1.12: Twenty-First Century Public Health
- Page ID
- 116082
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)In the 21st century (the 2000's), we have a complex understanding of health problems at the population level.
- Some of these have to do with healthcare --- access, quality, cost, and fairness.
- Others have to do with how we live, where we live and what we do. Some public health professionals refer to this as "lifestyle diseases," which places the focus on health behaviors. Certainly, health behaviors have a huge influence on our health -- but what influences our health behaviors?
- Other public health professionals place more emphasis on the social determinants of health, meaning the social, economic and political conditions that influence how we live and what we do. Chapter 3 of this book explores this topic more in depth.
- We also face environmental problems -- everything from industrial pollution to food safety to climate change.
- We have seen emerging epidemics of infectious diseases, from H1N1 influenza to Zika virus to covid to possibly avian influenza in the future, should it become more transmissible person-to-person.
- Mental health problems and substance abuse are also major challenges today. Debilitating health conditions and deaths related to alcohol, drugs, depression and suicide are of great concern around the country.
The disparities or inequities in health that exist today -- some decreasing and others increasing -- draw our attention to how much work we still have to do to reach the ideal of health for all embodied in the World Health Organization's definition of health.
Public Health Achievements in the first part of the 21st Century
In the first quarter of the 21st century, great emphasis has been placed on improving health metrics (how we measure health), addressing the social determinants of health, improving health behaviors, integrating health into public policy (e.g., California's Health in All Policies initiative), and improving access and quality of healthcare. These priorities are reflected in the Healthy People initiatives.
And significant successes were achieved! For example, in 2011, the CDC celebrated key achievements of the first decade of the 21st century, including
- Vaccines to prevent disease, including improvements to the pneumonia vaccine and the launch of the rotavirus vaccine. More recently, vaccines have been developed to prevent HPV, covid, and other diseases, preventing illness and death.
- Control of infectious diseases, including large reductions in tuberculosis (over 30% drop in the US in the first decade of this century) and in certain hospital-acquired infections.
- Tobacco control, as use of cigarettes has continued to decline. We will discuss tobacco control more in Chapter __.
- Improvements in infant health such as a 36% reduction in neural tube defects, largely through ensuring pregnant individuals are getting enough folic acid, as cereals and other foods are now fortified with this important vitamin.
- Motor vehicle safety changes leading to lower rates of injury and death for drivers, passengers, and pedestrians.
- Cardiovascular disease prevention -- while heart disease and stroke are still leading causes of death, the rates have continued to decline, largely due to reduced tobacco use and improved medical treatments.
- Occupational safety guidelines and regulations have resulted in significantly lower rates of injury on the job for farmworkers, fishermen, hospital workers, and others.
- Improved screening techniques for cancer has meant earlier detection and treatment, reducing deaths from certain cancers.
- Reductions in childhood lead poisoning have been achieved, with lasting impacts on child health and learning. In 1980, 88% of children ages 1 to 5 had elevated blood lead levels; that number came down to under 1% by 2008.
- Improved public health preparedness and response. Disasters including the 9/11 attacks, the subsequent distribution of anthrax through the mail, and the devastation of Hurricane Katrina lead to more investment in public health preparedness and response. While this preparedness has been sorely tested by both natural disasters and the largest epidemic in 100 years (covid-19), the response to the 2009 H1N1 influenza pandemic was rapid and effective, preventing thousands of hospitalizations and deaths.
Federal Reorganization and Downsizing of Public Health
In 2025, a major shift in federal priorities in public health occurred under the second Trump Administration. As this chapter is being written, federal public health funding and infrastructure is being decimated, and it is likely that deep cuts to Medicaid will also curtail access to healthcare for many. These federal changes have ripple effects on state and local health departments, as well as on the healthcare system and the nongovernmental organizations involved in public health. The impact of such deep cuts and reorganization cannot yet be measured, but are likely to be severe.
To quote "Your Local Epidemiologist" public health blogger Dr. Katelyn Jetalina,
"There’s no question that health institutions can be run more efficiently. I spent the last three years inside the CDC pushing for change—fighting for innovation, better systems, and clearer communication. I agree with some cuts and reorganization. Reimagining public health is essential. But tearing it down with no plan to rebuild isn’t transformation. It’s sabotage.
"The ultimate justification for these cuts is cost savings. But these cuts do not make financial sense. Federal workers make up less than 1% of the HHS budget. And, public health programs are all about prevention—which is not only good for our health but can be much cheaper than treating disease. For every $1 spent on flu vaccines for the elderly, $60 are saved. For every $1 spent in NIH funding, $4.25 is added to the local economies. Cutting these programs may save a dollar today, but when people start to get sick because of eliminated programs, we’ll pay many times more in health care costs down the road, much out of the government’s pocket for Medicare. We’re borrowing from our future selves with far too high an interest rate: in dollars, in health, and in lives."
References
https://open.substack.com/pub/yourlo...eOnShare=false