Chronic disease control in public health practice: looking back and moving forward.

Abstract

230 Public Health Reports / May–June 2004 / Volume 119 The origins of modern public health can be traced back to infectious disease epidemics of now uncommon diseases such as cholera, plague, and leprosy.1 As these diseases were controlled through a combination of improved sanitation and hygiene, the discovery of antibiotics, and vaccination programs, chronic diseases such as heart disease, cancer, and diabetes became increasingly prevalent over the 20th century. In 1900, the three leading causes of death were pneumonia and influenza; tuberculosis; and gastritis, enteritis, and colitis. These diseases accounted for nearly one-third of all deaths. Today, heart disease, cancer, and stroke are the three leading causes of death, accounting for almost two-thirds of all deaths. These and other chronic diseases are characterized by a complex interaction of risk factors, a non-contagious origin, a long latent period between risk factor exposure and clinical occurrence of disease, a long period of illness, and multiple risk factor etiology.2 Among the 10 greatest public health achievements of the 20th century, five relate directly to the prevention of chronic diseases:3