
resulted in the eradication of smallpox; elimination of
poliomyelitis in
the Americas; and control of measles, rubella, tetanus, diphtheria,
Haemophilus influenzae type b, and other infectious diseases in the
United
States and other parts of the world.
Ten Great Public Health Achievements -- United States, 1900-1999
Vaccination
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Recognition of tobacco use as a health hazard
Future reports that will appear in MMWR throughout the
remainder of
1999 will focus on nine other achievements:
Improvements in motor-vehicle safety have resulted from
engineering
efforts to make both vehicles and highways safer and from
successful
efforts to change personal behavior (e.g., increased 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 (2).
Work-related health problems, such as 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
have
decreased; since 1980, safer workplaces have resulted in a
reduction of
approximately 40% in the rate of fatal occupational injuries
(3).
Control of infectious diseases has resulted from clean water
and
improved sanitation. Infections such as typhoid and cholera
transmitted
by contaminated water, a major cause of illness and death early
in the
20th century, have been reduced dramatically by improved
sanitation. In
addition, the discovery of antimicrobial therapy has been
critical to
successful public health efforts to control infections such as
tuberculosis and sexually transmitted diseases (STDs).
Decline in deaths from coronary heart disease and stroke have
resulted
from risk-factor modification, such as smoking cessation and
blood
pressure control coupled with improved access to early
detection and
better treatment. Since 1972, death rates for coronary heart
disease
have decreased 51% (4).
Since 1900, safer and healthier foods have resulted from
decreases in
microbial contamination and increases in nutritional content.
Identifying essential micronutrients and establishing
food-fortification programs have almost eliminated major
nutritional
deficiency diseases such as rickets, goiter, and pellagra in
the United
States.
Healthier mothers and babies have resulted from better hygiene
and
nutrition, availability of antibiotics, greater access to
health care,
and technologic advances in maternal and neonatal medicine.
Since 1900,
infant mortality has decreased 90%, and maternal mortality has
decreased 99%.
Access to family planning and contraceptive services has
altered social
and economic roles of women. Family planning has provided
health
benefits such as smaller family size and longer interval
between the
birth of children; increased opportunities for preconceptional
counseling and screening; fewer infant, child, and maternal
deaths; and
the use of barrier contraceptives to prevent pregnancy and
transmission
of human immunodeficiency virus and other STDs.
Fluoridation of drinking water began in 1945 and in 1999
reaches an
estimated 144 million persons in the United States.
Fluoridation safely
and inexpensively benefits both children and adults by
effectively
preventing tooth decay, regardless of socioeconomic status or
access to
care. Fluoridation has played an important role in the
reductions in
tooth decay (40%-70% in children) and of tooth loss in adults
(40%-60%)
(5).
Recognition of tobacco use as a health hazard and subsequent
public
health anti-smoking campaigns have resulted in changes in
social norms
to prevent initiation of tobacco use, promote cessation of use,
and
reduce exposure to environmental tobacco smoke. Since the 1964
Surgeon
General's report on the health risks of smoking, the prevalence
of
smoking among adults has decreased, and millions of
smoking-related
deaths have been prevented (6).
The list of achievements was developed to highlight the
contributions
of public health and to describe the impact of these contributions
on the
health and well being of persons in the United States. A final
report in
this series will review the national public health system,
including local
and state health departments and academic institutions whose
activities on
research, epidemiology, health education, and program
implementation have
made these achievements possible.
Reported by: CDC.
References
Bunker JP, Frazier HS, Mosteller F. Improving health: measuring
effects
of medical care. Milbank Quarterly 1994;72:225-58.
Bolen JR, Sleet DA, Chorba T, et al. Overview of efforts to
prevent
motor vehicle-related injury. In: Prevention of motor
vehicle-related
injuries: a compendium of articles from the Morbidity and
Mortality
Weekly Report, 1985-1996. Atlanta, Georgia: US Department of
Health and
Human Services, Centers for Disease Control and Prevention,
National
Center for Injury Prevention and Control, 1997.
CDC. Fatal occupational injuries -- United States, 1980-1994.
MMWR
1998;47:297-302.
Anonymous. The sixth report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. Arch Intern Med 1997;157:2413-46.
Burt BA, Eklund SA. Dentistry, dental practice, and the
community.
Philadelphia, Pennsylvania: WB Saunders Company, 1999:204-20.
Public Health Service. For a healthy nation: returns on
investment in
public health. Atlanta, Georgia: US Department of Health and
Human
Services, Public Health Service, Office of Disease Prevention
and
Health Promotion and CDC, 1994.
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