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

1. Ten Great Achievements of Public Health in US, 1900-1999MMWR 1999 TH Tulchinsky MD MPH Braun School Public Health October 2010 1

2. MMWR • www.cdc.gov/mmwr • Subscription to your email address • Weekly • Authoritative • Special Reports • Excellent source on most topics in PH 2

3. 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 3

4. Ten Great Achievements of Public Health in the US in the 20th Century • 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 4

5. 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 5

6. 6

7. 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 7

8. 8

9. 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% 9

10. 10

11. 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 11

12. 12

13. 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%. 13

14. 14

15. 15

16. 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 16

17. 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) 17

18. 18

19. 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 19

20. 20

21. 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 21

22. 22

23. 23

24. 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. 24

25. 25

26. 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 !! 26

27. 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 27