200 years of public health has doubled our life expectancy

With National Public Health Week taking place April 3-9, I ask you to take a trip back in time and imagine yourself living 200 years ago in 1817. Living conditions then were vastly different from today due to poor sanitation, lack of proper sewage management, non-existent or inadequate treatment of drinking water, no food inspection or municipal garbage collection, crowded housing and no real understanding of nutrition.

People died painfully, mostly in infancy or childhood, primarily from diseases such as tuberculosis, pleurisy, typhus, tonsillitis, cholera and dysentery. With a lack of medical understanding of these ailments, a common treatment was bloodletting. The average lifespan at the time was around 35 years.

Over the last 200 years, U.S. life expectancy has more than doubled to almost 80 years (78.8 in 2015), with vast improvements in health and quality of life. However, while most people imagine medical advancements to be the reason for this increase, the largest gain in life expectancy occurred between 1880 and 1920 due to public health improvements such as control of infectious diseases, more abundant and safer foods, cleaner water, and other nonmedical social improvements.

This period is actually referred to as the "First Public Health Revolution" and it occurred before the medical interventions of antibiotics and advanced surgical techniques were in place. Historians have concluded that improved sanitation, public water treatment, sewage management, food inspection and municipal garbage collection almost eliminated the aforementioned causes of death. Also, other social advancements such as greater understanding of nutrition, better housing conditions, air quality improvements, child labor laws and higher literacy rates also greatly improved overall health and life expectancy.

This historical examination would not be complete without an acknowledgement of the impact of vaccines on improved health and life expectancy in the U.S., although widespread use of vaccines did not occur until the 1900s compared to some of the earlier life-extending population health improvements mentioned above.

Vaccines have been so effective at improving health and saving and extending lives that most people in the U.S. have no idea what it's like to watch a child die a painful death from a tetanus infection or to witness a loved one experience brutal paralysis and death from polio. Providing and supporting vaccinations is a key tool in today's public health toolbox.

The importance of highlighting public health's role in extending life and improving health is crucial. Currently, medical health care expenditures amount to close to 18 percent of our GDP, whereas the more cost-effective public health initiatives have been vastly underfunded, despite the evidence that they greatly improve the health of the nation.

Health policy that aims to increase life expectancy and lower health care costs should demonstrate an investment in public health efforts that address multiple determinants of health, such as environmental factors, behavioral health and housing. Another important distinction between public health and individualized medical care is the foundational emphasis on health equity. Public health initiatives focus on serving populations, not just individuals, and improving everyone's ability to reach their highest health potential, not just those who can afford it.

On a local level, San Juan Basin Public Health is launching our next Community Health Assessment that will result in a new Public Health Improvement Plan to be released within the next year. As we embark upon this process, that includes collecting and analyzing data related to chronic health indicators as well as quality-oflife factors like housing, education and mental health, our goal is to engage local community members in the effort to shape public health policy.

With your feedback, SJBPH will prioritize the public health issues unique to the communities we serve, and through the plan, create strategies to work with local partner organizations and providers to address these issues.

SJBPH will be publicizing opportunities to participate in the assessment, and you can visit our website at sjbpublichealth.org for more information. Don't forget to thank your local public health practitioner for 30 additional years of life!

Claire Ninde is assessment, planning and communications director for San Juan Basin Public Health. Reach her at CNinde@sjbpublichealth.org.