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20th Century Public Health Achievements

According to the CDC, public health has been credited with adding 25 years to the life expectancy of people living in the U.S. in the 20th century. But, how? Since it can be difficult for the general public to understand the impact of public health interventions, the CDC created Ten Great Public Health Achievements in the 20th Century as a very helpful overview of all the great things public health has been able to achieve.

  • Vaccination to reduce epidemic diseases
    • At the beginning of the 20th century, infectious diseases such as smallpox, measles, diphtheria, and pertussis were widely prevalent. Since there were few effective measures available, death tolls were high. Both the development and promotion of vaccinations against preventable diseases has resulted in dramatic declines in morbidity and mortality and even results in the eradication of smallpox.
  • Improved motor vehicle safety
    • Since 1925, there has been a 90% decrease in the annual death rate due to motor vehicle travel. This is particularly impressive given the number of motor vehicles, drivers, and miles traveled in motor vehicles have all increased dramatically since 1925.Some of the biggest interventions include regulations developed and enforced regarding safety belts, alcohol-impaired drivers, young drivers, pedestrians, and child safety and booster seats.
  • Safer workplaces
    • Data from CDC's National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system indicate that the annual number of work-related deaths decreased 28% from 1980 to 1995 with a 43% decrease in occupational injuries during the same time.
  • Control of infectious diseases
    • The leading causes of death in 1900 were pneumonia, tuberculosis (TB), and diarrhea and enteritis whereas in 1997, 4.5% of deaths were attributable to pneumonia, influenza, and HIV infection. Sanitation and hygiene, vaccination, and antibiotics are among the control measures responsible for this marked decrease. Who knew handwashing could be so powerful!
  • Decline in death from cardiovascular disease
    • While deaths due to infectious death have gone down dramatically, heart disease has been the leading cause of death for most of the 20th century. Since 1950, age-adjusted death rates from cardiovascular disease have been cut by more than half. Some of the key public health factors contributing to this decline include the decline in tobacco use, changes in the U.S. diet, and better early detection and treatment of those at risk of cardiovascular disease (e.g. individuals with hypertension, high cholesterol, etc.)
  • Food Safety
    • Contaminated food and water resulted in many foodborne infections in early in the 20th century. Advances, such as refrigeration, pasteurization, pest control, animal control, and food safety regulations that promoted better hygiene and sanitation practices all contributed to decreases in foodborne infections.
  • Improvements in maternal and child health
    • Childbirth use to come with great risk to many mothers and infants. Over the span of the century, the infant mortality rate declined greater than 90% and the maternal mortality rate declined almost 99%. Improvements in nutrition, standards of living, access to health care, and surveillance and monitoring of disease contributed to reducing risks to mothers and infants.
  • Family planning
    • Better family planning interventions have resulted in longer intervals between births and smaller family sizes, both of which have been associated with improved maternal and child health outcomes.
  • Fluoridation of drinking water
    • At the beginning of the century, extensive dental caries was common in the U.S. with tooth extraction being the main treatment option available. Several studies have suggested that water fluoridation has contributed to reductions in dental caries when compared to communities without fluoridated water.
  • Reductions in prevalence of tobacco use
    • Smoking has been associated with a number of morbidities including cardiovascular disease, cancer, chronic obstructive pulmonary disease, and low birth weight. According to the CDC, it is the leading preventable cause of death and disability in the United States. Due to massive public health efforts that include smoking cessation interventions and regulation of the purchase and use of tobacco, there have been substantial reductions in smoking.

What is Public Health Now?

Health is dependent on a complex interplay among an array of genetic, environmental, and lifestyle factors. As a result, public health is built on expertise and skills from many areas, including biology, environmental and earth science, sociology, psychology, government, medicine, statistics, communication, and many others. Public health is about interventions that prevent disease from occurring. As a result, the benefits tend to be less obvious when compared to life-saving medical procedures designed to treat the problem. Prevention of disease both prolongs life and improves the quality of life. In a sense, public health is the heart disease that never developed, the epidemic that didn't happen, the outbreak of foodborne illness that never occurred, the child that would have developed asthma, but didn't. Public health is the disaster that didn't happen. 

The strategy employed by public health is to:

  • Identify and define health problems.
  • Identify the determinants, i.e., the factors associated with the problem.
  • Develop and test interventions to control or prevent the problem.
  • Assess the effectiveness of interventions.
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