EDITORIAL

Grand accomplishments of a century

Some time during these short winter days, when you feel in need of a lift, click your way to http://www.cdc.gov/phtn/tenachievements/charts/charts.htm . This Web site lists, and elaborates on, what the folks at the Centers for Disease Control and Prevention believe are the 10 great public health achievements of the past century: vaccinations; motor vehicle safety; improvements in workplace safety; safer and healthier foods; control of infectious diseases; decline in deaths from heart disease and stroke; healthier mothers and babies; family planning; fluoridation of drinking water; and reduction in tobacco use.

A glance at the list should make pediatricians proud and humble. We should be proud because we have participated in many of these achievements and because our patients have been direct beneficiaries. Pediatricians haven't simply complied with recommendations to immunize, treat infection, and improve nutrition for infants and children. The community of pediatricians has gone further, actively advocating for a number of efforts over the years: fluoridation of drinking water; encouragement of breastfeeding and development of safe, nutritious infant diets when breastfeeding is unsafe or impossible; protection of infants and children through the use of car seats; development of vaccines and of school health regulations that mandate their use; development of policies that reduce morbidity and mortality in newborns (for example, those that prevent neonatal group B streptococcal infection) and infants (the Back to Sleep campaign); and much more.

At the beginning of the 20th century, the idea of having doctors just for children was new. One hundred years later, the public recognizes pediatricians as the physicians who are most effective at providing medical care for infants and children; as investigators who work toward discoveries that enhance child health and reduce disease; and as advocates for public policies that put those discoveries to work.

The CDC's list of achievements is also humbling, however, because it reminds us that much remains to be done. Only a minority of infants in this country breastfeed, even during the first six months of life. Many infants and children do not travel in a secure safety seat or wear a bicycle helmet. Tobacco use among teenagers is on the rise again. And infants and children still suffer and die from infections—in some cases, ones that could have been prevented by timely immunization.

The human genome project permits us a vision of a time when many chronic illnesses from which children suffer will be preventable or effectively treatable. The CDC's list reminds us that we already know what can prevent most of the conditions that result in premature death among our patients, but that we do not know how to ensure protection for 100% of them.

At the beginning of this new century, only incremental improvements in the 10 great public health achievements of the 20th century are in view ahead. No single discovery or policy will affect diet, exercise, smoking avoidance or cessation, or health education for parents, or will make effective preventive health care available to all children. For now, we continue to work in increments—but wouldn't it be fascinating to see, at this moment, the list that the CDC will generate in 2100?

Julia A. McMillan, MD, Editor-in-chief of Contemporary Pediatrics, is Vice Chair, Pediatric Education, and Director, Residency Training, Johns Hopkins University School of Medicine, Baltimore.

Julia McMillan. Editorial: Grand accomplishments of a century.

Contemporary Pediatrics

2001;2:9.