Public Health Achievements in the 21st Century

I've written before about "Ten Great Public Health Achievements of the 20th Century," which the Centers for Disease Control and Prevention published in 1999. Now, CDC has put together a list of ten great public health achievements from 2001 to 2010, based on nominations from the agency's public health scientists. Here are the ten achievements from the first decade of the 21st century:

Vaccine-Preventable Diseases -- Cases, hospitalizations, and deaths from vaccine-preventable diseases have dropped over the past decade, and the impact of the pneumococcal conjugate and rotavirus vaccines has been particularly striking.

Prevention and Control of Infectious Diseases -- The rates of tuberculosis cases and central-line associated bloodstream infections have fallen; more people are getting earlier diagnoses of HIV/AIDS; and screening of blood donors has prevented many potential West Nile virus transmissions through blood transfusions.

Tobacco Control -- More states have enacted smoke-free laws; cigarette excise taxes have increased; and the FDA is using its new regulatory authority over tobacco products to ban flavored cigarettes, further restrict youth access, and propose more-graphic warning labels for cigarette packaging.

Maternal and Infant Health -- More states are screening newborns for genetic and endocrine disorders, which allows for earlier interventions and life-saving treatments. The number of infants born with neural tube defects has also declined: "Mandatory folic acid fortification of cereal grain products labeled as enriched in the United States beginning in 1998 contributed to a 36% reduction in NTDs from 1996 to 2006 and prevented an estimated 10,000 NTD-affected pregnancies in the past decade, resulting in a savings of $4.7 billion in direct costs."

Motor Vehicle Safety -- Protective policies like seatbelt and car- seat requirements and graduated drivers licensing systems for teens have contributed to the drop in the death rate related to motor vehicle travel.

Cardiovascular Disease Prevention -- "During the past decade, the age-adjusted coronary heart disease and stroke death rates declined from 195 to 126 per 100,000 population and from 61.6 to 42.2 per 100,000 population, respectively."

Occupational Safety -- Following targeted interventions, statistics show declines in low back injuries in the nursing home industry; the youth farm injury rate; and the rate of fatalities among crab fishers.

Cancer Prevention -- As cancer screening rates for colorectal, breast, and cervical cancer have improved, the death rates for theses cancers have declined.

Childhood Lead Poisoning Prevention -- More states have passed comprehensive lead poisoning prevention laws, and the drop in children's blood lead levels has been striking: "Findings of the National Health and Nutrition Examination Surveys from 1976--1980 to 2003--2008 reveal a steep decline, from 88.2% to 0.9%, in the percentage of children aged 1--5 years with blood lead levels â¥10 µg/dL."

Public Health Preparedness and Response -- The public health system's surveillance and response capacities have improved, and were recently put to the test: "During the 2009 H1N1 influenza pandemic, these improvements in the ability to develop and implement a coordinated public health response in an emergency facilitated the rapid detection and characterization of the outbreak, deployment of laboratory tests, distribution of personal protective equipment from the Strategic National Stockpile, development of a candidate vaccine virus, and widespread administration of the resulting vaccine. These public health interventions prevented an estimated 5--10 million cases, 30,000 hospitalizations, and 1,500 deaths."

The first seven of these achievements are very similar to those on the 20th century list. Cancer prevention, childhood lead poisoning prevention, and public health preparedness and response are new achievements -- they've essentially replaced safer and healthier foods, family planning, and fluoridation of drinking water on the 20th century list.

As budget cuts continue at both the state and federal level, I hope we won't see our progress on these and other public health priorities erode.