Changes in the public health system
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Changes in the public health system

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      The 10 public health achievements highlighted in this MMWR series (see box) reflect the successful response of public health to the major causes of morbidity and mortality of the 20th century (1-11). In addition, these achievements demonstrate the ability of public health to meet an increasingly diverse array of public health challenges. This report highlights critical changes in the U.S. public health system this century.

      In the early 1900s in the United States, many major health threats were infectious diseases associated with poor hygiene and poor sanitation (e.g., typhoid), diseases associated with poor nutrition (e.g., pellagra and goiter), poor maternal and infant health, and diseases or injuries associated with unsafe workplaces or hazardous occupations (4,5,7,8). The success of the early public health system to incorporate biomedical advances (e.g., vaccinations and antibiotics) and to develop interventions such as health education programs resulted in decreases in the impact in these diseases. However, as the incidence of these diseases decreased, chronic diseases (e.g., cardiovascular disease and cancer) increased (6,10). In the last half of the century, public health identified the risk factors for many chronic diseases and intervened to reduce mortality. Public efforts also led to reduced deaths attributed to a new technology, the motor vehicle (3). These successes demonstrated the value of community action to address public health issues and have fostered public support for the growth of institutions that are components of the public health infrastructure*. The focus of public health research and programs shifted to respond to the effects of chronic diseases on the public's health (12-17). While continuing to develop and refine interventions, enhanced morbidity and mortality surveillance helped to maintain these earlier successes. The shift in focus led to improved capacity of epidemiology and to changes in public health training and programs.

      Ten Great Public Health Achievements -- United States, 1900-1999

      • Vaccination

      • Motor-vehicle safety

      • Safer workplaces

      • Control of infectious diseases

      • Decline in deaths from coronary heart disease and stroke

      • Safer and healthier foods

      • Healthier mothers and babies

      • Family planning

      • Fluoridation of drinking water

      • Recognition of tobacco use as a health hazard

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