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| Ten Great Public Health Achievements United States, 1900 - 1999 Vaccination Family Planning Safer Workplaces Motor Vehicle Safety Safer and Healthier Foods Control of Infectious Diseases Healthier Mothers and Babies Fluoridation of Drinking Water Recognition of Tobacco Use as a Health Hazard Decline in Deaths from Coronary Heart Disease and Stroke |
 In 1900, health conditions were far from ideal in the New Mexico Territory. Infectious diseases such as tuberculosis, smallpox, typhoid fever, measles, diphtheria, whooping cough (pertussis), and dysentery were common. Smallpox occurred sporadically, and occasionally in severe outbreaks, causing many deaths. Average life expectancy in this soon-to-be state was only 47 years. The leading causes of death were infectious diseases, and these frequently took the lives of very young children. Medical care was provided through physicians and native healers in private, individual practice, compared to today’s large managed care organizations. Vaccines for diseases other than smallpox didn’t exist, antibiotics hadn’t been discovered, water supplies were untreated and many of the tools of modern medicine and public health were not available. A diagnosis of tuberculosis was frequently a death sentence. New Mexico had no health department when the devastating influenza pandemic of 1918 struck the state. The State Health Board (like others around the country) had insisted incorrectly that the flu epidemic wouldn’t cause any problems here.
In 1919, Governor A. O. Larrazolo and the New Mexico Legislature established a Department of Health. Over the next several decades, the Department and private medical providers dealt with a variety of pressing health issues, including high venereal disease rates, outbreaks of animal rabies (with a few human cases), tuberculosis, environmental sources of illness and the need for water and food sanitation, and cancer screening. Gradually, throughout the 1930’s, 40’s, and 50’s, the state began to address many of the major public health issues, through improvements in our drinking water supplies, restaurants and food supply, sewage wastewater treatment, vaccination programs, and treatment of infectious diseases with the advent of successful antibiotic therapy. In the 1950’s, outbreaks of polio swept the nation, killing many persons and leaving others with disabling paralysis. The state began immunizing children with the Salk polio vaccine in 1954.
Improvements in economic and general living conditions, improved water and food sanitation, vaccines, and antibiotic treatments soon led to major shifts in both the leading causes of death and life expectancy. These shifts required the combined and collaborative efforts of the public and private sectors. Successful sanitation programs led to a remarkable drop in typhoid fever and other diseases spread through contaminated water or food. Pasteurization of dairy products contributed to significant reductions in milk-borne diseases such as salmonellosis and tuberculosis. Vaccination programs aimed at preventing childhood diseases eventually led to the near-elimination of measles, mumps, rubella, diphtheria, pertussis, tetanus and recently Haemophilus influenzae type B. Local, state, national and international efforts led to the complete elimination of smallpox from the world by 1977. Both polio and measles are targeted for global elimination over the next 20 years. However, recent declines in immunization rates in New Mexico leave us vulnerable again to outbreaks of these vaccine-preventable diseases.
With the reductions in many childhood infectious diseases, improvements in water and food sanitation, and increased life expectancy, the state began to see other health conditions emerge. The 1960’s and 1970’s brought an increase in chronic conditions that are frequently related to lifestyle choices and behaviors, such as diabetes, heart disease and smoking-related diseases. As a result, public health programs in the last 30 years have been increasingly directed towards health behaviors such as smoking, alcohol and other substance abuse, diet and exercise. In the last 30 years, public health programs have played an increasing role in ensuring access to health services, including clinical preventive services such as cancer screening, smoking prevention and cessation programs, diabetes detection and management, family planning, and prenatal care. While the use of prenatal care has steadily increased from 1989 to 1996, it dropped in 1997 and 1998. Adequate prenatal care has been shown to result in lower infant mortality rates and healthier babies. Increased efforts are needed to increase appropriate prenatal care for all New Mexicans. Efforts to improve New Mexico’s infamous death rates from motor vehicle crashes have begun to show results. While our highway death rates are still higher than national rates, our rates are declining faster than the national rate. This has come about through improved vehicle and highway design, seat belt use, and reductions in driving while intoxicated (DWI).
As a state, we need to find ways to reverse the trend toward increasing rates of obesity. Obesity is a risk factor for many health conditions, e.g., heart disease, diabetes, stroke, and joint problems. High-fat diets are frequently responsible for obesity, and contribute to the development of certain cancers, heart disease, hypertension, and diabetes. To combat this trend, we need to promote healthy diets and regular exercise. New Mexico’s high rates of alcohol and other substance abuse continue to be major public health problems. A rapid increase in drug abuse-related deaths starting in the 1980’s is cause for alarm. The causes of this increase are not fully understood. It may be related to variations in the types of heroin being used in the state, and/or the use of combinations of substances (heroin together with alcohol or other drugs). Despite major challenges, the last 100 years have seen major improvements in health status in New Mexico. Life expectancy has increased dramatically— primarily due to public health measures. Childhood vaccine-preventable diseases are at an all-time low. Heart disease death rates are among the lowest in the nation, and public health activities are beginning to reduce our motor vehicle mortality rates.
In the years ahead, our most pressing problems will require collaborative efforts by the public and private sectors together. The State of Health in New Mexico Report and the DOH Strategic Plan present us with the opportunity to assess and address current challenges and improve health for future generations of New Mexicans.
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