100 things that impacted public health


The Johns Hopkins Bloomberg School of Public Health turns 100 this year. The school came to life during a time when women frequently died during childbirth and infant mortality was a grave concern. Inadequate nutrition, sanitation and often-fatal diseases were common.

Since then, public-health agencies in the United States and abroad have had numerous victories, such as the eradication of smallpox. In 1916, the average life expectancy at birth in the United States was around 52. Today, it's nearly 79. But public health remains a complex and challenging field — figuring out how to control gun violence and addiction, exploring the science of aging, keeping refugees healthy, closing the gap on health-care disparities in minority populations.

And improving public health means navigating the contentious landscape between public good and individual choice. Vaccination provokes controversy to this day.

"Especially in the United States, we have this ideal of rugged individualism," Michael Klag, dean of the Bloomberg School, said. "But to have a well-functioning society, we need to think beyond the individual and think about what will benefit everyone."

The issue, of course, is that unless we're facing an immediate problem (think Zika or the water crisis in Flint, Mich.), most of us just don't think about it.

In celebration of its centennial, the Bloomberg School has drawn up a list of 100 objects that have affected public health, for good and ill.

"We purposefully picked items that seem out of place," Klag said. "We want people to look at them and think, 'That can't possibly have anything to do with public health.' But they can, and they do."

Of the 100 items, which can be found at wapo.st/GlobalHealthNow, we have chosen a few to highlight. This seemingly odd but fascinating collection is a great way to start thinking outside the box about public health.

• Birth certificates: "Counting births. Counting deaths. It's how we were able to start looking at the health of large groups of people," Klag said. Although birth registries have been maintained throughout the world for centuries, a standardized method of doing so in the United States has been the norm only since the 1930s.

• The Corvair: Despite the assurance that "nine years of planning and testing" went into the 1960 Corvair, the car was fingered by consumer advocate Ralph Nader for its many safety flaws. This, and Nader's complaints about automobile safety generally, helped spur the creation of the National Highway Safety Bureau, which became the National Highway Traffic Safety Administration.

• Window screens: While we may look at them primarily as air conduits rather than disease-vector barriers, "window screens are certainly not an abstract public-health construct to the people within the Zika box in Miami," Joshua Sharfstein, an associate dean of public health practice and training at the Bloomberg School, said. Before screens, the only way to effectively keep flies and mosquitoes from entering a house was to shut the windows.

• Sidewalks: It's well documented that walking is a great way to fight obesity and that well-planned sidewalks promote walking.

• American cheese: Processed foods have been around for thousands of years. Bread, beer and pickles are all examples of foods that have been processed by human beings. Processing can keep food fresh longer and can make food safer by killing harmful bacteria. These days, however, products that considered ultra-processed, including American cheese, have begun to make up a significant part of the American diet.

• Vitamin D milk: Deficiencies in vitamins and minerals can cause horrible diseases. Over the past century, fortifying foods has been an effective way of getting essential micronutrients to people. A lack of vitamin D in children causes, among other things, rickets, a disease characterized by skeletal deformation. Although seldom seen in developed countries today, rickets remained a concern in the United States until early in the 20th century. So beginning in the 1930s, vitamin D was added to foods, most notably milk, a beverage that most young people drink.

• The toilet: It's hard to think of a more important invention for promoting public health. Toilets channel human waste into sewer systems instead of into the water supply. Water contaminated with feces can carry potentially fatal diseases including cholera, dysentery and diarrhea. According to the Centers for Disease Control and Prevention, diarrhea is the world's second-leading cause of death in children younger than 5.


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