Prescriptions for a new year
In the year 1900, you had beaten the odds if you saw your 49th birthday; the average life expectancy for Americans was 48 years. The leading killers were infectious diseases like tuberculosis, diphtheria, and influenza and other diseases and injuries associated with unsafe workplaces and hazardous occupations. Smallpox had a large and lethal presence as well. For women, death also came from complications of childbirth. But in this new year, Americans will live 30 years longer, on average, than they did a century ago. This is due largely to the triumph of public-health interventions: sanitation, health education, improved hygiene and nutrition, clean water and air, measures to reduce infant and maternal mortality, safety regulations, and increased access to healthcare. Biomedical advances like vaccinations and antibiotics also played a role. Last year's census forms offered a three-digit space for entering one's age, and an unprecedented number of people are using all three spaces.
The very success of public-health interventions has resulted in a shift in the threats to Americans' health. Today the major killers are chronic illnesses, including heart and lung disease, cancer, stroke, and diabetes, as well as violence and injuries. As many as half of the causes linked to these conditions, it is estimated, are behavioral and environmental factors. Smoking is one (400,000 Americans die annually from tobacco-related illnesses), overweight another (300,000 people in the United States die each year from illnesses caused by or linked to obesity). Injuries and alcohol and substance abuse (over 110,000 deaths annually associated with alcohol abuse alone) are also on the list.
Prevention advances. Although the diseases have changed, America's approach to preventing and treating them should not. For example, public-health interventions beginning in the 1960s targeted smoking, reducing smokers from 42 percent of adults in 1965 to 24 percent in 1999. Highway safety laws have helped to cut the number of motor vehicle deaths dramatically.
So in 2002, much as it did 100 years ago, improving the nation's health means keeping public health at the forefront of the country's healthcare agenda. Today, increased attention to prevention strategies is needed to reduce risk factors for chronic diseases and injuries. Perhaps more than any miracle drug that could be discovered, developing and implementing ways to reduce health-damaging behaviors and eliminate environmental hazards could decrease the 2 million deaths that occur annually in the United States by as much as one half as well as cut healthcare costs. Public-health efforts are needed to continue the fight against contemporary epidemics. These include tobacco use (30 percent of high school seniors smoke), obesity (61 percent of Americans are overweight), lack of physical activity (40 percent of Americans don't move around in their leisure time), and unsafe sexual behavior (there are 12 million cases of sexually transmitted diseases each year; nearly 1 million people in the United States are infected with HIV/AIDS). Public-health interventions are already being applied to violence, suicide, and accidental injuries. A similar approach is critical for eliminating health disparities due to race, ethnicity, and gender. And public health must address mental illness, diseases that affect 1 out of 5 Americans each year.
Last year, Americans celebrated scientific breakthroughs like mapping of the human genome, holding out hope of dramatic new therapies for some diseases. Just a few months later, as a result of the bioterrorist attacks, national attention has focused once again on major causes of death from the year 1900 like smallpox. The dangers of bioterrorism and illnesses like AIDS underscore the importance of public-health interventions to fight emerging and re-emerging threats.
So in the new year, Americans should remember the public-health lessons of the past and apply them to new health challenges by strengthening the public-health infrastructure. Americans should do it by emphasizing the power of disease prevention and health promotion for communities and for individuals, by fostering and disseminating advances from research and by increasing access to healthcare services. The result could be a healthier future for all Americans--and, in the next century's first census, millions of people born in 2002 filling out the three-digit space on their forms.
This story appears in the January 14, 2002 print edition of U.S. News & World Report.