Ten Great Achievements of Public Health in US, 19001999 MMWR 1999

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

• TH Tulchinsky MD MPH
• Braun School Public Health

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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 gt30 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
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
• Sanitation - waste collection, treatment,
  disposal
• Immunization
• Measures to control TB, STDs, AIDS
• Antimicrobial therapy
• Access to medical care

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Vaccination

• Eradication of smallpox
• Elimination of poliomyelitis in the Americas
• Control of pertussis, diphtheria, tetanus,
  measles, mumps, rubella
• Haemophilus influenzae type b, and other
  infectious diseases in US and other parts of the
  world
• New vaccines - hepatitis A and B, varicella
• New technology
• Combination cocktails

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Pneumonia
Tuberculosis
Diarrhea and Entoritis
Heart Disease
Stroke
Liver Disease
Injuries
Cancer
Senility
Diphtheria
Heart Disease
Cancer
Stroke
Chronic Lung Disease
Unintentional Injury
Pneumonia and Influenza
Diabetes
HIV infection
Suicide
Chronic Liver Disease
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Decline in Deaths from Coronary Heart Disease
and Stroke

• Risk-factor - understanding and modification
• Professional and public awareness
• Smoking cessation
• Blood pressure control
• Improved access to early detection and care
• Improved treatment i.e. secondary prevention
• Since 1972, death rates for CHD reduced by 51

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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
  establishing food-fortification programs
  eliminated major micronutrient deficiency
  diseases rickets, goiter, pellagra in the US
  folic acid and other new disease- preventing
  functional food elements

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Healthier Mothers and Babies

• Better hygiene and nutrition
• Spacing of pregnancies
• Safe delivery in hospital
• Antibiotics, vaccines
• 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

• 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
• Preconceptional 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

• Began 1945 to prevent tooth decay
• In 1999 reaches estimated 144 million in US
• Safe, inexpensive 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

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Recognition of Tobacco Use as a Health Hazard

• Public anti-smoking campaigns
• Changes in social norms
• To prevent initiation of tobacco use
• To promote cessation of use
• To reduce secondary environmental exposure
• Since 1964 Surgeon-General's report on health
  risks of smoking, prevalence of smoking among
  adults decreased millions of smoking-related
  deaths have been prevented

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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 health works
• Source CDC. Ten Great Public Health Achievements
  - United States, 1900-1999. MMWR.
  199948(12)241- 243