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.


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