Public Health
Improvements in COMMUNITY SANITATION, such as
sewage and garbage control, in the late 19th and
early 20th centuries further contained diseases
spread through close contact reduced pest and
vermin infestation and the resultant diseases,
including the much dreaded “black death,”
plague. Cities and towns focused effort on main-
taining clean and safe drinking water supplies,
decreasing waterborne illnesses. The home refrig-
erator debuted in 1913 and quickly replaced the
icebox as the standard for food storage, dramati-
cally decreasing FOODBORNE ILLNESSES.
Doctors and others began to recognize, by the
start of the 20th century, the extent to which com-
munity and personal cleanliness influenced health
and illness. Poor ventilation and overcrowded liv-
ing and working conditions, especially in densely
populated cities, encouraged rampant and rapid
spread of infectious diseases. In 1900 pneumonia,
tuberculosis, and GASTROENTERITIStogether were to
blame for a third of all deaths in the United States.
Annual influenza outbreaks could kill entire fami-
lies, even communities, within weeks. In cities,
infections caused the deaths of nearly a third of
infants before their first birthdays.
With clean water standards came assurances
that bathing would no longer be the source of ill-
ness but rather could be the guardian of health.
Public officials began to extol the virtues of fre-
quent HAND WASHINGand daily, or at least weekly,
bathing. Between 1920 and 1937 illnesses and
deaths from waterborne infections such as cholera
and typhoid fever plummeted, and by 1950 were
nearly nonexistent. Health officials also encour-
aged opening windows and getting fresh air,
measures that helped dilute the concentration of
airborne pathogens such as viruses and BACTERIA
and reduce opportunities for infection to occur. In
1944 the US Congress passed the Public Health
Service Act that established a consistent frame-
work for public health laws, standards, and proce-
dures throughout the United States.
Life expectancy A key measure of public health
and the effectiveness of disease-prevention efforts
is LIFE EXPECTANCY. A child born in 1900 could
expect to live to age 47. A child born in 1950, the
dawn of the golden era of preventive health care,
could expect to live nearly half again as long, to
age 68. These children were the first who also
could expect to grow up without experiencing the
CHILDHOOD DISEASESthat claimed the lives of one in
five children in their parents’ generation.
Epidemics and pandemics Epidemics and pan-
demics strike fear in the hearts of health experts
and individuals alike. Epidemics are extensive but
localized outbreaks of illness or infection. Pan-
demics are worldwide outbreaks. Despite vaccina-
tion efforts, annual influenza epidemics sicken
millions and cause the deaths of 30,000 Ameri-
cans. Health experts believe basic preventive
measures such as frequent hand washing and
appropriate SNEEZE/COUGH ETIQUETTE, combined
with more comprehensive vaccination, could pre-
vent most of these infections.
The Spanish influenza epidemic of 1918, the
worst pandemic of modern history, claimed the lives
of half a million Americans and more than 20 mil-
lion people worldwide. It also provided much learn-
ing for public health officials about how, and how
quickly, such infections spread. Health experts have
used this knowledge to develop mechanisms and
systems to detect and report outbreaks that have
pandemic potential. Such efforts could not entirely
prevent, though did help contain, influenza pan-
demics in 1957 (the Asian flu) and 1968 (the Hong
Kong flu). They did, however, allow early detection
and containment of small outbreaks of avian
influenza in 2000 and 2004, and of the deadly SEVERE
ACUTE RESPIRATORY SYNDROME(SARS).
Motor vehicle safety A uniquely modern-day
public health issue is motor vehicle safety. Coming
into its own in the early 1900s, the automobile
wasted little time acquiring notoriety. By the time
Henry Ford set the standard for the “everyman”
car, MOTOR VEHICLE ACCIDENTShad already claimed
more than 40,000 lives. By the 1960s, motor vehi-
cle accidents accounted for more than 40,000
deaths each year. Measures such as structural
integrity requirements, seat belts, and airbags
have held motor vehicle deaths steady near that
level since 1998.Individual Health Factors
The recognition that PERSONAL HYGIENE—frequent
hand washing and daily or at least weekly
bathing—could prevent the passing of disease
from one person to another was a milestone in2 Preventive Medicine