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M I L E S M I L E T O N E S S T O N E S IN PUBLIC HEALTH IN PUBLIC IN PUBLIC HEALTH ACcOMPLISHmENTS IN PUBLIC HEALTH OVER THE LAST 100 YEARS MILESTONES IN PUBLIC HEALTH Cover photo key Imhotep, regarded in ancient Egypt as the god of medicine (courtesy National Library of Medicine) An image from space showing a hole in the Earth’s ozone layer (© NASA–GSFC-SVS) The bifurcated needle, which simplified the administration of smallpox vaccine (© Creatas) Dr. Edward Jenner, who pioneered the smallpox vaccine (© Bettman/Corbis) Margaret Sanger, an early promoter of family planning (© Bettman/Corbis) The Ebola virus (© Corbis) MRI of cancerous breast tissue (© Howard Sochurek/Corbis) Tooth with protective sealant An image of the human immunodeficiency virus (HIV) (© Michael Freeman/Corbis) An image from the U.S. Department of Agriculture’s food pyramid (courtesy www.MyPyramid.gov) Milestones in Public Health is published by Pfizer Global Pharmaceuticals, Pfizer Inc, New York, NY, © 2006 Pfizer Inc. All rights reserved. The contents do not necessarily reflect the views of Pfizer Inc. No part of this publication may be reproduced in any form without prior written permission from the publisher. Correspondence should be addressed to: Milestones in Public Health, c/o Senior Medical Director/Group Leader, Pfizer Inc, 235 East 42nd Street, New York, NY 10017-5755. ISBN 0-9761815-1-7 Printed in Canada. IN PUBLIC HEALTH ACcOMPLISHmENTS IN PUBLIC HEALTH OVER THE LAST 100 YEARS i Milestones . Acknowledgments Acknowledgments Milestones in Public Health is a journey through the seminal accomplishments in the field of public health during the 20th century, as well as an inquisitive—and hopefully— inspirational look at the next set of challenges faced by our nation’s public health system. It is not intended to be a textbook or research publication. Rather, it is a general-interest book about public health that should appeal to students in any health-related field, as well as public health professionals and others with a keen interest in this field. At the same time, I hope, in a very personal way, that this book will engage those with little knowledge of the field to learn more about it. I know that a book can change a life’s direction, as I myself entered public health after a book awakened my curiosity about the prevention and control of infectious diseases. Readers will note that we have listed all sources by chapter at the end of the book rather than annotating each fact as it appears in the body of the text.This conscious decision on our part should make the book more readable while allowing those who would like to pursue particular topics to find useful references. Milestones in Public Health is the third in a series of books published by Pfizer Inc’s Public Health Group.These books are a part of our ongoing commitment to public awareness and understanding of the field of public health. As with our previous publications – Advancing Healthy Populations: The Pfizer Guide to Careers in Public Health and The Faces of Public Health – this book represents the collective efforts of many individuals who have dedicated countless hours to its development and production. Our sincere thanks go to Dilia Santana and Oscar Perdomo, U.S. Public Health, Pfizer Inc; Ana Rita González, ScD, Sydney Ann Neuhaus, and Nadjha Acosta of Fleishman-Hillard International Communications; David L. Farren; and Matt Warhaftig of Warhaftig Associates. Special thanks must also go to our expert reviewers: Myron Allukian, retired from the Boston Health Commis- sion (Oral Health); Susan Baker, Bloomberg School of Pub- lic Health, Johns Hopkins University (Automotive Safety); ii Joseph Califano, Executive Director, CASA, Columbia University (Addiction);James Curran, Dean, Rollins School of Public Health, Emory University (Infectious Disease Control);D.A. Henderson, Center for Biosecurity, Universi- ty of Pittsburgh Medical Center and Dean Emeritus, Johns Hopkins University School of Hygiene and Public Health (Vaccines); Richard Jackson, California Department of Health Services (Environmental Health);William Keck, Northeastern Ohio Universities College of Medicine (Public Health Infrastructure);Thomas Pearson, School of Medicine & Dentistry, University of Rochester (Cardiovas- cular Disease); Allen Rosenfield, Dean, Mailman School of Public Health, Columbia University (Maternal and Child Health);John A. Seffrin, Executive Director, American Cancer Society (Cancer); and Ernest Julian, Director of Food Protection, Rhode Island Department of Health (Food Safety).We appreciate as well the contributions of David Satcher, former Surgeon General and Interim President, Morehouse College of Medicine. We are especially grateful to Hugh Tilson, School of Public Health, University of North Carolina at Chapel Hill. Deeply committed to raising the visibility of the public health community, Hugh provided important perspective and insights throughout the development of this book. His energy and enthusiasm for our entire series of books are invaluable and drive us toward continued partnership with this special community. Barbara A. DeBuono, MD, MPH November 2005 iii Milestones . Contents Contents Prologue 1 With remarks by David Satcher, MD, PhD Morehouse School of Medicine, 16th U.S. Surgeon General 1.Vaccines and the Eradication of Smallpox 5 Expert Reviewer: D.A. Henderson, MD, MPH Center for Biosecurity, University of Pittsburgh; and Dean Emeritus, Bloomberg School of Public Health, Johns Hopkins University Looking Back 5 Case Study: Eradication of Smallpox 9 Vignette: Hib Vaccine 15 Looking Ahead: Advances in Vaccine Research 16 2. Automotive Safety 21 Expert Reviewer: Susan Baker, MPH Bloomberg School of Public Health, Johns Hopkins University Looking Back 21 Case Study: Development of Seat Belts 28 Vignette: Air Bags 31 Looking Ahead: Advances in Automobile Manufacturing 33 3. Environmental Health 37 Expert Reviewer: Richard Jackson, MD, MPH Division of Environmental Health Sciences University of California, School of Public Health Looking Back 37 Case Study: Lead Poisoning 41 Vignette: Asbestos 49 Looking Ahead: Asthma 51 4. Infectious Disease Control 59 Expert Reviewer: James Curran, MD, MPH Rollins School of Public Health, Emory University Looking Back 59 Case Study: HIV/AIDS 65 Vignette: Development of Penicillin 73 Looking Ahead: Antibiotic Resistance 76 iv 5. Cancer 83 Expert Reviewer: John Seffrin, PhD American Cancer Society Looking Back 83 Case Study:Screening Tools for Cancer Detection 90 Vignette: Skin Cancer and Sunblock/SPF Products 100 Looking Ahead:Genomic Research and Medicine 101 6. Cardiovascular Disease 107 Expert Reviewer:Thomas A. Pearson, MD, MPH, PhD University of Rochester School of Medicine Looking Back 108 Case Study: Risk Assessment 111 Vignette: Statins 114 Looking Ahead: Obesity in Young Populations 116 7. Safer and Healthier Foods 123 Expert Reviewer: Ernest Julian, PhD Rhode Island Department of Health Looking Back 123 Case Study: Jack in the Box E. coli Outbreak 132 Vignette: Nutrition Labeling on Food Packaging 138 Looking Ahead: How to Ensure a Safe Food Supply 142 8. Advances in Maternal and Child Health 147 Expert Reviewer: Allen Rosenfield, MD Mailman School of Public Health, Columbia University Looking Back 147 Case Study: Folic Acid 158 Vignette: Amniocentesis 161 Looking Ahead: Genetic Screening 163 9. Oral Health 167 Expert Reviewer: Myron Allukian, DDS, MPH Former Director of Oral Health, Boston Public Health Commission Looking Back 167 Case Study: Fluoridation 176 Vignette: Dental Sealants 182 Looking Ahead: Oral Diseases, Still a Neglected Epidemic 183 v Milestones . Contents Contents 10. Addiction 191 Expert Reviewer: Joseph A. Califano, Jr. National Center on Addiction and Substance Abuse, Columbia University Looking Back 191 Case Study: Tobacco 199 Vignette: Mothers Against Drunk Driving (MADD) 204 Looking Ahead: Fighting Addiction in Young Women 207 11. U.S. Public Health Infrastructure 213 Expert Reviewer: C.William Keck, MD, MPH Northeastern Ohio Universities College of Medicine Looking Back 213 Case Study: The Creation of CDC 222 Vignette: Surgeon General’s Report of 1964 225 Looking Ahead: Public Health – A 21st Century Perspective 227 Epilogue 233 Barbara A. DeBuono, MD, MPH Pfizer Inc. References 238 Milestones . Prologue 1 Prologue Public health is the art and science of protecting and improving the health of a community through an organ- ized and systematic effort that includes education, assurance of the provision of health services and protection of the public from exposures that will cause harm. In other words, public health is what we as a society do collectively to assure the conditions in which people can be healthy. In order to effectively address challenges to people’s health, public health practice requires an organized and sustained population-based approach. Milestones in Public Health portrays public health as the vital, critical field it is today in the United States. Each chapter in the book celebrates an acknowledged milestone of public health, exploring first its historical developments, followed by an in-depth case study of the milestone and a vignette that illustrates another facet of the milestone, and concluding with a look ahead.The “Looking Ahead” sec- tion predicts advances yet to come in each of the broad areas of public health where milestones occurred, and acknowledges the paramount issue of preparedness now facing the public health community.The “Looking Ahead” sections may also explore issues of particular
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