CDC Identifies Top Global Public Health Achievements in First Decade of 21st Century

People live longer throughout the world, but gap between rich and poor remains, deaths from noninfectious diseases increasing

Global public health advances during the first 10 years of the 21st century resulted in longer lives worldwide, increasing the average life expectancy at birth in low-income countries from 55 to 57 years, and in high-income countries from 78 to 80 years, according to a report from the Centers for Disease Control and Prevention. The global public health achievements are published in today's issue of CDC's Morbidity and Mortality Weekly Report (MMWR).

The gains, which took place between 2001 and 2010, are a result of investments in scientific, technical, legal, and political resources to improve living conditions and activities to combat major infectious causes of death. Examples include substantially fewer deaths from malaria, tuberculosis, and HIV because of the ability to rapidly identify and treat people; near-eradication of Guinea worm disease through education and safe water technology; and 2.5 million fewer deaths among children younger than 5 by providing measles, polio, and diphtheria-tetanus-pertussis vaccines.

The report also notes a shift in the major causes of death from infectious to non-infectious diseases. By 2030, noncommunicable diseases such as cardiovascular disease, diabetes, and cancer are expected to cause more than 75 percent of the world’s deaths, regardless of a country’s income.  

 “Americans can be proud that people around the world are living longer, healthier lives because of the United States’ commitment to global health,” said CDC Director Dr. Thomas Frieden.  “But there are still far too many people who die from conditions that are easily preventable.  Continued investments will help millions more live healthy and productive lives while helping to protect our own country from health threats.” 

The top global public health achievements are:

Reductions in Child Mortality

During the past decade, the number of children who die each year has dropped by more than 2 million, and the child mortality rate declined from 77 deaths per 1,000 live births in 2000, to 62 per 1,000 in 2009. The vast majority of gains in child survival have been accomplished through expanded immunizations, micronutrient (particularly Vitamin A) supplementation, access to safe water, insecticide-treated bednets, oral rehydration therapy, antibiotics, antimalarial therapy, and antiretroviral therapies.

Vaccine-Preventable Diseases

Immunization has been identified as one of the most cost-effective ways to advance global welfare. In the first decade of the 21st century, an estimated 2.5 million deaths were prevented each year among children younger than 5 years using measles, polio, and diphtheria-tetanus-pertussis vaccines.

Access to Safe Water and Sanitation

Reducing global deaths from diarrheal diseases, currently 1.5 million children younger than 5 each year, depends on access to improved drinking water and sanitation and practice of hygienic behaviors such as handwashing. Between 2000 and 2008, the proportion of the world’s population with access to improved drinking water sources increased from 83 percent to 87 percent (an additional 800 million people), and the proportion with access to improved sanitation increased from 58 percent to 61 percent (an additional 570 million people).

Malaria Prevention and Control

Because of increasing attention and funding from partnerships like Roll Back Malaria, more vulnerable people in sub-Saharan Africa are now protected by insecticide-treated bednets, more homes have been treated with indoor residual spraying, diagnosis and treatment with effective therapy is faster, and more women receive preventive treatment during pregnancy. By 2009, the estimated number of malaria cases worldwide declined to 225 million, from 244 million in 2005, and estimated deaths decreased to 781,000, from approximately 985,000 in 2000. 

Prevention and Control of HIV/AIDS

The annual number of new HIV infections has declined steadily from an estimated 3.1 million in 2001 to 2.6 million in 2009. A decline has also been seen in the estimated number of AIDS-related deaths worldwide, from a peak of 2.1 million in 2004 to an estimated 1.8 million in 2009. Programs believed to have contributed to these gains include expansion of provider-initiated testing and counseling, preventing mother to child transmission, improved blood safety, and antiretroviral therapy. 

Tuberculosis Control

The use of the Directly Observed Therapy, Short-Course (DOTS) strategy for TB control, which focuses on quickly finding and successfully treating TB cases with standardized drug regimens, has resulted in 41 million cases cured and 6 million lives saved since 1995. Since 2000, the rates of detecting and successfully treating TB cases have each risen nearly 20 percent, while the numbers of new cases and the total numbers of cases are slowly declining. To sustain these tremendous gains in TB control and to meet the target of reducing TB mortality to 50 percent of 1990 levels by 2015, new tools for TB control are now being developed and rolled out.

Control of Neglected Tropical Diseases

Through mass drug administration and safe water programs, onchocerciasis (river blindness) in the Americas and Guinea worm and are on the verge of successful eradication or elimination. Through mass drug administration, the Onchocerciasis Elimination Program in the Americas has eliminated onchocercal blindness in all 13 affected regions. The goal is to eliminate transmission by 2012. Education and safe water practices have helped interrupt transmission of Guinea worm in all but four countries (Southern Sudan, Mali, Ethiopia, and Ghana). With only 1,797 cases reported in 2010, the goal of eradication in 2012 is within reach.

Tobacco Control

In 2003, commitments were made to reduce global tobacco use through the World Health Organization’s Framework Convention on Tobacco Control (FCTC). Today, 172 countries have adopted the FCTC and many are using the WHO-developed MPOWER package to support the effort. The acronym stands for Monitor tobacco use, Protect from tobacco smoke, Offer help to quit, Warn about the dangers, Enforce marketing bans, Raise taxes on tobacco. By 2010, 163 countries had completed youth surveys and 14 had completed adult surveys as part of the Global Tobacco Surveillance System. Findings help countries track tobacco use and encourage tobacco cessation through price increases, smoke-free policies, bans on tobacco advertising, and tobacco-related health information.

Increased Awareness and Response for Improving Global Road Safety

In 2001, the World Health Organization launched a five-year plan to improve global road safety and in 2004, along with the World Bank, issued the World Report on Road Traffic Injury Prevention. From 2001 to 2009, the number of annual traffic-related deaths in the European Union declined 36%, from 55,700 to 34,900. The largest declines in the traffic-related mortality rates from 2000 to 2009 were observed in Spain and Portugal; rates decreased 59.2% in Spain, from 14.5 deaths per 100,000 population to 5.9, and 47% in Portugal, from 12.9 deaths per 100,000 to 6.8.

Improved Preparedness and Response to Global Health Threats

The 2005 International Health Regulations, which entered into force in 2007, have modernized the international legal framework to improve preparedness and response to pandemic and other emerging health threats. Use of the Internet and other media for public health surveillance has expanded, and the Global Public Health Information Network, CDC’s Global Disease Detection (GDD) Operations Center, additional international influenza response networks, and other systems routinely detect and respond to clusters of unusual disease earlier than traditional surveillance.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES