Public Health: Six Success Stories
Do today's health-scare headlines get you down? Take heart by looking at our success in solving the health problems of the past.
In 1900, the average American life span was 45. That didn't mean people only lived until that age -- they lived a lot longer -- but many children died of infectious diseases that are now preventable. Those childhood deaths pull down the "average" life span to 45. The average life span today is past 80. The Centers for Disease Control and Prevention (CDC) says progress in clinical medicine accounts for just five of those years. Public health -- advances in sanitation, education and vaccines -- gets credit for increasing the average life span 30 years.
"When most Americans think about health, they think about hospitals and sophisticated doctors' treatments, and those are important," says former CDC director William Roper, M.D., Ph.D., and now dean of a School of Public Health. "But if you are talking about return on investment and impact on the lives of average Americans, public health has had a much bigger impact."
Let's look at six of public health's greatest hits:
Control of childhood diseases
The problem: In 1900, children under age 5 accounted for 30.4 percent of deaths. Infectious diseases bore much of the blame. The top killers included diphtheria, pertussis, tetanus, polio, smallpox and Hib (haemophilus influenza type b).
The solution: Routine childhood vaccines were introduced. In addition to preventing the diseases listed above, today vaccines also help prevent measles, mumps, rubella, chickenpox, hepatitis A and B, and pneumococcal pneumonia.
The result: Today, only around 1 percent of deaths involve children under 5. Thousands of deaths and serious illnesses are prevented by vaccines each year. Smallpox has been wiped out worldwide, polio has been eliminated from the Western hemisphere and measles are no longer seen in the United States. The CDC says each $1 spent on the measles-mumps-rubella vaccine saves $23. That lets us head off $9 billion a year in direct and indirect costs.
What's left to do: New diseases like AIDS and SARS drive home the need for caution. Infections such as influenza, pneumonia and AIDS still cause many deaths. A few old diseases, such as tuberculosis, have come back, too, and some of them in strains immune to drugs. And just 77 percent of U.S. children ages 19 to 35 months got all the vaccinations they needed in 2006 according to the CDC.
Safer, healthier foods
The problem: In the early 20th century, tainted food, milk and water caused a lot of infections. Typhoid fever, tuberculosis, botulism and scarlet fever led the list.
The solution: Stricter laws, hand washing, refrigeration, pasteurization, pesticides and healthier animal-raising methods all played a part. We identified key vitamins, improved our diets and started to fortify foods.
The result: Less contamination and more nutrients made our food supply much better. Diseases linked to poor nutrition like rickets and goiter are rare.
What's left to do: Changes in agriculture and food processing, including the global nature of today's food supply, fuel new foodborne threats. Among them: E. coli and listeria bacteria, and the rare but scary brain ailment called "mad cow disease." Some foodborne bacteria are now resistant to antibiotics, which are used a great deal in raising beef, pork and poultry. The CDC wants to attack contamination closer to the food's point of origin.
Automotive and road safety
The problem: In 1925, 18 people died in motor vehicle accidents for each 100 million miles that their vehicles traveled.
The solution: In the 1960s, federal laws set standards for motor vehicles and highways. New car safety features include energy-absorbing steering wheels, shatter-resistant windshields, antilock brakes, front and side air bags, and collision-avoidance systems. A lot of roads gained stripes, reflectors, breakaway signs, impact barriers, better lighting and guardrails. And police cracked down on risky acts such as drunk driving and failure to use safety belts.
The result: Compared with 1925, six times as many people drive 10 times as many miles. Yet the yearly death rate per 100 million vehicle miles traveled has tumbled 91 percent, to 1.51.
What's left to do: In 2003, 43,220 people died on our roads. While safety belt use has reached an all-time high, 21 percent of us still don't buckle up. After years of decline, alcohol-related fatalities have risen steadily since 1999. Motorcycle deaths and fatal rollover crashes are up, too. The auto industry has agreed to design changes to ease the mismatch that takes place when light trucks or SUVs collide with cars.
Fluoridation and tooth decay
The problem: Tooth decay was once widespread. The treatment of choice: pulling the tooth. Not having at least six teeth opposite each other was the top cause of rejection from military service in both world wars.
The solution: Starting in 1945, we added fluoride to many public water supplies. Its success led to its use in other products, notably toothpaste. We also use fluoridated water in many processed foods.
The result: Today, says the American Dental Association (ADA), half of all children ages 5 to 17 have never had a cavity in their permanent teeth. "Four decades ago, almost all children were susceptible to tooth decay and cavities," says John Stamm, D.D.S., an ADA spokesman and dean of the School of Dentistry at the University of North Carolina at Chapel Hill.
What's left to do: Among Americans who use public water, just 62 percent get fluoride, the ADA says. Dr. Stamm suggests you brush daily with fluoridated toothpaste wherever you live. Floss daily and see the dentist twice a year, too.
Drop in tobacco use
The problem: The lung cancer death rate rose 15-fold from 1930 to 1990 as smoking gained favor. By the mid-1960s, more than 42 percent of U.S. adults were lighting up. The average American smoked 4,345 cigarettes a year.
The solution: The tide began to change with the 1964 Surgeon General's report on smoking. Then came greater public awareness, advertising restrictions, prevention and cessation programs, militant nonsmokers, crackdowns on sales to minors, public smoking bans and higher tobacco taxes.
The result: The adult smoking rate fell to 22 percent in 2002. The lung cancer death rate among men has been in decline since 1990. The death rate for women, who began smoking in large numbers 20 years after men, has leveled off.
What's left to do: Millions still smoke. "And we seem to have reached a plateau with the remaining hard-core, addicted smokers," says Len Lichtenfeld, M.D., the American Cancer Society's chief medical officer.
Less saturated fat
The problem: Heart disease has been the chief U.S. cause of death since 1921. Out of every 100,000 Americans in 1950, heart diseases claimed 587 lives.
The solution: Through public educations campaigns, we cut the rate of smoking (which is tough on the heart) and began using less saturated fats such as lard and butter and more unsaturated fats such as vegetable oils and margarine. Average cholesterol levels have dipped because of better diets and drugs.
The result: Though heart disease is still the number one killers, age-adjusted death rates have fallen 58 percent. Among each 100,000 people, heart disease now fells 248 each year.
What's left to do: Obesity (also tough on the heart) is rampant. Many of us eat diets high in calories and get too little exercise.