Ten Great Public Health Achievements -- United States, 1900-1999
Ten Great Public Health Achievements -- United States, 1900-1999
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 (1). To highlight these advances, MMWR will profile 10 public health achievements (see box) in a series of reports published through December 1999.
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.
1. Vaccination
Vaccination programs have 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.
2. Motor vehicle safety
Improvements in motor-vehicle safety are attributable both to the engineering-based evolution of motor vehicles and highways and to campaigns to change driving-related behavior (e.g., to habitualize seat-belt use).
3. Safer workplaces
Policies and programs to improve occupational hygiene have contributed to a decrease in fatal job-related injuries of approximately 40 percent since 1980.
4. Control of infectious diseases
Decreases in water contamination, improvements in waste disposal, and antibiotic therapy have contributed to the control of infectious diseases such as cholera and typhoid.
5. Decline in deaths from coronary heart disease and stroke
Risk-factor modification, increases in the accessibility of early screening, and progress in treatment have resulted in a 51-percent decrease in CHD mortality since 1972.
6. Safer and healthier foods
Decreases in microbial contamination of food, the identification of essential nutrients, and the establishment of food-fortification programs have vastly improved the American food supply. The major deficiency diseases (e.g., goiter, pellagra, and rickets) have been almost eliminated in the United States.
7. Healthier mothers and babies
Nutritional and other improvements in hygiene, increases in the availability of antibiotics and healthcare services, and technological progress in maternal and neonatal medicine have contributed since 1900 to a decrease of 90 percent in infant mortality and to a decrease of 99 percent in maternal mortality.
8. Family planning
Increases in the accessibility of family planning and related services have contributed, for example, to a decrease in infant, child, and maternal deaths and to an increase in the use of condoms and other "barrier contraceptives" to prevent pregnancy and the spread of sexually transmitted diseases.
9. Fluoridation of drinking water
Community water fluoridation safely, inexpensively, conveniently, and importantly contributes to the prevention of tooth decay in children and adults and to the prevention of tooth loss in adults.
10. Recognition of tobacco use as a health hazard
The U.S. Surgeon General's 1964 report on the risks of tobacco use prompted antismoking campaigns that have resulted in a decrease in the prevalence of smoking among adults and in the prevention of millions of smoking-related deaths.
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. A final report in this series will review the national public health system, including local and state health departments and academic institutions whose activities on research, epidemiology, health education, and program implementation have made these achievements possible.
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 (1). To highlight these advances, MMWR will profile 10 public health achievements (see box) in a series of reports published through December 1999.
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.
1. Vaccination
Vaccination programs have 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.
2. Motor vehicle safety
Improvements in motor-vehicle safety are attributable both to the engineering-based evolution of motor vehicles and highways and to campaigns to change driving-related behavior (e.g., to habitualize seat-belt use).
3. Safer workplaces
Policies and programs to improve occupational hygiene have contributed to a decrease in fatal job-related injuries of approximately 40 percent since 1980.
4. Control of infectious diseases
Decreases in water contamination, improvements in waste disposal, and antibiotic therapy have contributed to the control of infectious diseases such as cholera and typhoid.
5. Decline in deaths from coronary heart disease and stroke
Risk-factor modification, increases in the accessibility of early screening, and progress in treatment have resulted in a 51-percent decrease in CHD mortality since 1972.
6. Safer and healthier foods
Decreases in microbial contamination of food, the identification of essential nutrients, and the establishment of food-fortification programs have vastly improved the American food supply. The major deficiency diseases (e.g., goiter, pellagra, and rickets) have been almost eliminated in the United States.
7. Healthier mothers and babies
Nutritional and other improvements in hygiene, increases in the availability of antibiotics and healthcare services, and technological progress in maternal and neonatal medicine have contributed since 1900 to a decrease of 90 percent in infant mortality and to a decrease of 99 percent in maternal mortality.
8. Family planning
Increases in the accessibility of family planning and related services have contributed, for example, to a decrease in infant, child, and maternal deaths and to an increase in the use of condoms and other "barrier contraceptives" to prevent pregnancy and the spread of sexually transmitted diseases.
9. Fluoridation of drinking water
Community water fluoridation safely, inexpensively, conveniently, and importantly contributes to the prevention of tooth decay in children and adults and to the prevention of tooth loss in adults.
10. Recognition of tobacco use as a health hazard
The U.S. Surgeon General's 1964 report on the risks of tobacco use prompted antismoking campaigns that have resulted in a decrease in the prevalence of smoking among adults and in the prevention of millions of smoking-related deaths.
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. A final report in this series will review the national public health system, including local and state health departments and academic institutions whose activities on research, epidemiology, health education, and program implementation have made these achievements possible.
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