Public Health's Greatest Hits

The inventions that saved more lives than any medicine

Photo: Jason Richard / Unsplash

In 1900, a baby born in the U.S. could expect to live to...

47

Today it's about 79. Where did 30 extra years come from?

Most of it did not come from hospitals. It came from things you never think about.

CDC National Center for Health Statistics

U.S. life expectancy at birth, 1900 to 2023

1900
Number 5

Fluoride in the water

Grand Rapids, Michigan, 1945: first city to add fluoride to its water supply.

~25%fewer cavities, kids and adults
~$1per person, per year

It works on everyone in the city, whether or not they brush, floss, or have a dentist.

CDC, Community Water Fluoridation

Photo: manu schwendener / Unsplash
Number 4

Seatbelts

Required in new cars from 1968. New York passed the first law requiring you to actually wear one in 1984.

45%lower risk of death, front seat
~90%drop in deaths per mile driven since 1925

The safety belt was not the invention. The law was.

NHTSA; CDC MMWR, Ten Great Public Health Achievements 1900 to 1999

Photo: Remy Lovesy / Unsplash
Number 3

Telling people cigarettes kill

1964: the Surgeon General's report linked smoking to lung cancer. It was front-page news.

42%of U.S. adults smoked in 1965
~11%in 2022
8Mearly deaths avoided, 1964 to 2012

There was no drug and no surgery. A report, then warning labels, taxes, and ad bans did the work.

CDC; Holford et al. 2014, JAMA

Photo: Pascal Meier / Unsplash
Number 2

Vaccines

Smallpox killed an estimated 300 million people in the 20th century. Last natural case: 1977. Declared gone: 1980.

Polio in the U.S., 1952: about 21,000 kids paralyzed in one year. Vaccine in 1955. Zero U.S. cases since 1979.

Smallpox is the only human disease ever eradicated. The tools were a vaccine and decades of coordinated case tracking.

WHO; CDC Pink Book

Photo: Mufid Majnun / Unsplash
Number 1

Clean water

London, 1854. John Snow maps cholera deaths, finds they cluster around one pump on Broad Street, and has the handle removed.

U.S. cities start filtering and chlorinating water around 1908. Typhoid deaths fall from ~30 per 100,000 to almost zero by 1950.

~½of all the decline in city deaths, 1900 to 1936
~¾of the decline in infant deaths

Cutler & Miller 2005, Demography

John Snow's cholera map, 1854. Wikimedia Commons, public domain

Notice the pattern

That is what public health does. It changes the environment so the healthy choice is the default.

Still in progress

EPA; Falcaro et al. 2021, The Lancet

Prevention added more years of life than treatment did.

Questions?

Play the quiz

→ Space clicknext
← Backspaceprevious
Home / Endfirst / last
ffullscreen
?this help
Escclose