THE TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTH MODULE #3

1. Missouri Association of Local Boards of Health (MALBOH) Presents THE TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTHMODULE #3

2. TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTH (WHY WE DO THE THINGS WE DO)! Modules developed by Ross McKinstry, MPH; Sheila Guice, MPH; and MahreeSkala, MA

3. ACHIEVEMENT #4: Maternal and Infant Health

4. Tombstone

5. Healthier Mothers And Babies—Progress During the 20th Century • Infant mortality decreased by 90% • Life expectancy went up 62%, from 47 years to 78, largely because more people survived childhood • In 1900, only 41% of newborns survived to age 65; in 1991, 80% survived to age 65

6. Healthier Mothers And Babies—Progress During the 20th Century Improvements • Better hygiene and nutrition • Safe drinking water and waste disposal • Safe milk supplies, pasteurization • Longer spacing of pregnancies, smaller families • Early entry into prenatal care • Management of pregnancies • Safe delivery in general hospitals

7. Healthier Mothers And Babies—Progress During the 20th Century Improvements • Introduction of antibiotics, electrolyte replacement therapy, and safe blood transfusions • Social benefits, maternity leave, living standards • Greater access to health care • Advances in technologies for maternal and neonatal care • Advances in maternal and neonatal medicine • Public health measures (new vaccines, Back to Sleep, folic acid supplementation)

8. Healthier Mothers And Babies—Progress During the 20th Century Maternal Deaths • Maternal mortality decreased by 99% in the 20th century • Shift from home births to hospital births (90% in hospitals by 1948) • Medical advances and changes in policies and practices

9. Healthier Mothers And Babies—Progress in the 21st Century Progress 2000-2010: • 36% fewer infants born with neural tube defects such as spina bifida, due to folic acid fortification of cereal grain products • Expansion of newborn screening for metabolic and other hereditary disorders • Early diagnosis of infant hearing disorders

10. WIC Program

11. Well Child Check-ups

12. Healthier Mothers And Babies—Challenges in the 21st Century • The US still has higher maternal and infant mortality rates than other countries do, and rates are higher for black women and infants • Incidence of low birth weight (LBW) has not decreased in recent decades • LBW, preterm births, and birth defects must be reduced to lower neonatal mortality and reduce disparities

13. POLICY CHALLENGES IN MISSOURI • We need to encourage early entry into prenatal care, infant immunizations, and parenting classes • Encourage participation in the Women, Infants, and Children (WIC) program • Expand home visitation programs for young, first time parents

14. ACHIEVEMENT #5: Family Planning

15. A CENTURY AGO, LARGE FAMILIES WERE COMMON.

16. Family Planning—Progress During the 20th Century • Fertility decreased as couples chose to have fewer children (trend began around 1800) • More people are able to achieve desired birth spacing and family size • Smaller families and longer birth intervals contribute to better health of infants, children and women,plus improved economic and social status of women

17. Family Planning—Progress During the 20th Century • Safe and effective methods developed • Access to family planning and contraceptive services increased • Smaller families • Longer intervals between births, resulting in higher birth-weight babies • Fewer abortions

18. Family Planning—Progress During the 20th Century • Increased opportunities for prenatal counseling • Pre-conceptional counseling and screening • Increased awareness of sexually transmitted disease identification and prevention • Altered social and economic roles of women • Fewer women, infant and child deaths!

19. Prenatal/Preconception Counseling

20. Family Planning—Challenges in the 21st Century • Even today, about half of all pregnancies in the US are unintended (49% in 2011) • 4 out of 5 pregnancies among women under 19 are unintended • Unintended pregnancies are a higher risk for mothers and infants

21. POLICY CHALLENGES IN MISSOURI • Make sure teens get access to good information about pregnancy prevention and their health.

22. ACHIEVEMENT #6: Fluoridation of Drinking Water to Prevent Dental Caries

24. Dental Caries—Progress During the 20th Century • Dental caries (cavity) is an infectious, communicable disease in which bacteria dissolve the enamel surface of a tooth • Dental caries can result in loss of tooth structure and discomfort • Untreated cavities can lead to severe pain, bacterial infection, pulpal necrosis, tooth extraction and loss of dental function • May progress to an acute systemic infection

25. Many Young People Have Never Had A Cavity... Due to regular check-ups, dental sealants, fluoridation of water and fluoride treatments

26. Dental Caries—Progress Due to Water Fluoridation • Water fluoridation began in 1945 with a study of four cities • Now reaches an estimated 204 million people in the US (in 2010), or 73.9% of those on community water systems • Safely and inexpensively prevents tooth decay • (regardless of socioeconomic status) • Reduction of tooth decay in children by 40-70% • Reduction of tooth loss in adults by 40-60%

27. In Missouri More than 3.9 million citizens (79.8%) have access to fluoridated water. Missouri ranks 23rd in the nation for fluoridation of water.

28. Challenges in the 21st Century • Despite the overall decrease in prevalence and severity, dental caries is still common • 67% of 12- to 17-year-olds and 94% of people 18 and older have caries • although the average number of cavities per 12-year-old decreased from 4 in 1970 to 1.3 in 1994 • Other factors, such as dietary changes, still contribute to caries formation

29. Challenges in the 21st Century • Since the 1950’s, opponents of water fluoridation have claimed it causes many different health problems • Safety and effectiveness have been studied frequently, and there is no credible evidence of adverse health effects • Small community water systems may find the cost of fluoridation per person served too high

30. POLICY CHALLENGES IN MISSOURI • Children on Medicaid (CHIP) can’t get access to dentists because of low payment rates • The number of dentists in Missouri is declining because we don’t train enough • Low-income adults have no access to care (Springfield’s new FQHC filled 3 years’ appointments within 2 weeks of opening). • More ER visits, lost productivity, and caries contributes to heart disease

31. References • Ten Great Achievements of Public Health in the 20th Century Morbidity and Mortality Weekly Report April 2, 1999 / 48 (12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm • Ten Great Public Health Achievements—United States, 2001-2010 May 20, 2011 / 60(19);619-623 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5.htm

32. References, Continued • Achievements in Public Health, 1900-1999: Healthier Mothers and Babies October 01, 1999 / 48(38);849-858 • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm • Achievements in Public Health, 1900-1999: Family Planning December 03, 1999 / 48(47);1073-1080 • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4847a1.htm

33. References, Continued • Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries October 22, 1999 /48(41);933-940 • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm

34. Thanks! Questions