by

Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina

LIFE SPAN IN THE 20TH CENTURY

Life span in the world has increased dramatically during the 20th century. Russia is a notable exception. The United States is in the forefront because of our modern medicine, preventive medicine and may other developments, techniques and inventions.

One of the finest articles that I have read which directly relates to this issue was printed in the Journal of the American Medical Association of April 28th, 1999, Volume 281, No. 16, p. 1481. It is incredible that a one-page article should have so much information. The article discusses ten great public health achievements in the United States during the 20th century. The life span of the American male was 44 to 45 years in 1900 - now it is about 74 to 75 years. The corresponding numbers for females are about five years greater. What accounts for this? Well, there are about ten major categories as listed by the Center for Disease Control and Prevention from which this information is derived.

Vaccination has had a major effect on life expectancy. Smallpox and polio have been virtually eradicated in the United States by appropriate vaccination. Control of many other diseases has also been impressive - measles, tetanus and diphtheria, for example.

Major improvements in motor vehicle safety have occurred. While accidents still occur, if one has a seat belt on the chances of death are reduced significantly. One state police officer said he never unbuckled a dead man. The same is true when wearing a helmet when riding a motorcycle. There also have been major designs in manufacturing to achieve greater safety. While much remains to be done, still there has been significant accomplishment during the century.

Work-related health problems have be reduced considerably. Such disorders as coal workers' lungs have been well controlled. In general, there are much safer work places - there has been a reduction of approximately 40 percent in the rate of fatal occurrences while at work.

Control of infectious disease has improved dramatically. Some of this has resulted from cleaner water. Improved sanitation, for example, has resulted in near elimination of such disorders as typhoid. The use of antibiotics has made a striking reduction in infectious diseases. Pneumonia use to be associated with a very high mortality - now the vast majority of patients survive.

There has been a marked decline in deaths from heart disease and stroke. Much of this has occurred because of risk factor modification. The lowering of blood pressure, the reduction of cholesterol, encouragement of exercise, abstinence from smoking serves to help prevent heart attacks and strokes. Major improvements in treatment have further reduced mortality and increased life expectancy. The use of ultrasound, pacemakers, and intensive care units have markedly increased survival. The overall effect has been a reduction in mortality of about 51 percent since 1972.

Safer and healthier foods have resulted in less contamination and better nutrition and this has reduced the incidence of such diseases as rickets and goiter, to mention but two.

Better hygiene, improved nutrition, use of antibiotics and improved access to health care have resulted in healthier mothers and healthier babies. A striking reduction in infant mortality has occurred - about 90 percent, and also about 99 percent for mothers.

Better family planning has altered social and economic roles for women and this has had an effect on better health and fewer deaths.

Fluoridation of drinking water has improved health for children and adults by preventing tooth decay. This was begun in 1945 and at the present time it affects about 144 million people. Estimates vary somewhat, but it has been estimated that there is a 40 to 70 percent reduction in tooth decay in children. A similar reduction in tooth loss has occurred in adults.

And finally, the recognition of tobacco as a health hazard, with the subsequent anti-smoking campaign. The 1964 Surgeon General's report sparked the war against tobacco. Who knows how many patients have escaped lung cancer and heart attacks? The impact has been considerable. Unfortunately, this has been lost on our youth since those aged 15 to 25 continue to smoke in abundance. But, fortunately, there has been a marked reduction in smoking in the adult population.

These results are impressive without a doubt. One wonders what is in store for the next century.



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