nutrition caused by a more equal allocation. Another good example of a
successful public health campaign was the National Malaria Control
Programme introduced in 1953 in India based on large-scale spraying of DDT.
Within five years the annual incidence of malaria dropped from 75 million
cases and 800,000 deaths, to 2 million cases and 150,000 deaths. Other
improvements in public health have included filtering and chlorinating water
supplies, building sanitation systems, draining swamps, pasteurising milk, and
mass vaccination campaigns. They also include micro-changes made by indi-
viduals but often encouraged by the public sector such as boiling bottles and
milk, protecting food from insects, washing hands, ventilating rooms and
keeping children’s vaccinations up to date.
As a country begins to urbanize and industrialize it is likely that public
health measures become more important. High mortality in cities can be effec-
tively tackled by focusing on the delivery of clean water, removal of waste, and
campaigns to improve personal health practices. This was discussed in the
context of the second stage of the demographic transition in Chapter 4.
Vaccination and medical treatment
The first important medical interventions were vaccines. Variolation (the intro-
duction of smallpox scabs from previous victims to bodies of the healthy) was
introduced to Europe from Turkey and to the American colonies by African
slaves in the early eighteenth century. Since the late nineteenth century there
has been a steady stream of new vaccines such as rabies (1885), plague (1898),
dipthheria (1923),pertussis (1926), tubercolosis (1927),tetanus (1927),
yellow fever (1935), polio (1955 and 1962), measles (1964), mumps (1967),
rubella (1970) and hepatitis B (1981). Chapter 5 discusses very recent efforts
to develop a vaccine for malaria. The morbidity consequences of these diseases
was high but the available historical data suggests that in the now-rich coun-
tries direct mortality from these diseases had declined to low levels (except for
tuberculosis) before these vaccines were introduced. Something else, perhaps
nutrition, perhaps public health, was more important. Antibiotics (such as
Sulfa drugs and penicillin) developed in the 1930s and 1940s were the first of
a new wav e of medical therapies and had a dramatic impact on mortality. By
1960 mortality from infectious diseases had already declined to its current
level in developed countries.
The near-eradication of smallpox, once thought to be impossible, represents
an enormous success of medical intervention. The elimination of measles,
which was still killing 800,000 people every year in 1998, is possible if global
vaccination levels can be raised. Malawi, where 20 per cent of the population
had no access to health service and less than 50 per cent had access to safe
water, committed itself to high levels of routine measles immunization in the
early 1990s; by 1999 no children’s deaths due to measles and only two
confirmed cases were reported in the country. The WHO, with donations from
NGOs and the global pharmaceutical industry, are aiming at the global elimi-
nation of seven other diseases (Chagas disease, guinea-worm disease, leprosy,
Education and Health 137