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Public Health 101: Ten Great Achievements

When I first started to get interested in public health several years ago, I thought of it mostly as dealing with things like vaccines and handwashing. From one of my friends who enrolled in a Master of Public Health program, I learned that it actually covers a whole range of issues that affect the population's health and quality of life - things like workplace and highway safety and smoking cessation, in addition to control of infectious diseases.

1. Immunizations At the start of the 20th century, people used to die routinely from infectious diseases like measles, polio, smallpox, and diptheria. The combination of vaccine development and policies promoting childhood immunization have brought the toll of these diseases and others close to zero. For instance, a 2008 Morbidity & Mortality Weekly Report piece on measles explains:

2. Motor-Vehicle Safety Driving was far less common at the start of the 20th century, but as more vehicles started traveling more miles we saw an increase in deaths and injuries from motor-vehicle crashes. The National Highway Safety Bureau, now the National Highway Traffic Safety Administration, was created in 1966, and its first director, Dr. William Haddon, took a public health approach to reducing deaths and injuries from crashes.

3. Workplace Safety At the start of the 20th century, it was hard to even know how many workers were dying or becoming ill from workplace hazards. One of the earliest data points is a survey of workplace fatalities in Allegheny County, Pennsylvania from July 1906 - June 1907; that survey reported that 526 workers *in that one county* died from "work accidents" in a single year. The 1907 explosion at a Monongah, West Virginia coal mine killed between 362 and 550 workers, and in 1911 the Triangle Shirtwaist Factory fire killed 146, many of whom leapt to their death from building windows because they had been locked in.

4. Control of Infectious Diseases In addition to immunizations, other measures have also dramatically improved the control of infectious diseases. CDC cites improvements in sanitation and hygiene and the discovery of antibiotics as major steps toward infectious-disease control. Penicillin was first produced in substantial quantities for medical use in the 1940s, and it and other antimicrobials have saved many lives. Here's MMWR's overview of sanitation and hygiene improvements:

5. Declines in Deaths from Heart Disease and Stroke Since 1938, heart disease has been the leading cause of US deaths and stroke has been the third leading cause (cancer is currently #2); the good news is that age-adjusted death rates from both diseases has declined. Advances in diagnosis and treatment of these diseases have been important; these include things like more emergency services for heart attacks and stroke as well as the development of medications for treating high blood pressure and high cholesterol.

6. Safer and Healthier Foods Early in the 20th century, contaminated food and water often caused typhoid fever and other foodborne diseases, but improvements in sanitation, refrigeration, pasteurization improved the safety of the food supply. In 1900, the incidence of typhoid fever was roughly 100 per 100,000 population; by 1950, that had dropped to just 1.7. Thanks in part to Upton Sinclair's muckraking novel The Jungle, which exposed horrific conditions in the meatpacking industry, the Pure Food and Drug Act was passed in 1906.

7. Healthier Mothers and Babies MMWR lays out the statistics on death during childbirth and infancy:

8. Family Planning When people can choose how many children to have and when, they tend to have fewer children and allow for longer intervals between births. These changes contribute to better health for infants, children, and women. In 1900, the average US family had 3.5 children; the number dropped to 2.3 children in 1933, then jumped to 3.7 during the baby boom. Since 1972, US average family size has remained at approximately two children.

9. Fluoridation of Drinking Water Dental caries (which most of us refer to as cavities) can lead to incapacitating pain and severe infections. Extensive dental caries were common in the early 20th century in most of the US, but dentist Frederick McKay established a practice in Colorado Springs and noticed that many of his patients had stained teeth but seemed less susceptible to caries. Upon investigation, he concluded something in the public water supply was probably responsibile. When aluminum-company chemist HV Churchill identified high concentrations of fluoride in an Arkansas well where another dentist had noted mottled enamel on children's teeth, McKay sent him a water sample and found that it, too, contained high levels of fluoride. Further investigation by other researchers concluded that adjusting flouride levels confirmed that higher fluoride levels correlated with lower prevalence of caries and identified an optimum range of fluoride concentration (0.7-1.2ppm). Fluoridation of public water supplies was rapidly adopted and dental caries dropped dramatically during the second half of the 20th century. For 12-year-old US residents, the mean number of decayed, missing, or filled teeth fell from 4.0 in 1966-1970 to 1.3 in 1988-1994.

10. Tobacco as a Health Hazard In the US, smoking is the leading preventable cause of disease, disability, and death; it's responsible for an estimated 443,000 premature deaths each year. After increasing at the start of the 20th century, smoking decereased. Annual per capita cigarette consumption was 4345 cigarettes in 1963 and 2261 in 1998. Between 1964 and 1992, approximately 1.6 smoking-caused deaths were prevented. Read more at scienceblogs.com