Public Health Achievements of the 20th Century. Part 2

Recognition of tobacco’s health hazards. Although tobacco industry scientists were well aware of tobacco’s adverse health effects in the 1950s, the public only slowly became aware of the dangers of smoking. The landmark 1964 Surgeon General’s Report is credited with expediting this educational process. Since that report, adult smoking rates declined from over 70 percent to their current rate of approximately 25 percent. Unfortunately, the rate of teen-age smoking is now on the rise. This will undoubtedly lead to a reversal of recent trends toward lower heart disease and cancer rates, if more is not done to educate our youth.

Safer and healthier foods. Careful safeguards have given us the world’s safest food supply. However, occasions of microbial contamination still occur. The U.S. Department of Agriculture has recently approved food irradiation, which may help lessen the rate of contamination incidents.

Identifying appropriate levels of needed nutrients, with later fortification of certain foods, has helped eliminate deficiency diseases such as pellagra, and markedly reduced incidents of rickets and goiter. There is reason to believe that fortifying certain foods with folate, a B-vitamin, will reduce certain birth defects.

Control of infectious diseases. In addition to vaccinations, better sanitary and hygienic conditions for all Americans have been largely achieved. As a result, there has been a major reduction in many of the infectious diseases that have plagued. Chlorinating water to purify it has eliminated cholera and typhoid. And the discovery of antibiotics was a very important factor in the reduction of sexually transmitted disease and tuberculosis.

Safer workplaces. Many workplace-related health problems, such as black lung and fire hazards, have been drastically reduced. Since as recently as 1980, there has been a 40 percent reduction in fatal workplace injuries.

Healthier mothers and babies. Since 1900, infant mortality has dropped 90 percent and maternal deaths have dropped by 99 percent. These rewarding statistics are the result of better access to prenatal care, better overall nutrition, appropriate antibiotic use and technological advances in obstetrical and neonatal medicine.

Family planning. Acceptance of the concept of contraception, as well as wider availability of effective contraceptive methods and family planning services, has led to smaller families and fewer maternal and infant deaths. Barrier contraceptives have also led to lower rates of sexually transmitted disease, including AIDS.

Motor vehicle safety. Although automobile accidents still take a heavy toll, there has been a significant reduction in death and injury due to several factors: engineering efforts have resulted in safer highways and vehicles; changes in personal behavior, including seat-belt use and child-safety seats; and less drinking and driving.

Medical prevention. Routine screening for certain conditions has become a prominent part of clinical evaluation over the past few decades. Pap smears and mammograms for women have been proven to save lives, as has colorectal cancer screening for adults over 50. Periodic blood pressure checks and blood tests for sugar and cholesterol levels have also helped to improve public health.

As we enter the new millennium, we see how much has been accomplished and how much remains to be done. Each time period has its unique health challenges. Old solutions may not be readily transferable to new, unforeseen problems. Worldwide application of the wonders we have enjoyed should be a prime concern, including improving access to healthcare and fighting hunger and infection in the developing world.

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