Public Health: The Development of a Discipline, Twentieth-Century Challenges

Introduction

xiii INTRODUCTION We are slowly learning one of life’s most important lessons: not just how to live longer, but also how to stay longer in good health with less dependence on others. —World Health Report 1998. Life in the 21st Century. A Vision for All. Report of the Director-General. Geneva, Switzerland: World Health Organization. 1998. In 1900, life expectancy for whites in the United States was about 50 years; for blacks it was about 35 years. In England and Wales, life expectancy in 1900 was about 45 years; in India it was about 23 years. A century later, life expectancy had risen across the globe, though unevenly . Those born in the United States, the United Kingdom, and most of Europe in the year 2000 could expect to live into their mid to upper seventies; those in India could expect to live to about 60 years of age. The longest life expectancy, averaging about 85 years, was estimated for those born in Andorra, a tiny country about 2.5 times the size of Washington, D.C., located in the Pyrenees Mountains between France and Spain. Other countries with high life expectancies in 2000 were Japan, Macau, San Marino , and Singapore. The shortest life expectancies in that year, averaging only about 35 years, were for those born in Angola, Liberia, Swaziland, Zambia, and Zimbabwe, countries stricken by war, famine, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/ AIDS). Why life expectancy rose more in some places than it did in others over the twentieth century can be explained by a few key factors, such as sanitation, political and economic stability, and the investments governments made in their own people, especially for education and health care. For example, the Brookings Institution lists 3 of the 10 most important achievements of the U.S. government in the twentieth century as being related directly to the public health of American citizens: 1) reducing disease (polio vaccination; targeting heart disease, cancer, and stroke; banning smoking; and preventing lead-based poisoning); 2) ensuring safe food and drinking water (Federal Insecticide, Fungicide, and Rodenticide Act of 1947; Poultry Products Inspection Act of 1957; Wholesome Meat and Poultry Acts of 1967 and 1968; Federal Environmental Pesticide Control Act of 1972; Safe Drinking Water Act of 1974; and the Food Quality Protection Act of 1996); and 3) increasing access to health care xiv INTRODUCTION for older Americans (Medicare, 1965). Similarly, the Centers for Disease Control and Prevention (CDC) lists the 10 great public health achievements in the United States as 1) vaccination, 2) motor-vehicle safety, 3) safer workplaces, 4) control of infectious diseases, 5) decline in deaths from coronary heart disease and stroke, 6) safer and healthier foods, 7) healthier mothers and babies, 8) family planning, 9) fluoridation of drinking water, and 10) recognition of tobacco as a health hazard. The World Health Organization (WHO) also helped improve global public health. That agency can take credit for the global eradication of smallpox and nearly global eradication of polio, two diseases that diminish life expectancy. Private foundations and organizations, too, played a role in improving both health and longevity of people in many regions of the world, particularly with regard to clean water access and education. National and local efforts dedicated to improving health for all by creating healthy nations, healthy cities, healthy communities, and healthy people all began in the twentieth century. Indeed, global awareness about the importance of public health for improving the quality of life for all people continues to grow. Addressing all of the players and factors that contributed to the advancement of public health in the twentieth century is a challenge. As we began outlining Volume II, it soon became apparent that the format we used for Volume I of this series, which focused on the selected works of individuals who drove the development of public health from the Age of Hippocrates to the Progressive Era, was inadequate. The second volume would require the recognition of the technological advances, social movements , and the political and economic decisions that drove the field. After several attempts at an organizational structure, we finally decided on separating the volume into three parts. Part I covers population health issues: the recognition of food and nutrition (or the lack thereof), tobacco, and dental caries as potential health risks; the emerging fields of environmental and occupational health; and concerns about the health of women, including maternal–child health. Part II contains six chapters that focus on major...