Washington — Reductions in child mortality and progress in the prevention and treatment of diseases such as HIV/AIDS, tuberculosis and malaria are among the top 10 public health achievements in the first decade of the 21st century, according to the U.S. Centers for Disease Control and Prevention (CDC).
The nation’s premier public health agency published “Ten Great Public Health Achievements — Worldwide, 2001-2010” June 24 in its Morbidity and Mortality Weekly Report (MMWR).
The CDC polled global health experts for their nominations in public health achievements. The list is derived from those suggestions. The report says these 10 are not ranked; all hold equal standing.
Two million fewer children die before the age of 5 than in years past, evidence that a reduction in child mortality is a significant health achievement of the last decade, according to the report. The annual rate of improvement in child mortality is also increasing. Greater access to immunizations, micronutrient supplementation and expanded access to freshwater helped to save the lives of children who might have died too soon in the past.
Expanded vaccination campaigns are key to the steep decline in deaths from infectious diseases, according to MMWR. Immunization against measles, polio and diphtheria-tetanus-pertussis prevented 2.5 million deaths a year. Broader understanding of the effectiveness of vaccines and innovative financing mechanisms led to this health achievement, according to MMWR.
The proportion of the world population with access to safe water rose from 83 percent in 2000 to 87 percent in 2008, while access to improved sanitation increased from 58 percent to 61 percent. These combined initiatives are helping to save young children from succumbing to diarrhea, which kills more young children every year than AIDS, malaria and measles combined.
A reduction in the number of new cases of HIV/AIDS and expanded access to treatment for the AIDS disease are also cited as health achievements of the last decade. The population in low- and middle-income countries receiving anti-retroviral treatment climbed to more than 5 million by 2009, a number that was inconceivable when the decade began.
The campaign against HIV/AIDS is closely linked to a reduction in the incidence and mortality of tuberculosis, one of the opportunistic infections that can attack the compromised immune system of a person who has developed AIDS. “Since 2000, case detection and treatment success rates each have risen nearly 20 percent, with incidence and prevalence declining in every region,” according to MMWR.
The first decade of the 21st century also brought progress against diseases that had come to be known as “neglected” tropical diseases, not because they are rare, but because they affect the world’s poorest people who have little economic or political power to muster a strong counter-disease strategy. The expert poll found concerted efforts to make progress against three of these conditions, and elimination or eradication is in sight for dracunculiasis (Guinea worm disease) onchocerciasis (river blindness) and lymphatic filariasis. Fewer than 1,800 cases of Guinea worm disease were detected in 2010, and the CDC reports it is on the way to eradication. Drug distribution has controlled river blindness in the six countries where it is a threat, and elimination of transmission is expected by 2012. Lymphatic filariasis infected 120 million people in 2000, but massive drug administration campaigns have dramatically scaled back the number of cases. Sixty-three countries are still at risk.
Sometimes lives saved are not the measure of success, and such is the case with tobacco control. Premature deaths linked to smoking have risen by some 600,000 since 2000, but governmental commitments to reduce smoking through smoke-free policies, taxation, education, advertising and other methods surged, and for that reason, the CDC expert poll ranks tobacco control among the great public health achievements of the decade.
Education and awareness are the hallmark of progress for the CDC designation of global road safety as a public health achievement. Worldwide 1.3 million people die on the road each year, a number that is still climbing in developing nations. But the report finds an increased awareness of highway deaths as a public health issue, which has led to significant declines in road deaths in Europe. The U.N. General Assembly has designated 2011 to 2020 as a Decade of Action for Road Safety.
Increased international cooperation in the public health community has helped boost detection and awareness of pandemic diseases, another public health achievement of the last decade, the CDC said. International Health Regulations that became effective in 2007 provide greater capabilities for coordinated analysis and response in the event of an outbreak of a new virulent disease, the report says.
Through the CDC and the U.S. Agency for International Development (USAID), the United States has lent significant support to these achievements in public health. The President’s Emergency Plan for AIDS Relief (PEPFAR), launched with $15 billion in 2003, has helped distribute HIV/AIDS treatment to millions of people. In 2010, the Obama administration introduced the Global Health Initiative, a $60 billion program to continue the battle against disease in the developing world. The United States has also been in a leader in expanding immunization programs to protect more and more children from infectious disease, and in the continued pursuit of the eradication of polio.
The CDC report is available on the agency’s website.