Ask Dr. Hallberg: Improvements in public health

Malaria prevention, access to safe drinking water, and improved road safety are among the top 10 greatest public health achievements in the past decade, according to a new report from the Centers for Disease Control and Prevention.

MPR medical analyst Dr. Jon Hallberg discussed the report with MPR's Tom Crann this week. Hallberg is a physician in family medicine at the University of Minnesota and director of the Mill City Clinic.

Tom Crann: Let's start with an obvious one that probably won't surprise too many people, and that is control of vaccine-preventable diseases. Put this in perspective and what kind of numbers prove that this is working.

Dr. Jon Hallberg: Well, this is certainly the obvious one. Over the last century, the twentieth century, some of the great strides in public health were because of immunizations and making inroads.

But let me give you two examples. One is that they estimate that 12.7 million deaths were averted from measles by simply giving the measles vaccination worldwide and having that increase. The other one that's quite remarkable is that at the beginning of 2000, there were 20 countries in the world that had endemic polio, in other words, where polio existed. The number of countries is now down to four, and in 2010, there were just 1,500 new cases of polio reported.

So these are two really concrete examples of immunizations we give here (and) we don't think about very often, but have resulted in saving millions and millions of lives worldwide.

Crann: There's an item on this list that really has to do with infrastructure that we in the developed world might not realize the importance of, and that is access to safe water and sanitation. Put that in perspective for us and what differences that makes globally health-wise.

Hallberg: Well, among children less than five, the majority of kids who die of infectious diseases die of diarrheal illnesses. And this is something like 1.5 million kids a year under the age of five, and that is more than die every year from AIDS, malaria, and measles combined. Something like a third of the world's population every year gets a diarrheal illness.

So having access to clean, safe drinking water is of critical importance. And though the world's population has increased substantially, the percentage of people in the world that have access to clean water has also increased. And so that's really one of the great triumphs in the last decade.

It's important to remember too that it was just last century, in the twentieth century, that Europe, North America, Japan figured out ways of giving clean drinking water to its citizens, and by doing so, that simple thing, relatively simple thing, eliminated cholera and typhoid. So you just don't see those things in our nations, and you hope obviously that that's where the world is headed.

Crann: What was the surprising thing for you as you looked at this list?

Hallberg: The fact that the World Health Organization is now looking at driving and road safety really struck me as something interesting. I had never thought that that was something that the WHO would even think about, but this has been a big initiative on their part for the last decade.

Crann: And it's on the list as "increased awareness and response for improving global road safety." And I was just reading about this. There's been a big push in European Union countries for this. I was even reading this somewhat comic article by a car writer about how you can't drive fast in Italy anymore because there are all these traffic controls and police out. It's really having an effect, isn't it?

Hallberg: It's a huge effect. It's really interesting, and I think that so many times when we look at these public health improvements, we don't even talk about Europe. We don't talk about North America or Australia. We'll assume that everything's set there, but this is one of the top ten that the EU has really been dealing with in the last decade.

In fact, in Spain, for example, mortality rates on the road have dropped 60 percent, and in Portugal, they dropped something like 47 percent. It's almost cutting the rates of deaths in half, and the focus has been on better roads, people wearing seatbelts, cracking down on drunk drivers, things we just take for granted here, but these have really made a big inroad.

And now, of course, with more and more people driving in India and China on roads that are not designed for increased road traffic, the rate of mortality on the roads is going to rise greatly. So on the one hand, there's been great improvement, and on the other hand, this is going to be something that they're going to be looking at in the years to come.

Crann: So as you look at this list, how do you think it shapes the agenda for public health in the coming decades?

Hallberg: I think that the shift is clearly going from infectious diseases as the leading cause of mortality in the world to diseases of chronic conditions. And the big three, of course, are going to be heart disease, diabetes, and cancer, and that's exactly what we're dealing with in this country. So it's almost like we're on one end of that bell-shaped curve, and the world is sort of catching up to the way that the developed nations have been.

Crann: And if you looked at a list of the top ten public health achievements in the U.S., how would that list look different?

Hallberg: They made a point, with this list, of not ranking them in any kind of priority, but I would bet that at the top for the U.S. is going to be a decrease in the cancer fatalities and tobacco achievements. I suspect those will be among the top two. Certainly we're not talking about the infectious diseases the way we are when we're looking at things globally. We're not worried about our drinking water supply, at least not to the degree that other countries are.

(Interview edited and transcribed by MPR reporter Madeleine Baran)

LIST OF TEN GREAT PUBLIC HEALTH ACHIEVEMENTS WORLDWIDE, 2001-2010

(Source: CDC's Morbidity and Mortality Weekly Report)

• Reductions in Child Mortality

• Vaccine-Preventable Diseases

• Access to Safe Water and Sanitation

• Malaria Prevention and Control

• Prevention and Control of HIV/AIDS

• Tuberculosis Control

• Control of Neglected Tropical Diseases

• Tobacco Control

• Increased Awareness and Global Road Safety

• Improved Preparedness and Response to Global Health Threats

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