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The major public health achievements of the first 10 years of the 21st century included improvements in vaccine preventable and infectious diseases, reductions in deaths from certain chronic diseases, declines in deaths and injuries from motor vehicle crashes, and more, according to a report from the Centers for Disease Control and Prevention. The 10 domestic public health achievements are published in today's issue of CDC's Morbidity and Mortality Weekly Report (MMWR).
One of the major findings in the report is that the United States has saved billions of dollars in healthcare costs as a result of these achievements. For instance, fortifying our foods with folic acid has resulted in a savings of over $4.6 billion over the past decade, by reducing neural tube defects in children. Continued investments will save more. For example, ensuring that all children are vaccinated with the current schedule could result in a savings of $20 billion in healthcare costs over the lifetime of those children. Preventing motor vehicle crashes could save $99 billion in medical and lost work costs annually and the economic benefit of lowering lead levels among children by preventing lead exposure is estimated at $213 billion per year.
"Americans are living longer, healthier, and more productive lives than ever before thanks in part to extraordinary achievements in public health over the past decade," says CDC director Thomas R. Frieden, MD, MPH. "However, we can do much more to protect and promote health. Continued investments in prevention will help us and our children live even longer, healthier and more productive lives while bringing down healthcare costs."
The accomplishments include:
A number of new vaccines were introduced during the first decade of the 21st century. Two of the most significant were the pneumococcal conjugate vaccine, which has prevented an estimated 211,000 serious pneumococcal infections and 13,000 deaths and the rotavirus vaccine, which now prevents an estimated 40,000 to 60,000 rotavirus hospitalizations each year. Other achievements included record low reported cases of hepatitis A, hepatitis B, and chickenpox. A recent economic analysis indicates that vaccinating each child born in the United States in a given year with the current childhood immunization schedule could prevent approximately 42,000 deaths and 20 million cases of disease.
Prevention and Control of Infectious Diseases
The first decade of the 21st century saw a 30 percent reduction in reported tuberculosis cases in the United States and a 58 percent decline in central line-associated bloodstream infections. A central line is a tube that a doctor usually places in a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become a freeway for germs to enter the body and cause serious bloodstream infections. These infections can be deadly.
Other achievements included improvements in lab techniques and technology that made it easier to identify contaminated foods more rapidly and accurately to help control the spread of foodborne illness outbreaks. Broader HIV screening recommendations led to an increase in the number of people getting earlier HIV diagnosis, which provided them earlier access to live-saving treatment and care. The development of a blood donor test to screen for West Nile Virus has identified an estimated 3,000 potentially infected U.S. blood donations, removing them from the blood supply.
Improved Public Health Preparedness and Response
There has been much progress made since September 11, 2001 expanding the capacity of the public health system to respond to public health emergencies and disease outbreaks. The first decade of the 21st century also saw improvements in laboratory response for identifying and reporting disease outbreaks. In addition, influenza vaccination, along with other public health measures taken during the 2009 outbreak of H1N1, prevented an estimated 5 million to 10 million cases, 30,000 hospitalizations, and 1,500 deaths. The decade also saw the percentage of state public health agencies that were prepared to use Strategic National Stockpile (SNS) material increasing from 70 percent to 98 percent. SNS has large quantities of medicine and medical supplies to protect the American public if there is a public health emergency (such as terrorist attack, flu outbreak or earthquake) severe enough to cause local supplies to run out.
The United States has seen significant improvements in working conditions and the risk of workplace-associated injuries during the past decade. Examples of these improvements include patient lifting guidance for U.S. healthcare workers that has reduced, by 35 percent, back injuries among these workers, a comprehensive childhood agricultural injury prevention initiative, which has resulted in a 56 percent decline in farm injury rates among young people, and reductions in deaths among crab fisherman from overturned fishing vessels as the result of a U.S. Coast Guard initiative to correct stability hazards.
The number of states with comprehensive smoke-free laws grew from zero in 2000 to 25 states and D.C. in 2010. In 2009, a new federal cigarette tax took effect, bringing the combined federal and average state excise tax for cigarettes to $2.21 per pack, an increase of 76 cents per pack since 2000. By 2010, FDA had banned flavored cigarettes, established restrictions on youth access to tobacco products, and proposed larger, more effective graphic warning labels. Smoking still results in an economic burden, including medical costs and lost productivity, of approximately $193 billion per year.
Maternal and Infant Health
The past decade has seen significant reductions in babies born with birth defects such as spina bifida. This is due largely to folic acid fortification of cereal grain products in the United States as well as public health campaigns encouraging women of childbearing age to make sure they get the recommended amounts of folic acid. These efforts have led to a 36 percent reduction in babies born with neural tube defects.
Motor Vehicle Safety
From 2000 to 2009, the death rate related to motor vehicle travel went from 14.9 per 100,000 people to 11 per 100,000. The injury rate fell from 1,130 per 100,000 people to 722. The decade also saw a decline of 49 percent in pedestrian deaths among children, and a 58 percent decline in the number of bicyclist deaths. These achievements are likely the result of improved safety of vehicles and roadways, and safer behavior on the part of both motorists and pedestrians as a result of strong seat belt, child safety seat and other regulations.
Cardiovascular Disease Prevention
Heart disease and stroke are still among the nation's leading killers. However, deaths from both diseases have declined over the past decade, continuing a trend that began in the early 1900s for stroke and the 1960s for heart disease. These declines in deaths are mainly due to lower smoking rates as well as improvements in treatment, medications and quality of care, which has led to reductions in major risk factors for heart disease and stroke, such as uncontrolled high blood pressure and high cholesterol.
Improvements in screening techniques along with strong cancer screening recommendations have led to improved screening rates and a reduction in deaths of 23 percent per year from colorectal, breast and cervical cancer. In addition, the creation of the National Breast and Cervical Cancer Early Detection Program has reduced disparities by providing breast and cervical cancer screenings to uninsured women.
Childhood Lead Poisoning Prevention
By 2010, 23 states had comprehensive lead poisoning prevention laws compared to just five states in 1990. Enforcement of these statutes, along with federal laws that reduce hazards in the highest risk housing, has significantly reduced the prevalence of lead poisoning. The percentage of children aged 1 to 5 years with elevated blood lead levels has declined significantly going from 88.2 percent in 1980 to under 1 percent in 2008.