Health Care In The 20th Century - Statistical Data Included

Pediatrics for Parents, Jan, 2001 by Harry Pellman

The history of vital statistics in the United States dates back to 1632 when the General Assembly of Virginia passed a law requiring the registration of christenings, marriages, and deaths. Other colonies soon followed suit.

The United States Constitution included a provision for a decennial census but left the vital registration function to the states. In 1902, the U.S. Bureau of Census became a permanent agency of the federal government and was authorized to obtain, annually, copies of death records from states and to publish the data. Only a few states and cities kept adequate records in those days to meet the publication criteria.

The National Birth Registration Agency was established in 1915. By 1933, all states were registering live births and deaths with acceptable accuracy to provide valid statistics. In 1946, the US Public Health Service became responsible for collecting and publishing vital statistics.

The National Center for Health Statistics was established in 1960 by a merger of the National Office of Vital Statistics and the National Health Survey. Finally, in 1987, the National Center for Health Statistics became part of the Centers for Disease Control and Prevention, US Department of Health and Human Services.

The 20th century teemed with progress. Horse and buggy, boat, and rail travel were, to all intents and purposes, replaced by the automobile and jet plane. Communication by telegraph and mail service was replaced by telephone, satellite, the World Wide Web, and more efficient mail service (though junk marl is a twentieth century phenomenon).

Live entertainment was to a significant degree replaced by the radio, phonograph, audio and video tape, CD, and television. Home heating, air conditioning, lighting, water and toilet facilities were all improved or introduced during the last century.

Health care was no exception to the amazing progress made during the last one hundred years. During the 20th century, the age adjusted death rate declined by 74% and life expectancy increased 56%. This is considered a triumph of public health and biomedical research.

These hundred years saw changes in health care that included the widespread use of immunizations, vast improvements of sanitation, surgical milestones that included sterile techniques, safer anesthesia, miniaturization of many surgeries, less invasive methods of surgery, and the transplantation of organs.

Much safer and more varied medications, including the introduction of antibiotics and antiviral therapies, became available. Diagnostic tools now used routinely that were unavailable 100 years ago include a wide variety of sophisticated blood tests, X-rays, and imaging studies such as bone scan, thyroid scan, CT and MRI. The ECG, EMG, and EEG are products of the last century.

"Scoping," such as arthroscopy and endoscopy, was introduced as well as the medical (and industrial) use of laser technology. The list could go on and on.

There were many vital statistics that changed during the last 100 years. Life expectancy went from the mid 40s to the high 70s. In the early part of the previous century respiratory infectious diseases accounted for almost a quarter of all deaths. Pneumonia and influenza remained the second leading cause of death overall until 1933 when cancer replaced it. In 1998, the two leading causes of death overall were heart disease and cancer. Pneumonia and influenza have dropped to numbers six and seven on the list.

We often hear the term "baby boom." The peak years of the baby boom occurred in 1950 to 1957 when 123 out of every 1000 women aged 15 to 44 gave birth (actually very similar to the birth rate in the 1920s). To compare, the birth rate during the last quarter century has stayed relatively flat at about 65 births per 1000 women of childbearing age.

Maternal mortality slowly declined early in the twentieth century. Maternal deaths is defined as the number of deaths during pregnancy and the following 42 days. Beginning in 1935, the mortality rate of 582 deaths per 100,000 live births began a precipitous decline so that by 1956 it was 40 deaths per 100,00 live births and in 1998 7.1 deaths per 100,000 live births. There was an overall drop in maternal mortality of 90%.

Infant mortality also declined. In 1915, about 100 white infants per 1000 live births and twice as many black infants died in the first year of life. In 1998, the infant mortality rate was 7.2 overall, 6.0 for white and 14.3 for black infants. Several important advances in neonatology have been instrumental in significantly reducing infant mortality over the last twenty years.

For children older than one year old, the decline in mortality was even greater. In 1900, about 30 children in a thousand died between ages one and twenty. In 1998, the number had reduced to less than two. The leading causes of death in children in 1900 were infectious diseases (diarrheal diseases, diphtheria, measles, pneumonia, influenza, scarlet fever, tuberculosis, whooping cough, typhoid fever, etc.). Infectious disease as a cause of death declined from 61.6% to 2% over the last century.