Public Health Efforts since 1950

Overview

Public health is a branch of preventative medicine concerned with the physical, mental, social, and environmental health of the community as a whole. From everyday lifestyle needs such as food and workplace safety to emerging infectious diseases, public health professionals apply scientific principles to analyze a community environment and institute measures which promote community well-being. In the latter half of the twentieth century, public health achievements such as the eradication of smallpox and institution of vaccination and health education programs have benefited millions throughout the world.

Background

Most developed countries support national public health institutions which research current health trends, and rely on information provided to them by smaller local public health centers throughout the country. For instance, the Center for Disease Control and Prevention (CDC) in the Unites States, among its other functions, collects and analyzes data provided by state and local health departments. Special methods of information-gathering regarding disease prevalence, along with methods to recognize patterns and institute control measures for significant findings, form the basis of epidemiology. Epidemiologists use statistics to find relationships between the incidence of disease and correlating factors, such as diet, lifestyle patterns, and the environment.

International public health goals are set by agencies such as the World Health Organization (WHO), established in 1948 as a special adjunct of the United Nations. During the 1950s and 1960s, the WHO successfully conducted mass campaigns to minimize endemic diseases (diseases normally occurring in a population at a relatively unchanged rate), as well as epidemic diseases (diseases with a rapid increase in the rate of infection) in the developing world. Additionally, the WHO helped teach the methods of epidemiology and public health principles to developing countries so that they could establish their own public health programs. Regardless of the level of the organization—local, national, or international—public health agencies assist the government in passing legislation to protect the health of the population at large.

Impact

Twentieth-century gains in public health dramatically impacted life expectancy. Many public health officials credit the chlorination of water with the almost 50% jump in life expectancy experienced by the end of the century. Waterborne diseases such as cholera and typhoid are almost non-existent in developed countries, but remain a threat in some countries where nearly half of the population still drinks untreated water. Poverty, overcrowded living conditions, and lack of infrastructure to treat and deliver water contribute to water-borne diseases which kill approximately 25,000 people in developing nations a day. Waterborne-diarrheal disease outbreaks in the early 1990s were particularly deadly to children, killing more than three million infants and children in a five-year period. The World Health Organization identified the availability of safe drinking water through chlorine decontamination as its number one priority of the 1990s, and, along with other international assistance groups, is providing developing countries with technical assistance and education to help improve the quality of drinking water.

Infectious diseases have spurred some of twentieth century's most spectacular public health accomplishments, as well as occupied public health scientists with some of its most frustrating mysteries. Almost all bacterial infections were considered curable with the advent of powerful and specialized antibiotics, until the 1970s, when bacteria resistant to standard antibiotic treatments began to emerge. The liberal over-usage of antibiotics, and failure to complete courses of antibiotics when prescribed, presumably encouraged bacterial evolution which created resistant strains.

Poliomyelitis, an infectious viral disease of childhood that often resulted in severe muscle paralysis, created a decade-long atmosphere of panic in the United States—with mothers isolating their children from both playmates and public locations fearing exposure to the disease. By 1954, American physician Jonas Salk (1914-1955) tested his polio vaccine made from the killed virus, and Americans eagerly waited in lines at makeshift public health centers by the thousands to inoculate their children. Polio is now on the brink of extinction, with vaccination routine in the developed world, and efforts to vaccinate those in remote areas continuing.

Other infectious diseases were the target of successful public health interventions. The last known case of smallpox occurred in Africa in 1977. Smallpox vaccinations are no longer routinely necessary as the disease is considered eradicated. As a result of global vaccination efforts, 80% of the world's children are vaccinated against major childhood diseases such as diphtheria, pertussis, measles, polio, and tetanus. Subsequently, child mortality dramatically decreased since 1980.

The emergence of the Human Immunodeficiency Virus (HIV) which progresses to AIDS (Acquired Immunodeficiency Syndrome) in the early 1980s sparked a public health revolution. As the epidemic took hold across the world, public health officials responded to intense pressure to quickly disseminate the latest knowledge and preventative strategies. Previous social taboos vanished as public health officials spoke openly of the connection between AIDS and sexuality in churches, schools, and other public forums. As cities debated needle exchange programs and distribution of condoms, public health officials continued its education strategies to minimize public misconception of the blood-borne illness. Today, as the epidemic continues, public health agencies world wide participate in the search for a vaccine to prevent AIDS, to document the epidemic's evolution, and to educate the public in preventing its spread.

In the 1990s, bloodborne types of hepatitis, hemorrhagic fevers, and the re-emergence of tuberculosis (including resistant strains) all join AIDS in challenging public health professionals to educate and protect the public, as well as healthcare workers caring for victims of these evolving diseases.

Preventative services for chronic conditions brought about by age, genetics, or lifestyle are also within the scope of public health. In the last half of the twentieth century, public health officials identified risk factors for chronic conditions, then planned interventions to reduce mortality. The reduction of deaths from heart disease, due in part to a diet- and exercise-conscious public in the 1970s and 1980s, is hailed as one of the great public health accomplishments of the century. Deaths from stroke also decreased in the United States, as a televised public health campaign labeling hypertension (high blood pressure) as the "silent killer" encouraged citizens to seek screening and treatment. Infant mortality decreased as pregnant women were encouraged to seek prenatal treatment.

Public health dramatically affected women's issues during the 1960s and 1970s. Sexually transmitted disease screening was included in family planning care, and the advent of the oral contraceptive enabled women to exercise more control of their bodies. The sexual revolution of the 1960s evolved to the women's movement of the 1970s, and women entered the workforce in record numbers. During these two decades, mortality from cervical cancer plummeted, as women were encouraged to seek regular pap smears for early cervical cancer detection.

The environment in which people live and work is a public health concern. Pressure from an increased population and increased industrial activity in the twentieth century contributed to a higher volume of pollutants threatening the air and water. Public health officials monitor air quality, post alerts on high pollution days, and support legislation enforcing clean air emission standards from industry and automobiles. Additionally, public health organizations monitor bodies of water, as well as municipal water supplies for biological and chemical contaminates. Public health officials also plan for environmental disasters which may affect the water supply or air quality, such as radioactive discharges, severe flooding, or biological terrorism.

The effects of tobacco use in the United States were a major public health concern as the twentieth century ended. Although per capita consumption of cigarettes was down in 1998 to its lowest level since the 1940s, smoking among young people has been on the rise since 1991. Many states successfully litigated against tobacco companies, claiming teens were especially targeted by tobacco advertisements. Some tobacco companies were ordered to pay for anti-smoking advertising aimed at teens, and to fund public health campaigns stating the dangers of smoking. Stricter policies to protect the public from second-hand smoke have been implemented. Many states passed laws restricting smoking in governmental and private worksites. Since the Surgeon General's 1964 report which first spoke of the dangers of cigarette smoking, strong clinical evidence has been compiled by the medical community supporting the link between smoking and lung cancer. Although public health agencies encouraged "smoke-free" days each year and engaged in anti-smoking advertising campaigns aimed at teens, smoking remained a frustrating addiction resulting in 30% of all cancer deaths in the United States. World-wide, smoking grew at exponential rates, especially in developing countries.

Smoking restrictions prompted some to claim that governmental public health policies interfered with individual citizen rights, though few argued that laws prohibiting the sale of tobacco to children were oppressive. This public health double-edged sword can also be illustrated by the decision of some mothers not to vaccinate their children against childhood diseases, claiming that the risk of exposure was low since most other children were vaccinated. In most cases the public good was eventually satisfied by enacting laws—for example, requiring children to be vaccinated before conferring eligibility to enter school. Instances of exotic or unusual burial requests sometimes made news, and were almost always refuted by strict burial and tissue disposal laws enacted to protect the public from the shedding of potentially harmful or infected cells from the deceased. One exception to this was the Ebola outbreak of the 1990s in Africa. New cases of the deadly virus continued to emerge until control measures banned customary mourning practices of handling the dead victim's body. Some legislative insistence to public health conformity is less controversial, such as requirements to buckle the seat belt while driving a car.

Public health official still face many challenges. At the close of the twentieth century, overcrowding and growth pressures expanded as the Earth's population reached six billion. Gains in mental health care eroded as the result of budgetary cuts. Environmental concerns such as global warming and the depletion of the ozone layer may affect the world's ability to grow crops. Hunger persisted in large parts of the world. With surveillance and applied principles of epidemiology, public health professionals hope to tackle these problems in the twentieth-first century, and assist the peoples of the world to achieve better states of health and well-being.

BRENDA WILMOTH LERNER

THE CAMPAIGN TO ERADICATE POLIO

In 1988 the World Health Organization launched a global drive to eradicate polio by the year 2000. Joined by Rotary International, the De Beers diamond company, UNICEF, and the governments of Australia, Canada, Denmark, Germany, Japan, the United Kingdom and the United States of America, the campaign has been a spectacular success. Most countries are now free of the disease, and the goal appears to be within reach. The WHO has targeted the Indian subcontinent and sub-Saharan Africa in their final push to eliminate the disease.

When WHO announced their eradication drive in 1988, there were 35,000 cases of polio worldwide. Using a strategy similar to the one that had eliminated smallpox a decade earlier, the number of cases dropped to 6,000 within 10 years. An outbreak in Angola pushed the numbers higher in 1999, but in the first quarter of 2000, there were only 39 confirmed cases. The WHO plans to target measles for their next eradication campaign.

For more information see the WHO web site:
http://www.who.int/vaccines-polio/eradconcept.htm