This month professors from the School of Public Health offer readers comments on the "20th Century's Top 10 Achievements in Public Health."

Compiled by Dr. Ross Brownson

During the 20th century, the health and life expectancy of persons residing in the United States improved dramatically. Since 1900, the average lifespan has lengthened by greater than 30 years; 25 years of this gain are attributable to advances in public health. The top 10 advances in public health were highlighted recently by the Centers for Disease Control and Prevention. This article describes these achievements, along with additional details for those areas of focus for the Saint Louis University School of Public Health. This list is not ranked in order of importance.

1. Vaccination. This century, vaccines have been developed or licensed against 21 diseases, 11 of which are recommended for all U.S. children. Substantial achievements have been made in the control of many vaccine-preventable diseases. For example, rates have declined for nine vaccine-preventable diseases and their complications. "Our research in federally qualified public health centers in St. Louis has shown that computer-tailored reminder calendars can greatly increase the rates of childhood immunizations," said Dr. Matt Kreuter, associate professor of behavioral science and health education.

2. Motor-vehicle safety. 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, such as 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.

3. Safer workplaces. 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. "In rural areas of Missouri, we have conducted multiple studies of lead mining and the health effects of lead contamination in the environment. These efforts are leading to better ways to control lead poisoning," said Dr. Greg Evans, associate professor of environmental and occupational health.

4. Control of infectious diseases. 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. "While overall the century has seen a dramatic decrease in the number of deaths due to infectious disease, public health continues to be challenged by the introduction of new epidemics such as HIV and the resurgence of TB and other diseases that we have not completely eradicated," said Dr. Dan Gentry, assistant professor of health administration.

5. Decline in deaths from coronary heart disease and stroke. This has 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 percent. "On-going interventions in southeastern Missouri are having a positive effect on behavioral risk factors for heart disease, such as physical inactivity and smoking," said Dr. Ross Brownson, director of the Prevention Research Center. "In these projects, we work closely with the Missouri Department of Health and focus on populations with some of the highest rates of heart disease in the United States and world."

6. Safer and healthier foods. 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. "Our work in the St. Louis area with the Parents as Teachers organization is designed to increase healthy eating among African-American parents -- and results to date are promising," said Dr. Debra Haire-Joshu, associate professor of behavioral science and health education.

7. Healthier mothers and babies. Thanks to better hygiene and nutrition, availability of antibiotics, greater access to health care and technologic advances in maternal and neonatal medicine, the world has healthier mothers and babies. Since 1900, infant mortality has decreased 90 percent, and maternal mortality has decreased 99 percent.

8. Family planning. 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 intervals 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.

9. Fluoridation of drinking water. 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 reduction in tooth decay (40 percent to 70 percent in children) and of tooth loss in adults (40 percent to 60 percent).

10. Recognition of tobacco use as a health hazard. This 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. "Our recent research has shown that stronger laws preventing teen access to tobacco are significantly related to lower rates of youth smoking -- changes in health policies are critical to the further reduction in U.S. smoking rates," said Doug Luke, assistant professor of biostatistics.

Please note this reflects my own interpretation of history, and it is not an official list representing the collective ideas of the department of history at Saint Louis University.

Have an idea for a Top 10 list? Call Joe Muehlenkamp at 977-2519.

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