History of Public Health(part 8)

continued from History of Public Health(part 7)

THE LATE TWENTIETH CENTURY

In the last half of the twentieth century, public health continued to expand its established roles. However, new forces were at work to further broaden its purview. Among these were the aging of the populations in industrialized regions, recognition of the importance of behavioral factors in determining the health of populations, exacerbation of social inequalities in health, increasing violence (at the domestic level as well as at the civil and international level), and globalization.

As infant and child mortality declined in the industrialized countries, life expectancy and the proportions of the elderly in populations increased. Consequently, diseases such as heart disease and cancer became more important. After World War II, epidemiological research concentrated on identifying risk factors for these and other chronic diseases. A prominent role for behavioral factors was readily demonstrated. Particularly, cigarette smoking was identified as a major etiological factor for heart disease and for several cancers, particularly lung cancer. Other behavioral factors, such as diet, exercise, and obesity, were found to be causally associated with several other diseases. Ameliorating adverse behavioral risk factors has become a major function of public health agencies.

Since the mid–nineteenth century, the relationship between socioeconomic status and health has been widely recognized. However, in the late twentieth century epidemiological research has pointed out additional differences in health status between gender, ethnic, and occupational groups. Such inequalities appear to be increasing and are being recognized as a major challenge for modern public health.

Domestic violence, gang warfare, ethnic conflicts and genocide, and civil wars and wars between nations have resulted in substantial mortality and a vast disruption of societies. In some countries, including the United States, homicide has become a major cause of death among those under twenty years of age. Around the world, many millions of displaced persons live in enormous refugee camps with minimum medical and public health facilities. Clearly, the health effects of war and violence demand to be addressed.

Increased globalization and technological advances have resulted in worldwide economic, political, and social interdependence. However, recognition of the interdependence of regions and nations with respect to health and disease was institutionalized in 1902, when the Pan American Health Organization was established to coordinate communicable disease surveillance and quarantine in the western hemisphere. By the end of the century, the major global public health problems included the manifold consequences of atmospheric warming; pollution of the oceans and fresh waters of the world and the depletion of fisheries; the rapid growth of the world'spopulation; the emergence of new infectious diseases, including HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome); and the increased production and use of addictive drugs. These are daunting challenges for the World Health Organization and other international agencies.

Nevertheless, in 1977, public health registered its greatest historical feat. In that year, the eradication of one of the human species' most dreaded and lethal diseases, smallpox, was completed. The last case occurred in 1977 in the East African nation of Somalia and the eradication was certified by a Commission of the World Health Organization in 1979.