75 Years of Public Health Achievement
In 1923, the automotive industry discovered that by adding lead to gasoline, cars could run more smoothly and economically. For the next 50 years, a strong industrial lobby helped keep lead in gasoline--despite concerns about the health risks of automotive lead exhausts--and government policymakers refrained from imposing regulations. Matters changed in 1965, with the publication of a major study showing extensive contamination of Arctic snow fields with automotive lead. Subsequent studies linked environmental exposure to automotive lead--especially in early life--with a range of metabolic disorders and developmental disabilities.
SPH Professors Bertram Dinman and Jerome Nriagu contributed to critical assessments of the extent of automotive lead pollution in the U.S., and in a widely cited study in Nature in 1979, Nriagu provided the first global inventory of lead emissions to the atmosphere. In 1985, SPH biostatistician Richard Landis coauthored a paper showing links between environmental lead exposure and cardiovascular abnormalities in adult males. As a result of these and other studies, gasoline today is lead-free in practically every country in the world.
SPH epidemiologist Thomas Francis Jr. conducted the clinical trials that led to his celebrated announcement in U-M's Rackham Auditorium on April 12, 1955, that a polio vaccine developed by Jonas Salk was "safe, effective, and potent." Francis designed and oversaw the year-long trials, which involved an unprecedented 1.8 million children during an era before computers. The vaccine, developed by Salk using techniques he'd learned from Francis while completing a postdoctoral fellowship at SPH, effectively ended one of the 20th century's most dreaded diseases.
Today, polio is on the verge of global eradication, and a team of SPH researchers--including James Koopman, Marisa Eisenberg, David Hutton, and Joseph Eisenberg--is working with the World Health Organization and with support from the National Institutes of Health to ensure that this goal is achieved.
Lower Smoking Rates
Once a ubiquitous feature of social life, smoking is now the exception in countries like the U.S., and there's a major push to lower tobacco use in low- and middle-income countries. The first big step toward this major public health achievement occurred in 1964, with the release of the first Surgeon General's Report on Smoking and Health. Smoking in the U.S. dropped 15 percent in the first three months after the report's release.
SPH Professor Kenneth Warner played a key role in subsequent efforts to lower smoking rates, advocating for federal cigarette excise tax increases and representing the World Bank at negotiations to create the WHO Framework Convention on Tobacco Control, the world's first international health treaty. Since ratified by 180 countries, the FCTC addresses the global tobacco epidemic through price and tax measures, education, advertising, packaging, and an array of other means.
For Kenneth Warner's keynote address on "Tobacco and Health: Progress to Date and the Path Forward," delivered at the 2016 U-M SPH schoolwide symposium, [NEED LINK].
Health Care Quality
In 1966, SPH Professor Avedis Donabedian published an article, "Evaluating the Quality of Medical Care," which laid the foundation for a profound and widespread change in the measurement and improvement of quality of care. Donabedian's study became one of the most frequently cited public health articles in the next 50 years. Its paradigm-shifting conclusion was that assessments of the quality of health care services focused on either structure, process, or outcomes. That insight--and the conceptual framework Donabedian developed as a result of it--underlies important work currently being done in quality assessment and improvement, as well as in areas such as medical-risk management, medical-error prevention, hospital rankings, and payment for health services. Donabedian continued to build on his landmark 1966 study, devoting his career to the principle that health care is "a sacred mission," not a commercial enterprise.
Before 1972, some clinicians and scientists believed that high blood pressure was a normal part of aging--despite emerging evidence that lowering elevated blood pressure would prevent strokes, heart failure, and heart attacks. That year, the National Heart, Lung, and Blood Institute launched a new National High Blood Pressure Education Program, and a few years later, SPH alumnus Ed Roccella, MPH '69, became its director.
By the early 2000s, the success of that program--coupled with new research on hypertension control by the likes of SPH biostatistician Richard Remington, and earlier findings from the U-M Tecumseh Community Health Study and other community studies--contributed to a 70- and 60-percent decline, respectively, in age-adjusted stroke and heart-disease mortality. The Centers for Disease Control and Prevention hailed the decline in cardiovascular disease as one of the 20th century's ten great public health accomplishments. Today SPH researchers are developing new guidelines, therapies, and policies aimed at preventing and reducing hypertension and cardiovascular disease in all populations.
Throughout the 20th century, the absence of a comprehensive national health insurance system left millions of Americans vulnerable to disease, disability, and death. As early as 1928, U-M Professor Nathan Sinai undertook research to address the crisis. His colleague Sy Axelrod followed suit in 1969 by co-founding the Committee for National Health Insurance. Furthering their efforts, SPH health economist Catherine McLaughlin chaired nationwide hearings and community meetings on health care coverage and costs in 2005, and from 2001 to 2008 directed the Robert Wood Johnson'funded Economic Research Initiative on the Uninsured. Her former student John McDonough, DrPH '96, was a key force behind passage of the Massachusetts Health Reform Law of 2006.
All of this work contributed to the game-changing 2010 Affordable Care Act, as did research conducted in the U-M Center for Value-Based Insurance Design, conceptualized by SPH Professors Michael Chernew and Mark Fendrick. V-BID principles underlie Section 2713 of the ACA, which eliminates consumer cost-sharing for specific preventive services, among them cancer screenings, counseling, and immunizations. As a result, over 137 million Americans now have enhanced access to preventive care.