U.S. Public Health

During the 20th century in the U.S., life expectancy at birth increased by 62 percent, from 47 years in 1900 to 76 years in 2000—a nearly 30-year increase. Improvement in the health status of all age groups was reported.

Is it likely that the 21st century will see a comparable advance in public health? Scientists at the Centers for Disease Control and Prevention were asked by its publication Morbidity and Mortality Weekly Report to nominate noteworthy public health accomplishments in the first decade of the new century, between 2000 and 2010. Here’s a look at a few of their nominations that have had major impacts on public health.

Tobacco control

The U.S. was the first country to put a health warning label on cigarette packages, starting in 1966. Despite progress made to reduce tobacco use, smoking still results in an economic burden of approximately $193 billion per year in medical costs and lost productivity.

In 2009, the Food and Drug Administration (FDA) gained the authority to regulate tobacco products. By 2010, the FDA had banned flavored cigarettes and established restrictions on youth access. New warning labels that will graphically depict the negative consequences of smoking and will cover 50 percent of the front and rear of each pack are required on packaging by September 2012.

Secondhand smoke exposure results in an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths among nonsmoking adults in the U.S. each year, according to the American Cancer Society.

In 2000, no state had a comprehensive smoke free law, but by 2010, 25 states and the District of Columbia had enacted smoke-free laws that prohibit smoking in all private indoor areas—worksites, restaurants, bars—to protect nonsmokers from involuntary exposure to secondhand smoke.

Motor vehicle safety

Motor vehicle crashes are among the top 10 causes of death in the U.S., and are the leading cause of death for 5- to 34-year olds. In 2007, motor vehicle crashes ranked third—behind cancer and heart disease—in terms of potential life lost before age 65. In economic terms, crashes account for an estimated $99 billion in medical and lost-work costs annually.

Crash-related deaths are largely preventable, and improvements have been made. Between 2000 and 2009, the number of miles traveled by motor vehicles nationwide increased by 8.5 percent, yet the injury rate declined. Big drops occurred for children, with 49 percent fewer pedestrian deaths and 58 percent fewer bicycle deaths.

While safer roadways, safer vehicles and safer road use continue to make a difference, it’s the changes in behavior that have a major impact in reducing crash deaths. The best examples of behavior change include:

  • Passing and enforcing effective seat belt laws in 49 states and the District of Columbia (What’s up, New Hampshire?)
  • Passing and enforcing effective legislation to protect children riding in cars and using safety seats in all 50 states
  • Adoption of graduated driver licensing policies for teens, admitting young beginners to full driving privileges in phases (implemented to varying degrees in most states and the District of Columbia)

Focus on disease prevention

Many of the nominated health accomplishments focused on preventing one or more of the 15 leading causes of death, including:

Cancer. Stronger adoption of cancer screening methods coupled with new screening test standards resulted in improved test quality and contributed to a decrease in colorectal cancer deaths. Smaller
declines were noted for breast and cervical cancer death rates in the same period.

Heart disease and stroke. Coronary heart disease and stroke death rates declined. A reduction in the prevalence of risk factors, including attention to high blood pressure, cholesterol, smoking cessation, exercise and diet, and improvements in treatments, medications and quality of care, is credited.

Vaccine-preventable diseases. The U.S. has increased the number of diseases targeted by the nationwide immunization policy to 17, adding new vaccines that combat rotavirus, herpes zoster (shingles), human papillomavirus and other diseases.

The current childhood immunization schedule prevents an estimated 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and
$69 billion in indirect costs.

Combining classic public health tools—observation systems, guideline dissemination and taking action on research findings—with effective use of newer tools, such as regulatory and taxation measures—appears to be a good route for matching or beating the public health advancements of the last century.


Calcium and Vitamin D: Do They Benefit Women?

Postmenopausal women consistently taking calcium and vitamin D supplements may have the best shot at preserving bone mass and preventing fractures.

New research from the calcium and vitamin D supplementation arm of the Women’s Health Initiative (WHI) reveals only small benefits for women taking the supplements. It shows women taking a daily dose of 1,000 milligrams of elemental calcium as calcium carbonate combined with 400 international units (IUs) of vitamin D have a 1-percent higher hipbone density than those taking a placebo.

The benefits increased greatly in certain subgroups. Researchers found women most compliant about taking the supplements had a 29-percent decrease in hip fractures. Women ages 60 and older had 21-percent fewer broken hips. The study assessed 36,000 participants.

“The value of a study this large is that it does shows, even if only on a small scale, that the intervention can be effective to lower the risk of osteoporosis within two to three years,” says Rebecca Jackson, lead author and The Ohio State University Medical Center’s principal investigator for WHI. “Any supplementation of this kind is potentially beneficial, particularly in women over 60 years old. That’s a huge finding.”

Despite the benefits in preserving bone mass and preventing hip fractures, the study reveals calcium and vitamin D supplements do not prevent other types of fractures or colorectal cancer.

Researchers also found overall, the supplements were well tolerated but were associated with an increased risk of kidney stones.

SOURCE: The New England Journal of Medicine, 2006;354:669-683

Colon Cancer

Cancer of the colon and its neighboring area, known sometimes as colorectal cancer, affects both men and women. Like breast cancer and prostate cancer, colorectal cancer is seen much more frequently than skin cancers and is much more deadly. About 150,000 Americans are told each year that they have colon cancer, and about 35 percent of these will die of it. There are many contributing factors in why someone gets colon cancer, but the most commonly acknowledged one is diet. Diets high in fat and nonorganic non-grass-fed red meat are especially dangerous. Other diets, such as high in fruits, vegetables, and other natural raw and organic foods, help prevent colon cancer.

A study published in the Journal of Clinical Oncology in 2008, conducted by lead researchers Dr. Kimmie Ng of the Dana-Farber Cancer Institute in Boston found that high blood levels of vitamin D increased colon cancer patient’s survival rate by 48 percent. In this study, Dr. Ng and her team collected data on 304 patients who had been diagnosed with colon cancer between 1991 and 2002. Everyone in the study had their vitamin D blood levels measured a minimum of two years before being diagnosed with the disease. The patients were tracked until they died or until the study ended in 2005; 123 patients died, 96 of them from colon or rectal cancer during the follow-up period. Dr. Ng and her team found that the patients with the highest vitamin D levels were 39 percent less likely to die from colorectal cancer than the patients who had the lowest levels.

These findings are consistent with dozens and dozens of other observations that have been made in the past decade, including those by Dr. Cedric Garland. His lab reports that you are three times less likely to die from colon cancer if you have healthy levels of vitamin D in your bloodstream.