Historic Impact of Public Health
By Kelly Evans-Hullinger, M.D.
Life expectancy is a measure commonly considered when it comes to the overall health of a population. In this day and age, when most of us think about which medical interventions are most important to increase life expectancy, we probably think about things like treatment of cancer, interventions to treat heart attacks, or surgeries for life threatening illnesses. While those things are all important, their overall impact on a population’s life expectancy pales in comparison to the prevention of infectious disease.
Average life expectancy around the world has doubled in the last two hundred years, from about 40 years to 80 years, with the bulk of that change occurring long before we had effective cancer treatment or cardiac catheterization. Before the 20th century, infant and childhood death was extremely common due to infections spread by contaminated water and food. It is estimated that through most of human history nearly half of children died before adulthood, almost entirely due to infections.
Armed with the new knowledge of germ theory, societies in the late 1800’s began instituting early public health interventions such as sewage management, water treatment, milk pasteurization, and garbage collection, which resulted in rapid decreases in death from food and water borne infections, and thus increased population wide life expectancy.
Later, widespread use of vaccines for many fatal diseases led to enormous improvements in the health and longevity of populations across the globe. Try to imagine a world in which almost everyone is affected by the death of children due to polio, measles, smallpox, tetanus, the list goes on. That these deaths are now extremely rare or eliminated altogether is nothing short of a modern miracle, and we ought not take it for granted.
Antibiotic use has exploded since the discovery of penicillin in 1928, and the proper use of antibiotics continues to help us prevent early death due to infections that might have been fatal left untreated. Modern science has led to effective treatments for even the most challenging infections such as tuberculosis and HIV.
Modern medicine uses abundant, wonderful technologies and treatments which help us extend lives and reduce suffering of our individual patients. But statistically, no fancy new development is likely to have the quantitative impact on human society that compares to those early public health measures. As a society, we would be careless to forget the worth of our public health institutions which have helped us thrive and double our average life expectancy.
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.