By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In the last century, major changes in health care and technology, as well as simple progress in such innocuous conveniences such as public water fountains, have dramatically improved the quality of life. These have increased the average life expectancy in the United States from 47 years in 1900 to 78 years in 2011 almost doubling life expectancies. Health advances achieved throughout the 20th century and into the 21st are a result of investments and improvements in scientific, technical, legal, and political resources for the purpose of improving living conditions.
This blog is the first in a series of four in which I will discuss these.
Following are the first six of a list of seventeen of the most important achievements in health care and quality of life. It should serve as a reminder of how health innovations and common science have improved the comfort and longevity of our lives.
1. Vaccines and Immunizations.
Throughout history, communicable diseases have been a devastating cause of early death in every civilization. Thus, the development of one of the most effective ways to defend against rampant viral infection--vaccination--has had a tremendous impact on public health.
When I was a child, polio was still running rampant. We had friends and neighbors whose children were crippled by the disease or who only survived in "iron lungs" keeping them breathing artificially. Now this disease has been virtually eliminated in the U.S.
The concept of vaccinations was introduced in the late 1700s. However, it wasn't until World War I and World War II when a large number soldiers were successfully vaccinated against diseases like diphtheria and typhus that the preventative power of vaccinations was fully realized.
"Whooping cough," diphtheria, cholera and rubella were diseases which killed many infants.
Now, U.S. vaccination coverage is at record high levels. Mandatory childhood immunizations protect everyone from debilitating disease of the past. Dramatic declines in morbidity have been reported for polio, measles, diphtheria, pertussis, tetanus, mumps and rubella. Smallpox has been completely eradicated.
Like vaccinations, antibiotics have had a considerable impact on preventing the spread of illnesses.
Penicillin, the first antibiotic, was discovered accidentally in 1928. It soon developed into a widely available medical product that provided complete treatment of previously incurable bacterial illnesses.
Antibiotics are now used to treat a plethora of bacterial illnesses including streptococcal and staphylococcal infections, gonorrhea, syphilis, and other infections. Drugs also have been developed to treat viral diseases, fungal diseases and parasitic diseases.
3. Surgical Anesthetic and Antisepsis.
One hundred years ago, undergoing surgery was considered almost a worse fate than remaining ill.
The pain and shock associated with the surgery, or post-surgical infections, were liable to be just as deadly as the underlying illness or injury.
Although many patients may still feel nervous about the idea of surgery, the risk associated with surgical procedures has been greatly reduced with the widespread implementation of anesthetic in the 1900s. Antiseptic techniques pioneered by Lister and others, have decreased post-surgical infections by magnitudes.
With anesthetic, the pain associated with surgery has been largely eliminated. With the advent of antisepsis -- the creation of a sterile surgical environment -- a patient's likelihood of survival has been increased logarithmically.
4. Clean Water and Improved Sanitation.
Improvements in water sanitation throughout the 20th century dramatically decreased occurrences of deadly water-borne diseases like cholera. This has also drastically lowered the incidences of parasitic infections and other health conditions related to the unclean water.
The filtration and aeration of water as well as the addition of chemicals to public water supplies, has lead to the elimination of almost all water-borne illnesses, absent a natural disaster. Access to copious, cheap water through public utilities has further reduced this. Mandatory testing of well water has also aided this endeavor.
5. Family Planning.
Despite the rocky history of family planning in the United States, it has provided health benefits such as:
- Smaller family size and longer intervals between the birth of children;
- Increased opportunities for preconception counseling and screening;
- Fewer infant, child, and maternal deaths; and
- The use of barrier contraceptives to prevent pregnancy and transmission of human immunodeficiency virus (HIV), syphilis and other STD's that might injure or kill the newborn.
In 1912, the modern birth-control movement began when a public health nurse became concerned about the adverse health effects of frequent childbirth, miscarriages, and abortion. She began to circulate information about and provide access to contraception. As a result of her efforts, physicians gained the right to counsel patients and to prescribe contraceptive methods, according to the CDC.
Family planning was further advanced with the introduction of the birth control pill in 1960. Although the Federal Drug Administration (FDA) approved this form of contraception in the early 1960s, it only became legal for married couples in 1965 and for unmarried couples in 1972.
6. Childbirth Advancements.
While family planning and contraception helped women control fertility, improvements in childbirth helped women survive pregnancy.
Until the mid 20th century in the United States, childbirth was considered the scariest time in a woman's life. However, the development of anesthesia, cesarean section, and forceps delivery, increased the chances of a successful pregnancy. According to the CDC, infant mortality has decreased 90%, and maternal mortality has decreased 99% since 1900, childbirth a celebrated moment instead of a feared one.
Brayer, Toni. "Top 10 Greatest Public Health Achievements of this Century." MyLifeStages. (May 26, 2011). From
Centers for Disease Control and Prevention. "Ten Great Public Health Achievements in the 20th Century." Centers for Disease Control and Prevention. (Aug. 20, 2008). From http://www.cdc.gov/about/history/tengpha.htm.
Childs, Dan and Susan Kansagra. "10 Health Advances That Changed the World." ABC News. (Sept. 20, 2007). From
Elliot, Jason. "What You Should Know About Drinking from a Public Water Fountain." Yahoo! Voices. (March 21, 2007). From
Stibich, Mark. "Top Life Expectancy Achievements." About.com. (Sept. 29, 2009). From http://longevity.about.com/od/wholiveslongest/tp/life-expectancy-successes.htm?p=1
Wight, David. "A Pound of Cure." The Costco Connection. (April 2012).
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Tag words: public health, health innovations, health achievements, health care advances, centers for disease control and prevention, vaccines, health improvements, workplace safety, motor vehicle safety, heart disease prevention, tobacco education, radiology, radiologic imaging, organ transplants, antibiotics, anesthetic, antiseptic, motor-vehicle safety