Life and Death in America: A Return to 19th Century Life Expectancy?


We have all read how life expectancy in the United States has drastically increased from the 1800’s, and even since the mid 20th Century. Few, however, are cognizant of exactly how that has happened. Yes, food production is increased drastically, however food quality has not necessarily improved, at least the food that the majority of Americans eat every day. The answer would seem to lay in American healthcare system, particularly the advancements in public health. Your chances of dying from an infectious disease have declined significantly during the 20th century, along with a significant decrease in infant and child mortality to a nearly 30 year increase in life expectancy, yet today infant and child mortality is increasing).

At the beginning of the 20th Century, nearly a third of all deaths occurred among children age less than five years, by 1997 that percentage had dropped to 1.4%. In 1900, the three leading causes of death were pneumonia, tuberculosis, diarrhea and enteritis, accounting for 34% of deaths; 40% of these deaths were among children aged five years or less. By 1997, heart disease and cancers accounted for nearly 55% of all deaths, with less than 5% owing to infection, including influenza, pneumonia, and HIV. Despite this significant progress in public health and medical practice overall, the most devastating epidemic in modern human history occurred during the 20th century: the 1918 influenza pandemic. Since that time, the US seems to be stepping back.

The United States suffered a loss of 500,000 people in less than a year; the death toll from the 1918 influenza pandemic is estimated at 20 million. HIV, first recognized in the early 1980s’, is an ongoing pandemic that has affected over 30 million people and has caused an estimated 14 million deaths. These events occurred despite significant advances in public health and remind us that infectious disease and emergent diseases are unpredictable. Without the 19th-century discovery of the Germ theory of disease, the death toll of infectious disease deaths would likely be well over 100 million…..and counting.

Epidemiologists were the first to recognize that many serious diseases can be tracked and predicted, and therefore to a greater or lesser extent, prevented. Improvements in sanitation and hygiene, the discovery and creation of antibiotics, and implementation of universal childhood vaccine programs have significantly diminished both viral and bacterial infections diseases among children. Although a diverse field today, epidemiology had as its founding principle the control and prevention of infectious disease, particularly typhus and malaria.

Through the ability to objectively examine diseases, disease trends, and identifying who became ill and when, epidemiology moved from solving epidemics into the field of preventive medicine. Sadly, the vast majority of public health endeavors, particularly epidemiological, have been efforts supported by local, state, and federal Governments. Unlike Europe, Asia, and even parts of Canada, where public health professionals, particularly epidemiologist and clinical epidemiologist are active in the fields of preventative medicine and community health, in the United States the emphasis has always been on treatment rather than prevention. This is largely the flaw of biomedicine, and one that has been taken up by and defended by insurance companies and hospital administrators. Until such time as America embraces prevention over treatment, public health endeavors will be the purvey of local health departments, private research organizations, and the Centers for Disease Control and Prevention, the CDC.

Another area of epidemiological disease prevention is animal and pest control. These tend to be nationally sponsored, state-coordinated vaccination and animal control programs that have eliminated a number of animal to animal diseases such as rabies, and the virtual illumination of malaria, once endemic in the southeastern United States. However, even bubonic plague, now known to be spread by rats, is making a comeback in certain parts of the world. The last major associated outbreak of plague In the United States occurred in 1924 in Los Angeles. This should stand to serve notice that due diligence is necessary for public health to prevent the reemergence of even well-controlled diseases. This is particularly disheartening concerning the reemergence of vaccine-preventable childhood diseases that once killed tens of thousands of children in the United States.

Recently, measles has become epidemic once again in the United States. How this can be explained is quite simple: non-medical, self-proclaimed experts who champion naturopathic or herbal treatments have decided that, based on now well-documented flawed research, that vaccines are unsafe. Despite repeated investigations conducted by private research groups, universities, medical schools, and public health euros in several European and North American regions, I handful of people have decided that vaccines are at best unnecessary, and at worst, lead to a number of neurological disorders, despite overwhelming evidence from virtually every health science researcher.

Anti-vaccine proponents, or Anti-vaXXers as they are known, will quickly suggest that health scientists who have researched vaccines and found them to be a safe and necessary aspect of modern health and preventative medicine, will quickly suggest that health scientists are on the payroll of big pharmacies, the government, or simply do not understand what they are talking about, despite a decade of graduate education in medicine or health science, along with years of clinical research practice. These anti-vaccine proponents will also suggest that research by scientists identified by anti-vaccine web sites are correct, despite the fact that very few of these scientists are in the health sciences or medical field, or in fact understand the research themselves. However, like religion, these anti-vaccine proponents are not interested in expanding their knowledge base, or reading anything that disagrees with their opinion. The majority of the people who got measles were unvaccinated. Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa, and travelers with measles continue to bring the disease into the U.S. Measles can spread when it reaches a community in the U.S. Where groups of people are unvaccinated or under vaccinated. This has to do with the phenomenon known as herd immunity.

When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for the disease to get a foothold. While the virus is within the protected population, it cannot exist in sufficient numbers to cause illness. Even those who are not eligible for certain vaccines, for example infants, pregnant women, or those persons who are immunocompromised (for example patients getting chemotherapy, undergoing steroid treatment) get some protection because the spread of contagious disease is contained. When a high enough percentage of people in the community do not get vaccinated, the whole group is at increased risk. This was seen in the US in late 2014, when an outbreak originated in a US amusement park. Analysis by CDC scientists shows that the measles virus in this outbreak is identical to the virus type that caused the large measles outbreak in the Philippines in 2014. However, the same virus type has been identified within the past 6 months in 14 other countries and at least 6 U.S. states not associated with the current outbreak, so it is difficult to say exactly where the outbreak originated.

Regardless, the current mindset of many Americans concerning the necessity of vaccines, the importance of diet, along with a host of other health related issues will create a first in recorded history: a generation unlikely to live longer or more healthy lives than their parents. The same parents who today seek medical advice from the internet and reality television are alive and well today because they had the benefits of public health, including vaccines.



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