Public Health:
An Investment in Your Future

What is Public Health?

• Prevent epidemics and the spread of disease
  
• Protect against environmental hazards
  
• Prevent injuries
  
• Promote and encourage healthy behaviors
  
• Respond to disasters and assist communities in recovery
  
• Ensure the quality and accessibility of health services.
  

   

One among many public health successes over the years has been the increase in life expectancy of Americans from 45 years to 75 years. While curative medicine is credited with five of those years, public health prevention measures are responsible for the vast majority of the gain--25 extra years of living. Our public health system, with its focus on primary prevention, continues to be our first defense against disease and injury and the basis for future improvements in the length and quality of our lives.

Public health shares its successes with the public it serves because ultimately our collective and individual health depends on the partnership of public health with legislatures, the media, business, scientists, the medical community, other governmental agencies, voluntary organizations, and individuals. Please join in celebrating the many successes in our public health.

Before the measles vaccine was approved in 1963, 3 to 4 million people contracted measles and several hundred, mostly children, died each year.

Today, measles has all but disappeared in the United States along with many other infectious childhood diseases. Effective immunization involves more than giving children shots; it requires many public health activities, including researching and testing vaccines, mobilizing health care workers, and educating parents. Some causes for celebration:

Disease		Reported Cases in Worst Year	Cases in 1993	

Measles 		894,134	(1941)		     281
	
Diphtheria 		206,939	(1921)		     0
	
Mumps 			152,209	(1968)	           1,640
	
Polio 			21,269	(1952)		       4
	
Tetanus 		  1,560	(1923)		      43
	
Rubella 		 57,686	(1969)		     195
	
Whooping Cough		265,269	(1934) 		   6,335
	

It was public health that identified lead in gasoline as a major source of exposure among children and influenced its removal. As a result of that change alone, blood lead levels of children declined 70%. Public health also has been instrumental in:

• Eliminating lead in paint
• Eliminating lead solder in food cans
• Keeping lead out of drinking water
• Reducing air pollution around ore smelters

Public health departments across the country continue to take an active role in educating parents about sources of lead poisoning, screening and identifying children and communities at risk, and developing effective, low-cost ways to remove lead-based paint from old housing.

This success is a result of public health leadership and combined efforts of people and legislatures. Activities in this collaborative effort include:

Public health education for legislatures and the public about the benefit of using seat belts. Federal laws mandating seat belts in vehicles. State laws requiring that seat belts be used. Personal efforts of people to use seat belts and encourage their passengers to do so.

As a result, in 1994:

• 47 States had seat belt laws
• 67% of passengers used them

The massive public health effort to reduce smoking that followed is a model of success. The percentage of American adults who smoke dropped from 42% in 1965 to 26% in 1994. Without the anti-smoking campaign, tens of millions more Americans would be smoking today.

Public health has collaborated with many partners to address:

Smoking behaviors Rights of nonsmokers Effects of second-hand smoke Advertising and influencing youth Insurance issues Economics of tobacco

Despite these successes, smoking remains the largest cause of preventable death. Continued efforts target the 48 million Americans who continue to smoke and the $50 billion annual price tag for direct medical costs related to smoking.

An example of public health’s ability to respond successfully occurred during the 1993 Midwest floods when 532 counties in 9 States were declared disaster areas. While the water was still rising, Federal dollars were flooding the area, and State and local public health workers were providing on-site recovery aid.

Their response required the full spectrum of public health activities, including monitoring environmental conditions, diagnosing health problems, mobilizing communities, and enforcing health regulations. Workers tested water in 8,000 wells for contamination and 300,000 mosquitoes for organisms that carry diseases.

Hospitals Home health agencies Hospices Nursing homes Ambulatory surgical centers Physical therapy/rehabilitation clinics Portable X-ray facilities Rural health clinics

To improve quality and reduce costs, public health agencies are beginning to evaluate medical care patterns and outcomes. For example, New York State public health conducted a program to evaluate and improve outcomes of coronary artery bypass surgery. Physicians and hospitals responded with changes that helped death rates from bypass surgery fall from 4.12% to 2.45% in a two-year period.

Public health research identified major risk factors, such as high blood pressure, high cholesterol, smoking, physical inactivity, and overweight, that could be modified by changes in lifestyle.

Public health also joined 2,000 national and local groups to educate people about these risks and help them make lifestyle changes. Successful community-wide programs involved:

Schools Worksites Hospitals Community centers

Multiple public health approaches increased the public’s understanding of heart disease and stroke. For example, the percentage of people who were aware of the relationship between high blood pressure and stroke increased from 24% to 90% and the percentage of hypertensive people whose blood pressure was controlled increased from 16% to 55% as a result of these efforts.