In a remarkable memoir about a remarkable man (Oblivion, a Memoir), the Colombian writer Hector Abad tells of his father’s passion for sweeping intercessions that would improve the health of the entire population far more than conventional curative medicine. Hector Abad Gomez was a physician who courageously took up the banner of public health in mid-20th century Colombia with notable success, amid opposition from conventional health care. He also became a prominent spokesperson for the poor and downtrodden, and this advocacy eventually cost him his life.
Gomez is the father of public health in Colombia and his writings tell the story of a man who probably saved more lives by his unswerving efforts to bring public health measures to a country with a population in woeful need of basic healthcare.
He believed in the power of education and public works to improve hygiene and had much success in generating measures to help all people, not just the rich, who were uniquely able to enjoy the benefits of modern medicine. He pushed for universal pasteurization of milk (simple boiling), which eliminated a form of tuberculosis. He said having drinkable water for the entire population saves more lives than sophisticated medical interventions, as so much disease in undeveloped countries is the product of unsafe water and poor sanitation. He highlighted the devastating effects of malnutrition. Anticipating the eradication of smallpox and the elimination of polio in countries with effective public health, he noted the power of vaccines, which have saved the lives of millions (maybe billions) worldwide,
Public Health in the United States
The public health measures cited above are so common and elementary in the United States that we can forget their power. But it was not that long ago that we resembled Columbia in the 1950’s.
Congress created the US Public Health Service in 1912, authorizing it to investigate tuberculosis, hookworm, malaria, leprosy, sanitation, water supply, and sewage disposal. Johns Hopkins University founded the first school of public health in 1916. Today, the public health establishment includes multiple agencies, including the National Institutes of Health, the Federal Drug Administration, the Center for Disease Control, the Health Resources and Services Administration, and a few more.
The reach of these agencies is broad, and, with some occasional but important glitches, they have had a profound positive effect on the health of the US population. One public health official estimated, perhaps somewhat immodestly, that public health added 25 years to the life expectancy of the average American between 1900 and 2000.
This assertion is not hard to believe when some great public health successes are highlighted. These include a 90 percent reduction in deaths due to motor vehicle travel since 1925, despite a phenomenal increase in vehicular traffic. Between 1980 and 1995, work-related deaths decreased by 28 percent. The US enjoys a water supply that is virtually free of microbial contamination. In 1900, tuberculosis killed 194 people per 100,000 in the US. In 2020, it was .2 per 100,000. Malaria does not exist in the US, except in people who contract the disease in other countries and then travel to our country. HIV/AIDS has gone from a 100 percent fatal disease to a chronic one. And tobacco! In the 1960’s, between 40 and 45 percent of adult Americans smoked cigarettes. Today, that figure is an astounding 13 percent. It goes on and on.
Countries with developed public health systems like the US enjoy a level of safety that should be a model for so-called third world countries. Today, 2195 children per day die of infectious diarrhea worldwide, primarily because of contaminated water supplies. Deaths from diarrhea in the US average about 300 per year.
In the handling of the Covid-19 epidemic, public health in the US, particularly the CDC, has come under much criticism, a lot of it merited. On the other hand, successes like the Covid-19 vaccines cannot be ignored. Based on research that was years in the making, the US produced the world’s best Covid vaccines almost within a year of the identification of the virus.
The Take Home
In the US, we see stupefying advances in medical technology almost weekly. But none of it approaches the impact on well-being that public health has had. The United States Public Health Service is the crown jewel of American healthcare. Dr. Gomez knew what he was talking about.
Excellent reminder for everyone that these are the good days. J
Jim can I use this in my newsletter for MN AAHAM as well?
Very interesting Jim
Great article, Jim! That the “medical establishment” opposed Dr. Gomez is a reminder that entrenched factions in medicine, typically aligned with economic self-interest, have been and will continue to be in conflict with those that seek a more egalitarian and equitable application of healthcare resources. In this country, the AMA fought against Medicare back in the 60’s, and the insurance, pharmaceutical and medical products industries continue to do their best to obscure the truth that national healthcare systems, not our privatized one, are the clear winner in the post WWII world for effectiveness and cost.
In the public health realm, effective public health departments are being pruned by budget cuts, and their programs transitioned to the private healthcare economy where they languish because they don’t pencil out to the bottom line in our healthcare system, which rewards billable services rather than long term outcomes like life expectancy, or population-based outcomes like maternal or infant mortality.
We are now seeing the backsliding of our past public health progress of the 20th century, with hundreds of thousands of excess deaths in the COVID epidemic in the U.S. due to failure to be vaccinated, wear masks, etc. One wonders how Dr. Gomez’s efforts would have fared in the mid 20th century if today’s internet culture of disinformation were present. Unfortunately, I think the Golden Age of public health is behind us, unless we can move past the divisiveness and healthcare disinformation that characterizes the present. But I urge all to support local and national budgets for public health measures and departments. It is money well-spent. And while you are at it, support Medicare for All! A national healthcare system would have more interest in public health outcomes!
Dr. Lindenbaum’s comments identify issues about the very existence of public health. He amplifies critical issues, prime among them a the population’s love affair with short term gains in health as opposed to the more powerful, but slow, gains public health provides. I love the comments… keep them coming.
Jim, thank you for this wonderful article which, for me. is an antidote to all of the cynicism out there. And, yes, to Medicare for All.
There are charities that help communities around the world struggling to get clean water. We support Water Mission; Christians who “walk their talk.”