During the 20th century, the health and life expectancy of
residing in the United States improved dramatically. Since 1900,
average lifespan of persons in the United States has lengthened by
than 30 years; 25 years of this gain are attributable to advances
health (1). To highlight these advances, MMWR will profile 10
achievements (see box) in a series of reports published through
Many notable public health achievements have occurred during
1900s, and other accomplishments could have been selected for the
choices for topics for this list were based on the opportunity for
prevention and the impact on death, illness, and disability in the
States and are not ranked by order of importance.
The first report in this series focuses on vaccination, which
resulted in the eradication of smallpox; elimination of
the Americas; and control of measles, rubella, tetanus, diphtheria,
Haemophilus influenzae type b, and other infectious diseases in the
States and other parts of the world.
Ten Great Public Health Achievements -- United States, 1900-1999
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Fluoridation of drinking water
Recognition of tobacco use as a health hazard
Future reports that will appear in MMWR throughout the
1999 will focus on nine other achievements:
Improvements in motor-vehicle safety have resulted from
efforts to make both vehicles and highways safer and from
efforts to change personal behavior (e.g., increased use of
belts, child safety seats, and motorcycle helmets and decreased
drinking and driving). These efforts have contributed to large
reductions in motor-vehicle-related deaths (2).
Work-related health problems, such as coal workers'
(black lung), and silicosis -- common at the beginning of the
have come under better control. Severe injuries and deaths
mining, manufacturing, construction, and transportation also
decreased; since 1980, safer workplaces have resulted in a
approximately 40% in the rate of fatal occupational injuries
Control of infectious diseases has resulted from clean water
improved sanitation. Infections such as typhoid and cholera
by contaminated water, a major cause of illness and death early
20th century, have been reduced dramatically by improved
addition, the discovery of antimicrobial therapy has been
successful public health efforts to control infections such as
tuberculosis and sexually transmitted diseases (STDs).
Decline in deaths from coronary heart disease and stroke have
from risk-factor modification, such as smoking cessation and
pressure control coupled with improved access to early
better treatment. Since 1972, death rates for coronary heart
have decreased 51% (4).
Since 1900, safer and healthier foods have resulted from
microbial contamination and increases in nutritional content.
Identifying essential micronutrients and establishing
food-fortification programs have almost eliminated major
deficiency diseases such as rickets, goiter, and pellagra in
Healthier mothers and babies have resulted from better hygiene
nutrition, availability of antibiotics, greater access to
and technologic advances in maternal and neonatal medicine.
infant mortality has decreased 90%, and maternal mortality has
Access to family planning and contraceptive services has
and economic roles of women. Family planning has provided
benefits such as smaller family size and longer interval
birth of children; increased opportunities for preconceptional
counseling and screening; fewer infant, child, and maternal
the use of barrier contraceptives to prevent pregnancy and
of human immunodeficiency virus and other STDs.
Fluoridation of drinking water began in 1945 and in 1999
estimated 144 million persons in the United States.
and inexpensively benefits both children and adults by
preventing tooth decay, regardless of socioeconomic status or
care. Fluoridation has played an important role in the
tooth decay (40%-70% in children) and of tooth loss in adults
Recognition of tobacco use as a health hazard and subsequent
health anti-smoking campaigns have resulted in changes in
to prevent initiation of tobacco use, promote cessation of use,
reduce exposure to environmental tobacco smoke. Since the 1964
General's report on the health risks of smoking, the prevalence
smoking among adults has decreased, and millions of
deaths have been prevented (6).
The list of achievements was developed to highlight the
of public health and to describe the impact of these contributions
health and well being of persons in the United States. A final
this series will review the national public health system,
and state health departments and academic institutions whose
research, epidemiology, health education, and program
made these achievements possible.
Reported by: CDC.
Bunker JP, Frazier HS, Mosteller F. Improving health: measuring
of medical care. Milbank Quarterly 1994;72:225-58.
Bolen JR, Sleet DA, Chorba T, et al. Overview of efforts to
motor vehicle-related injury. In: Prevention of motor
injuries: a compendium of articles from the Morbidity and
Weekly Report, 1985-1996. Atlanta, Georgia: US Department of
Human Services, Centers for Disease Control and Prevention,
Center for Injury Prevention and Control, 1997.
CDC. Fatal occupational injuries -- United States, 1980-1994.
Anonymous. The sixth report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. Arch Intern Med 1997;157:2413-46.
Burt BA, Eklund SA. Dentistry, dental practice, and the
Philadelphia, Pennsylvania: WB Saunders Company, 1999:204-20.
Public Health Service. For a healthy nation: returns on
public health. Atlanta, Georgia: US Department of Health and
Services, Public Health Service, Office of Disease Prevention
Health Promotion and CDC, 1994.
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