Ask Dr. Hallberg: Top 10 U.S. public health achievementsby Dr. Jon Hallberg, Minnesota Public Radio,
Tom Crann, Minnesota Public Radio
St. Paul, Minn. — A week ago on All Things Considered we talked about world public health developments in the last decade that have made the biggest differences, including things like reductions in child mortality and clean water. This week, we're going back to the Centers for Disease Control and Prevention for its list of those improvements here in the United States.
The CDC has a detailed explanation of each on its website. Here's the list:
• Vaccine-Preventable Diseases
• Prevention and Control of Infectious Diseases
• Tobacco Control
• Maternal and Infant Health
• Motor Vehicle Safety
• Cardiovascular Disease Prevention
• Occupational Safety
• Cancer Prevention
• Childhood Lead Poisoning Prevention
• Public Health Preparedness and Response
Tom Crann: The first thing we're going to talk about is cardiovascular health. I guess it's not shocking to see that on the list?
Dr. Jon Hallberg: Not at all. This is the one I assumed would be on the list. Heart disease has been the leading cause of death in the U.S. since 1921 and strokes were the third leading cause of death since about 1938. But things are starting to turn a little bit. Heart disease is still the leading cause of death but they are now estimating that instead of 195 people per 100,000 dying, it's dropped down to 126. That's a significant reduction in a decade. With strokes that number has gone from 61.6 to 42.2 per 100,000 and it's also dropped down to the fourth-leading cause of death.
Crann: What's going on to reduce those?
Hallberg: I think we're doing a much better job of controlling hypertension, high blood pressure, being aware of it, seeking care for that, reducing high cholesterol levels, more emphasis on smoking cessation. But also we've got better treatments. Statin drugs are now commonplace when people have high cholesterol. We have better quality of care, better intervention. And I think we the people deserve some of that credit — the message has gotten out to take better care of ourselves.
Crann: You say there's an improvement in cardiovascular health, but at the same time there's an obesity epidemic in this country. So there's still work to be done?
Hallberg: There's a lot of work to be done. But gone is the time when we weren't thinking about it. Now everybody knows we can't be sedentary, we can't keep eating the same simple carbohydrates and pre-packaged foods. We have to make changes. I think that's all part of this public health mission that's under way.
Crann: The second thing on the U.S. list is the reduction of infectious diseases. That's also on the global list, right?
Hallberg: Well, very different diseases that we're talking about here. There are two that really pop out. They talk about food safety, which has certainly improved, we're looking at things like West Nile virus and tracking new and emerging disease. But the thing that stuck out is the fact that there's been a 30 percent reduction from 2001 to 2010 in the number of tuberculosis cases noted in the U.S. I think a lot of us can recall early in the decade lots of concern about TB. It took all kinds of efforts from all kinds of people to make that happen.
The other surprising one was that in 2007, the CDC declared that the U.S. is canine-rabies free. What this means is that dogs are no longer harboring rabies. In other words, there are no dog-to-dog cases of rabies. An animal that isn't immunized could certainly get it from a bat or other rabid animal, but it's not in the dog population. Worldwide, 90 percent of human rabies cases are from dog bites, and that's just not going to happen in the U.S. This is obviously a huge feather in the cap of public health.
Crann: Next on the list is the reduction in lead poisoning in children. I think most of us would be surprised to learn that lead poisoning was an issue only 10 years ago.
Hallberg: I can recall being in residency and being quite vigilant about this with some of the kids we took care of, who were certainly in lower socioeconomic groups and the groups hardest hit with this. But between 1976 and 1980, something like 88 percent of all kids under the age of 5 had relatively high lead levels. And that's just unacceptable. But in this last decade that dropped down to less than 1 percent of children. That's a phenomenal drop. There's probably two main reasons for that. One is we don't have leaded gasoline anymore. All that exhaust would settle out in soil, kids playing in the dirt would breathe it and be getting lead levels. Also, the paint in homes that was lead-based. As decades have gone by, it's been painted over, it's been recovered, we've done a better job with substandard housing. All of this had led to this reduction.
Crann: When you look at this list, obviously there are medical breakthroughs that the medical community can claim. But there are all sorts of other issues — laws, or policies that have make a difference, too.
Hallberg: That's right. I love that about this list. So often when we talk about health care we're talking about doctors and nurses and people in clinics, but this is so much broader than that. This involves housing, transportation, scientific breakthroughs and people who you wouldn't think of as health care providers. It just goes to show that when you have a healthy society it takes all sorts of angles to cover that.
(Interview transcribed by MPR reporter Elizabeth Dunbar.)
- All Things Considered, 08/16/2011, 4:53 p.m.
Assistant professor in family medicine at the University of Minnesota, and medical director at Mill City Clinic.