1.11: Ten major accomplishments in the 20th century

As we have noted above, the work of public health is often unnoticed, especially when it is successful. With this in mind, in 1999 the CDC's weekly publication MMWR issued a list of 10 major public health accomplishments in the 20th century, a list that is still commonly used to illustrate public health's impacts. In most of these areas, we have continued to see improvements in the first part of the 21st century (e.g., further decline in motor vehicle deaths in the US, decline in deaths from coronary heart disease and stroke), while other areas have proven to be more challenging (e.g., maternal mortality, which has seen some increases in recent decades).

The text below is quoted from the CDC directly, with minor changes.

Ten Great Public Health Achievements -- United States, 1900-1999

• Vaccination
• Motor-vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard

Questions for reflection: What do you think of this list? Would you normally think of each of these as "public health accomplishments"? Anything that surprised you? Anything important left off the list that you would add? Anything you might leave off a list of great accomplishments?

The CDC (1999) provides a brief example for each of these accomplishments over the course of the 20th century, as well as a more comprehensive report for each (comprising 10 issues of the MMWR in total).

1. Vaccination has resulted in the eradication of smallpox; elimination of poliomyelitis in the Americas; and control of measles, rubella, tetanus, diphtheria, Haemophilus influenzae type b, and other infectious diseases in the United States and other parts of the world.
2. 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 (e.g., increased 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.
3. Work-related health problems, such as 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 have decreased; since 1980, safer workplaces have resulted in a reduction of approximately 40% in the rate of fatal occupational injuries.
4. Control of infectious diseases has resulted from clean water and improved sanitation. Infections such as typhoid and cholera transmitted by contaminated water, a major cause of illness and death early in the 20th century, have been reduced dramatically by improved sanitation. In addition, the discovery of antimicrobial therapy has been critical to successful public health efforts to control infections such as tuberculosis and sexually transmitted diseases (STDs).
5. Decline in deaths from coronary heart disease and stroke have resulted from risk-factor modification, such as smoking cessation and blood pressure control coupled with improved access to early detection and better treatment. Since 1972, death rates for coronary heart disease have decreased 51% (4).
6. Since 1900, safer and healthier foods have resulted from decreases in microbial contamination and increases in nutritional content. Identifying essential micronutrients and establishing food-fortification programs have almost eliminated major nutritional deficiency diseases such as rickets, goiter, and pellagra in the United States.
7. Healthier mothers and babies have resulted from better hygiene and nutrition, availability of antibiotics, greater access to health care, and technologic advances in maternal and neonatal medicine. Since 1900, infant mortality has decreased 90%, and maternal mortality has decreased 99% (comparing 1999 to 1900).
8. Access to family planning and contraceptive services has altered social and economic roles of women and other people with uteri. Family planning has provided health benefits such as smaller family size and longer interval between the birth of children; increased opportunities for preconceptional counseling and screening; fewer infant, child, and maternal deaths; and the use of barrier contraceptives to prevent pregnancy and transmission of human immunodeficiency virus and other STDs.
9. Fluoridation of drinking water began in 1945 and in 1999 reaches 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 care. Fluoridation has played an important role in the reductions in tooth decay (40%-70% in children) and of tooth loss in adults (40%-60%).
10. Recognition of tobacco use as a health hazard and subsequent public health anti-smoking 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, the prevalence of smoking among adults has decreased, and millions of smoking-related deaths have been prevented.

References:

CDC. (1999). Ten Great Public Health Achievements -- United States, 1900-1999. https://www.cdc.gov/mmwr/preview/mmw...l/00056796.htm