1. 1 Ten Great Achievements of Public Health in US, 1900-1999 MMWR 1999 TH Tulchinsky MD MPH Braun School Public Health October 2010

2. 2 MMWR www.cdc.gov/mmwr Subscription to your email address Weekly Authoritative Special Reports Excellent source on most topics in PH

3. 3 Ten Achievements of Public Health, MMWR, 1999  During the 20th century, the health and life expectancy in the US improved dramatically  Since 1900, average lifespan lengthened by >30 years; 25 years of this gain are attributable to advances in public health  MMWR profiled 10 public health achievements in a series of reports published through December 1999

4. 4 Ten Great Achievements of Public Health in the US in the 20 th Century 1.Control of infectious disease 2.Vaccination 3.Motor vehicle safety 4.Safer workplaces 5.Decline in deaths from coronary heart disease, strokes 6.Safer and healthier foods 7.Healthier mothers and babies 8.Family planning 9.Fluoridation of drinking water 10.Recognition of tobacco as a health hazard

5. 5 Control of Infectious Diseases  Clean water - filtered, chlorinated, monitored  Safe foods  Sanitation - waste collection, treatment, disposal  Immunization and vaccines  Measures to control TB, STDs, AIDS  Anti-microbial therapy  Access to medical care  New and resurgent infectious diseases

6. 6

7. 7 Vaccination  Control of pertussis, diphtheria, tetanus, measles, mumps, rubella  Global eradication of smallpox  Global eradication of poliomyelitis (by 2005?)  Measles control but not eradication  New vaccines - Haemophilus influenzae type b, hepatitis A and B, varicella, influenza, and pneumococcal pneumonia  New technology  Combination cocktails  No vaccines for AIDS, malaria and TB

8. 8

9. 9 Coronary Heart Disease and Strokes  Decline in deaths from coronary heart disease and stroke have resulted from:  risk-factor modification,  smoking cessation  blood pressure control  access to early detection and better treatment.  Since 1972, death rates for coronary heart disease have decreased 51%

10. 10

11. 11 Safer and Healthier Foods  Decreased contamination and food-borne disease  Improved food handling methods - refrigeration  Improved nutritional value of foods, crops  Food fortification  Identifying essential micronutrients and deficiency conditions  Food-fortification programs eliminated major micronutrient deficiency diseases: rickets, goiter, pellagra  Folic acid and other new disease- preventing functional food elements

12. 12

13. 13 Healthier Mothers and Babies  Better hygiene and nutrition  Spacing of pregnancies  Safe delivery in general hospitals  Antibiotics, vaccines, blood transfusions, Rh  Management of pregnancies  Social benefits, maternity leave, standards of living  Greater access to health care  Advances in maternal and neonatal medicine  Since 1900, infant mortality decreased by 90%, maternal mortality by 99%.

14. 14

15. 15

16. 16 Family Planning  Safe and effective methods  Access to family planning and contraceptive services  Altered social and economic roles of women  Health benefits e.g. smaller family size, longer interval between childbirth, less abortion  Pre-conceptional counseling and screening  Fewer infant, child, and maternal deaths  Barrier contraceptives to prevent pregnancy and transmission of HIV and other STDs

17. 17 Fluoridation of Drinking Water  Began in 1945 to prevent tooth decay  By 1999 reaches estimated 144 million in US  Controversial but safe and inexpensive  Strong professional support  Benefits for children and adults  Reaches all regardless of SES or access to care  Reduced decay by40%-70% in children  Reduced tooth loss in adults (40%- 60%)  Effects in preventing osteoporosis (with exercise, Vit D and calcium)

18. 18

19. 19 Recognition of Tobacco Use as a Health Hazard  1964 Surgeon-General's report on health risks of smoking  Public anti-smoking campaigns  Changes in social norms  Goals  To prevent initiation of tobacco use  To promote cessation of use  To reduce secondary environmental exposure  Prevalence of smoking among adults decreased  Millions of smoking-related deaths prevented  Still enormous public health problem among poor and adolescents

20. 20

21. 21 Workplace Safety Work-related health problems, e.g. coal workers' pneumoconiosis (black lung), and silicosis -- common at the beginning of the century -- have come under better control Severe injuries and deaths related to mining, manufacturing, construction, and transportation also decreased Since 1980, safer workplaces have resulted in a reduction of approximately 40% in the rate of fatal occupational injuries

22. 22

23. 23

24. 24 Motor Vehicle Safety  Improved motor-vehicle safety from engineering efforts to make both vehicles and highways safer.  Successful efforts to change personal behavior (e.g., use of safety belts, child safety seats, and motorcycle helmets and decreased drinking and driving).  These efforts have contributed to large reductions in motor-vehicle-related deaths.

25. 25

26. 26 How Was This All Accomplished?  National public health systems  Local and state health departments  Academic institutions - training, research, service  Increased professional public health manpower  Research, epidemiology, health education, and program implementation  Professional and advocacy groups  Public awareness  Professional awareness problematic  Public health works !!

27. 27 Source Source: CDC. Ten Great Public Health Achievements - United States, 1900-1999. MMWR. 1999;48(12);241- 243. www.cdc.gov MMWR Previous years 1999 ten publications