Top 10 Public Health Achievements of the Century
-- The United States, 1900-1999
Coming up with the top 10 public health feats (or the top whatever)
of the 20th century is something of an arbitrary exercise. The Merck
Manual of Diagnosis and Therapy has put together a list of the 100
major medical advances of the 20th century. Their top five
advances are as follows:
1. Control of infectious disease;
2. Mass immunization campaigns;
3. Vitamins;
4. Cardiovascular risk factors; and
5. Rational drug design.
-- Medical Editor, MedicineNet.com
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. The U.S. government's statistical
reporting publication, Morbidity and Mortality Weekly Report (MMWR),
reviewed health achievements of the 20th century and profiled ten as
listed below.
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 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.
Ten Great Public Health Achievements -- United States, 1900-1999
Vaccination Vaccination 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.
Motor-vehicle safety 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.
Safer workplaces 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.
Control of infectious diseases 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
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%.
Safer and healthier foods 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 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%.
Family planning 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 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%).
Recognition of tobacco use as a health hazard 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.
This Health Fact is based on:
Ten Great Public Health
Achievements -- United States, 1900-1999
Published in MMWR (Morbidity and Mortality Weekly Report) by the U.S.
Centers for Disease Control and Prevention (CDC)
Reference: MMWR 1999;48(12);241-243.
-- Medical Editor, MedicineNet.com
Last Editorial Review: 2/1/2005
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