Public Health: Six Success Stories

By Beans, Bruce E.

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.