ACHIEVEMENTS IN PUBLIC HEALTH

To those of us in the field of public health, the saying "we've come a long way, baby" accurately reflects the health achievements of the past 100 years. In a review of advancements in public health, the Centers for Disease Control and Prevention (CDC) cited what they consider to be the ten greatest public health achievements of the twentieth century, a time-span in which the average lifespan of the U.S. population lengthened by more than 30 years.

1. Vaccinations. Vaccinations have eradicated smallpox, eliminated poliomyelitis, and significantly controlled a number of infectious diseases, including measles, rubella, tetanus, diphtheria, and Haemophilus influenzae Type B, all of which once claimed the lives of large numbers of people in the early 1900s, many before they had reached the age of 5.

2. 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, such as the use of safety belts, child safety seats, and motorcycle helmets and the avoidance of drinking and driving.

3. Workplace safety. Work-related health risks common at the beginning of the century are now either under better control or completely eliminated. Since 1980 alone, safer workplaces have resulted in a 40 percent reduction in rate of fatal occupational injuries.

4. Control of infectious diseases. Clean water and improved sanitation have greatly reduced the development and transmission of infectious diseases since 1900. In addition, antimicrobial therapy, such as the discovery of and treatment with antibiotics, has greatly reduced the risk contracting diseases such as tuberculosis and sexually transmitted infections.

5. Cardiovascular disease (CVD) and stroke deaths. Efforts to educate the public on how to modify health risk factor: such as smoking cessation and blood pressure control, coupled with improved access to early detection and better treatment, have resulted in declines in incidences of CVD and stroke.

6. Safe and healthy foods. Since 1900, technology for eradicating microbial contaminants from foods has increased dramatically. In addition, identification of essential micronutrients and establishment of food-fortification programs have almost eliminated major nutritional deficiency diseases such as rickets, goiter, and pellagra.

7. Maternal and infant care. Better hygiene and nutrition, ii proved availability of antibiotics, greater access to health care, and technological advances in medicine have great reduced the risks to infants and mothers. Since 1900, infant mortality has decreased by 90 percent, and maternal mortality has decreased by 99 percent.

8. Family planning. Access to family planning and contraceptive services has altered social and economic roles of women. Family planning has provided health benefits that have helped reduce the number of infant, child, and maternal deaths; increased opportunities for pre-conceptional counseling and screening; and increased the use of barrier contraceptives to prevent unwanted pregnancies and transmission of sexually transmissible infections.

9. Fluoridation of drinking water. Fluoridation of drinking water began in 1945 and in 1999 reached 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 health care. Fluoridation has played an important role in the reductions in tooth decay in children and tooth loss in adults.

10. Recognition of tobacco use as a health hazard. This recognition and subsequent public health antismoking 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, millions of smoking-related health problems have been prevented and lives have been saved.

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