Which of the following contributed to increased life expectancy in the early twentieth century?

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During the 20th century, the health and life expectancy of persons residing in the United States improved dramatically. Since 1900, the average lifespan of persons in the United States has lengthened by greater than 30 years; 25 years of this gain are attributable to advances in public health (1). To highlight these advances, MMWR will profile 10 public health achievements (see box) in a series of reports published through December 1999.

Many notable public health achievements have occurred during the 1900s, and other accomplishments could have been selected for the list. The choices for topics for this list were based on the opportunity for prevention and the impact on death, illness, and disability in the United States and are not ranked by order of importance.

The first report in this series focuses on vaccination, which 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.

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

Future reports that will appear in MMWR throughout the remainder of 1999 will focus on nine other achievements:

• 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 (2).

• 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 (3).

• 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).

• 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).

• 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.

• 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%.

• Access to family planning and contraceptive services has altered social and economic roles of women. 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.

• 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%) (5).

• 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 (6).

The list of achievements was developed to highlight the contributions of public health and to describe the impact of these contributions on the health and well being of persons in the United States. A final report in this series will review the national public health system, including local and state health departments and academic institutions whose activities on research, epidemiology, health education, and program implementation have made these achievements possible.

Reported by: CDC.

References

1. Bunker JP, Frazier HS, Mosteller F. Improving health: measuring effects of medical care. Milbank Quarterly 1994;72:225-58.

2. Bolen JR, Sleet DA, Chorba T, et al. Overview of efforts to prevent motor vehicle-related injury. In: Prevention of motor vehicle-related injuries: a compendium of articles from the Morbidity and Mortality Weekly Report, 1985-1996. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 1997.

3. CDC. Fatal occupational injuries -- United States, 1980-1994. MMWR 1998;47:297-302.

4. Anonymous. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-46.

5. Burt BA, Eklund SA. Dentistry, dental practice, and the community. Philadelphia, Pennsylvania: WB Saunders Company, 1999:204-20.

6. Public Health Service. For a healthy nation: returns on investment in public health. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Office of Disease Prevention and Health Promotion and CDC, 1994.

   
   

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During the twentieth century, life expectancy at birth increased from 48 to 74 years for men, and from 51 to almost 80 years for women.

Title Health, United States, 2004: With chartbook on trends in the health of Americans Publisher Centers for Disease Control and Prevention Publication Date 2004 Authors Centers for Disease Control and Prevention, National Center for Health Statistics URL Read Full Resource

From Claire Ninde, APC Director

With National Public Health Week taking place April 3-9, I ask you to take a trip back in time and imagine yourself living 200 years ago in 1817. Living conditions then were vastly different from today due to poor sanitation, lack of proper sewage management, non-existent or inadequate treatment of drinking water, no food inspection or municipal garbage collection, crowded housing and no real understanding of nutrition.

People died painfully, mostly in infancy or childhood, primarily from diseases such as tuberculosis, pleurisy, typhus, tonsillitis, cholera and dysentery. With a lack of medical understanding of these ailments, a common treatment was bloodletting. The average lifespan at the time was around 35 years.

Over the last 200 years, U.S. life expectancy has more than doubled to almost 80 years (78.8 in 2015), with vast improvements in health and quality of life. However, while most people imagine medical advancements to be the reason for this increase, the largest gain in life expectancy occurred between 1880 and 1920 due to public health improvements such as control of infectious diseases, more abundant and safer foods, cleaner water, and other nonmedical social improvements.

This period is actually referred to as the “First Public Health Revolution” and it occurred before the medical interventions of antibiotics and advanced surgical techniques were in place. Historians have concluded that improved sanitation, public water treatment, sewage management, food inspection and municipal garbage collection almost eliminated the aforementioned causes of death. Also, other social advancements such as greater understanding of nutrition, better housing conditions, air quality improvements, child labor laws and higher literacy rates also greatly improved overall health and life expectancy.

This historical examination would not be complete without an acknowledgement of the impact of vaccines on improved health and life expectancy in the U.S., although widespread use of vaccines did not occur until the 1900s compared to some of the earlier life-extending population health improvements mentioned above.

Vaccines have been so effective at improving health and saving and extending lives that most people in the U.S. have no idea what it’s like to watch a child die a painful death from a tetanus infection or to witness a loved one experience brutal paralysis and death from polio. Providing and supporting vaccinations is a key tool in today’s public health toolbox.

The importance of highlighting public health’s role in extending life and improving health is crucial. Currently, medical health care expenditures amount to close to 18 percent of our GDP, whereas the more cost-effective public health initiatives have been vastly underfunded, despite the evidence that they greatly improve the health of the nation.

Health policy that aims to increase life expectancy and lower health care costs should demonstrate an investment in public health efforts that address multiple determinants of health, such as environmental factors, behavioral health and housing. Another important distinction between public health and individualized medical care is the foundational emphasis on health equity. Public health initiatives focus on serving populations, not just individuals, and improving everyone’s ability to reach their highest health potential, not just those who can afford it.

On a local level, San Juan Basin Public Health is launching our next Community Health Assessment that will result in a new Public Health Improvement Plan to be released within the next year. As we embark upon this process, that includes collecting and analyzing data related to chronic health indicators as well as quality-oflife factors like housing, education and mental health, our goal is to engage local community members in the effort to shape public health policy.

With your feedback, SJBPH will prioritize the public health issues unique to the communities we serve, and through the plan, create strategies to work with local partner organizations and providers to address these issues.

SJBPH will be publicizing opportunities to participate in the assessment, and you can visit sjbpublichealth.org/apc for more information. Don’t forget to thank your local public health practitioner for 30 additional years of life!