THE TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTHMODULE #3

Missouri Association of Local Boards of Health (MALBOH) Presents

TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTH

(WHY WE DO THE THINGS WE DO)!

Modules developed by Ross McKinstry, MPH;

Sheila Guice, MPH; and Mahree Skala, MA

ACHIEVEMENT #4:Maternal and Infant

Health

Tombstone

Healthier Mothers And Babies—Progress During the 20th Century

Infant mortality decreased by 90%• Life expectancy went up 62%, from 47

years to 78, largely because more people survived childhood

• In 1900, only 41% of newborns survived to age 65; in 1991, 80% survived to age 65

Healthier Mothers And Babies—Progress During the 20th Century

Improvements• Better hygiene and nutrition• Safe drinking water and waste disposal• Safe milk supplies, pasteurization• Longer spacing of pregnancies, smaller

families• Early entry into prenatal care• Management of pregnancies • Safe delivery in general hospitals

Healthier Mothers And Babies—Progress During the 20th Century

Improvements• Introduction of antibiotics, electrolyte

replacement therapy, and safe blood transfusions

• Social benefits, maternity leave, living standards• Greater access to health care • Advances in technologies for maternal and

neonatal care• Advances in maternal and neonatal medicine• Public health measures (new vaccines, Back to

Sleep, folic acid supplementation)

Healthier Mothers And Babies—Progress During the 20th Century

Maternal Deaths• Maternal mortality decreased by 99% in

the 20th century• Shift from home births to hospital births

(90% in hospitals by 1948)• Medical advances and changes in

policies and practices

Healthier Mothers And Babies—Progress in the 21st Century

Progress 2000-2010:• 36% fewer infants born with neural

tube defects such as spina bifida, due to folic acid fortification of cereal grain products

• Expansion of newborn screening for metabolic and other hereditary disorders

• Early diagnosis of infant hearing disorders

WIC Program

Well Child Check-ups

Healthier Mothers And Babies—Challenges in the 21st Century

The US still has higher maternal and infant mortality rates than other countries do, and rates are higher for black women and infants

Incidence of low birth weight (LBW) has not decreased in recent decades

LBW, preterm births, and birth defects must be reduced to lower neonatal mortality and reduce disparities

POLICY CHALLENGES IN MISSOURI

• We need to encourage early entry into prenatal care, infant immunizations, and parenting classes

• Encourage participation in the Women, Infants, and Children (WIC) program

• Expand home visitation programs for young, first time parents

ACHIEVEMENT #5:Family Planning

A CENTURY AGO, LARGE FAMILIES WERE COMMON.

Family Planning—Progress During the 20th Century

Fertility decreased as couples chose to have fewer children (trend began around 1800)

More people are able to achieve desired birth spacing and family size

Smaller families and longer birth intervals contribute to better health of infants, children and women, plus improved economic and social status of women

Family Planning—Progress During the 20th Century

• Safe and effective methods developed• Access to family planning and

contraceptive services increased• Smaller families• Longer intervals between births,

resulting in higher birth-weight babies• Fewer abortions

Family Planning—Progress During the 20th Century

• Increased opportunities for prenatal counseling

• Pre-conceptional counseling and screening

• Increased awareness of sexually transmitted disease identification and prevention

• Altered social and economic roles of women

• Fewer women, infant and child deaths!

Prenatal/Preconception

Counseling

Family Planning—Challenges in the 21st Century Even today, about half of all

pregnancies in the US are unintended (49% in 2011)

4 out of 5 pregnancies among women under 19 are unintended

Unintended pregnancies are a higher risk for mothers and infants

POLICY CHALLENGES IN MISSOURI

• Make sure teens get access to good information about pregnancy prevention and their health.

ACHIEVEMENT #6:Fluoridation of

Drinking Water to Prevent Dental Caries

Dental Caries—Progress During the 20th Century

Dental caries (cavity) is an infectious, communicable disease in which bacteria dissolve the enamel surface of a tooth

Dental caries can result in loss of tooth structure and discomfort

Untreated cavities can lead to severe pain, bacterial infection, pulpal necrosis, tooth extraction and loss of dental function

May progress to an acute systemic infection

Many Young People Have Never Had A Cavity...

Due to regular check-ups, dental sealants,fluoridation of water and fluoride treatments

Dental Caries—Progress Due to Water Fluoridation

• Water fluoridation began in 1945 with a study of four cities

• Now reaches an estimated 204 million people in the US (in 2010), or 73.9% of those on community water systems

• Safely and inexpensively prevents tooth decay ⁻(regardless of socioeconomic status)

• Reduction of tooth decay in children by 40-70%

• Reduction of tooth loss in adults by 40-60%

In Missouri

More than 3.9 million citizens (79.8%) have access to fluoridated water.

Missouri ranks 23rd in the nation for fluoridation of water.

Challenges in the 21st Century

Despite the overall decrease in prevalence and severity, dental caries is still common

67% of 12- to 17-year-olds and 94% of people 18 and older have caries although the average number of cavities

per 12-year-old decreased from 4 in 1970 to 1.3 in 1994

Other factors, such as dietary changes, still contribute to caries formation

Challenges in the 21st Century

Since the 1950’s, opponents of water fluoridation have claimed it causes many different health problems

Safety and effectiveness have been studied frequently, and there is no credible evidence of adverse health effects

Small community water systems may find the cost of fluoridation per person served too high

POLICY CHALLENGES IN MISSOURI

• Children on Medicaid (CHIP) can’t get access to dentists because of low payment rates

• The number of dentists in Missouri is declining because we don’t train enough

• Low-income adults have no access to care (Springfield’s new FQHC filled 3 years’ appointments within 2 weeks of opening).

• More ER visits, lost productivity, and caries contributes to heart disease

References

Ten Great Achievements of Public Health in the 20th CenturyMorbidity and Mortality Weekly ReportApril 2, 1999 / 48 (12);241-243http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm

Ten Great Public Health Achievements—United States, 2001-2010

May 20, 2011 / 60(19);619-623http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5.htm

References, Continued

Achievements in Public Health, 1900-1999: Healthier Mothers and Babies

October 01, 1999 / 48(38);849-858 http://www.cdc.gov/mmwr/preview/m

mwrhtml/mm4838a2.htm Achievements in Public Health, 1900-

1999: Family Planning December 03, 1999 / 48(47);1073-

1080 http://www.cdc.gov/mmwr/preview/m

mwrhtml/mm4847a1.htm

References, Continued

Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries

October 22, 1999 /48(41);933-940 http://www.cdc.gov/mmwr/preview/m

mwrhtml/mm4841a1.htm

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