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.

Comparisons

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.