Greatest Public Health Achievements of the 21st Century

Since the 1970s, the federal and state governments have made a concerted effort to control childhood lead exposure through prevention strategies and widespread screening of blood lead levels. While in 1990 only five states had comprehensive lead poisoning prevention laws, 23 states had enacted comprehensive laws related to controlling lead exposure by 2010. Increased lead inspection and removal efforts also helped reduce exposure. While in 2002 some 8.7% of children 1 to 5 years old tested positive for blood lead levels above 5 micrograms per deciliter, by 2016 that figure was just 1.3%, a difference of over 1.4 million children.

In March 2010, the U.S. Congress passed the Affordable Care Act, a landmark legislation that expanded the publicly funded Medicaid program and established a private health insurance marketplace for individuals and small businesses. Since the Medicaid expansion went into effect in 2014, the share of the U.S. population that is uninsured fell from 14.9% to 8.7%, reflecting an estimated increase of 20 million newly insured Americans. While it is difficult to quantify the impact of health insurance coverage on mortality, a 2019 study from the National Bureau of Economic Research estimates that the expanded Medicaid program led to a reduction in roughly 19,200 deaths over the first four years of the program.

The prevalence of HIV in the United States has reached an all-time low since the start of the epidemic. Prevention tools like pre-exposure prophylaxis (PrEP) and HIV treatment have lowered transmission rates, and improved screening efforts have helped identify HIV infections and further reduce spread. The Affordable Care Act granted greater access to care to at-risk individuals, and in 2015 the U.S. Department of Health and Human Services announced that Medicare would cover annual HIV screenings for all beneficiaries. Advances in HIV treatment have also led to reduced mortality from the disease overall. The number of deaths due to HIV fell from 5.2 per 100,000 Americans in 2000 to 1.4 per 100,000 in 2020, a reduction of more than 136,000 deaths.

Systematic efforts to improve motor vehicle safety began in the 1960s with the creation of the National Highway Traffic Safety Administration, which has continued to respond to the growth of automobile traffic with new car and roadway safety standards in the 21st century. The NHTSA required all new vehicles to include electronic stability control by 2012, which it estimates will save more than 1,300 lives annually when all vehicles on the road incorporate the technology. As of May 2018, the NHTSA required all new cars to include backup cameras, which are estimated to save between 58 and 69 lives per year. Since 2000, the motor vehicle fatality rate has fallen from 15.7 per 100,000 people to 12.9 per 100,000, reflecting roughly 165,000 lives saved over the period.

When the World Health Organization declared COVID-19 a pandemic in March 2020, the average time between researchers identifying a novel pathogen and developing a vaccine for it was 48 years. The COVID-19 vaccine was developed in less than a year, and by January 2022 more than 10 billion doses of the vaccine had been administered worldwide. According to a research letter published on the JAMA Network of peer-reviewed journals, COVID-19 vaccines saved over 240,000 lives in the first six months of 2021.

When hepatitis C was first discovered in 1989, the disease was largely viewed as incurable. While the first treatment was approved in 1991, the cure rate was only 6%. Hepatitis C quickly rose in prevalence, and in 2014 was the cause of death for 19,659 Americans – the most of any infectious disease at the time. In the last several years, however, screening efforts have dramatically improved, and a number of far more effective drugs have been developed. Today, 90% of patients with the most common form of hepatitis C can expect to be cured in fewer than eight weeks from starting treatment. A recent study published in the peer-reviewed journal Advanced in Therapy projects that the disease will be effectively eliminated in the United States by 2037, saving hundreds of thousands of lives.

The cancer death rate declined 27.6% in the United States over the last two decades, falling from 204.5 cancer deaths per 100,000 residents in 2000 to 148.1 per 100,000 in 2020 – a difference of over 615,000 deaths. Research suggests this decline is due in part to an increase in access to cancer screening tests that can catch cancer early, when the disease is more responsive to treatment. Other factors contributing to declining cancer mortality include new cancer treatments, an increase in vaccines for cancer-causing viruses, and a decline in tobacco use.

Since the Occupational Safety and Health Act was passed in 1970, establishing the Occupational Safety Health Administration and a number of federal standards for workplace safety, workplace deaths have consistently fallen, from an average of 38 worker deaths per day in 1970 to 15 a day in 2019. OSHA has continued to make life- and injury-sparing improvements in the 21st century, and was critical in ensuring worker safety during the COVID-19 pandemic. In one news release, OSHA estimated that its emergency temporary standard for covered employers to enforce a mandatory COVD-19 vaccination policy would save thousands of lives and prevent more than 250,000 hospitalizations. The AFL-CIO estimates that OSHA standards have prevented more than 618,000 worker lives in the last 50 years.

Over the last two decades, the federal and state governments have made substantial efforts to reduce tobacco use among U.S. adults and youths. In 2009, the federal government raised the federal excise tax from $0.39 to $1.01 per pack, resulting in a significant decline in the youth smoking rate. While no state had a comprehensive smoking ban in 2000, as of 2022 there are 28 states with laws banning lighting up in workplaces, restaurants, and bars. Adult smokin rates have fallen from 23.5% in 1999 to 13.7% in 2018, while youth rates have fallen from 34.8% to 8.8% – together resulting in millions of fewer deaths.

While heart disease is the leading cause of death in the United States, claiming one life every 36 seconds, the 21st century has seen dramatic improvements in its treatment and prevention. Progress has largely been fueled by a decline in tobacco use, improvements in hypertension treatment, and advances in cholesterol-regulating drugs. Deaths due to heart disease fell from 248 per 100,000 in 2000 Americans to 149.2 per 100,000 in 2020 – a difference of 3.1 million deaths over the period.