THE TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTH MODULE #3 Missouri Association of Local Boards of Health (MALBOH) Presents
Dec 15, 2015
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
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
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
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!
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.
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