Top 10 Public Health Troubles of the 20th Century

1 Prior to 1900-Present — Black Lung Disease: Hundreds of thousands of American miners have suffered and died from black lung disease (also known as “coal worker’s pneumoconiosis), a respiratory illness caused by the inhalation of coal mine dust. The combined failure of government, medicine, and industry to halt the spread of this disease — and even to acknowledge its existence — resulted in a national tragedy, the effects of which are still being felt today. Black lung disease usually affects workers over age 50. There is no cure for this disease, but it can be prevented by avoiding breathing in coal dust. After activism, Congress legalized the term “black lung” as a synonym for that disease in Title IV of the Coal Mine Act. It was the first time that Congress had mandated that an occupational disease occurring in a major industry must be eradicated. Congress also established the black lung benefits program, the first and only federal compensation statute to compensate victims of occupational diseases.

2 1916, 1952 — Polio: Polio occurred primarily in July, August, and September and hit regardless of geographic region, economic status, or population density. Relatively few people showed any symptoms and even fewer died or experienced paralysis, but the physical effects were dramatic. Communities reacted with dread because no one understood how or why people got it, and because children were the most frequently affected. Over 7,000 deaths and more than 27,000 cases reported in America’s worst polio (infantile paralysis) epidemic in the U.S. New York City experienced the first large epidemic of polio, with over 9,000 cases and 2,343 deaths. When the epidemic in the United States peaked in 1952, polio had struck nearly 58,000 people, mainly children and young adults. In that year, the U.S. reported 57,000 cases with 3,300 reported dead. In the three years between 1955 and 1957, the incidence of polio in the U.S. fell by 85 – 90 percent with the widespread use of Salk’s polio vaccine.

3 1918 — Spanish Influenza: More people were hospitalized worldwide during World War I (WWI) from influenza than from wounds, and this flu killed more people than the war itself — somewhere between 20 and 40 million people worldwide. US Army training camps became death camps with 80 percent death rate in some camps, and this pandemic is cited as killing more people in a single year than in four years of the Black Death Bubonic Plague from 1347 to 1351. Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, “One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred.”

4 1941, 1962-65 — Rubella (German Measles): Rubella (which means “little red” and is also known as German measles) originally was though to be a variant of measles. It is a mild disease in children and adults, but can cause devastating problems if it infects the fetus, especially if infection is in the first few weeks of pregnancy. Children who are infected with rubella before birth are at risk for growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems. Worldwide between 1962-65, this disease affected as many as 12.5 million causing deafness, blindness; approximately 30,000 babies in USA alone due to maternal rubella. Rubella can be prevented by the rubella vaccine. Widespread immunization against rubella is critical to controlling the spread of the disease, thereby preventing birth defects caused by congenital rubella syndrome.

5 1957-1958 — Asian Flu: Victims of this flu strain (subtype H2N2) experience fatigue, aches and pains and fever that can last two weeks. Experts identified the pandemic first in wild ducks the Far East in February 1957 before it mutated with the existing human flu strain. The virus first made its way to the U.S. in the summer of 1957 where it would account for 70,000 deaths. Although infection rates were highest among children and pregnant women, the elderly suffered the highest rates of death.

6 1961-1970 — Cholera: There are references to deaths due to dehydrating diarrhea — one of the symptoms of cholera — dating back to Hippocrates and Sanskrit writings. In 1961, the “El Tor” biotype (distinguished from classic biotypes by the production of hemolysins) reemerged and produced a major epidemic in the Philippines to initiate a seventh global pandemic in 1961. In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern sewage and water treatment systems. However, as a result of improved transportation, more persons from the United States travel to parts of Latin America, Africa, or Asia where epidemic cholera is occurring. U.S. travelers to areas with epidemic cholera may be exposed to the bacterium. In addition, travelers may bring contaminated seafood back to the United States. The CDC carries information for travelers.

7 1968-69 — ‘Hong Kong’ Flu: This flu (H3N2) often is confused with the common cold, but symptoms (high fever, joint pain, lack of energy) worsen and last longer. Symptoms normally cause a victim to become bedridden for up to two weeks. Named after the city where it was first detected in 1968, the virus returned in 1970 and 1972. The elderly were hardest hit. In the U.S., 34,000 fell victim to the Hong Kong influenza between September 1968 and March 1969, and almost one million people worldwide died.

8 1981-Present — AIDS/HIV: This pandemic was first recognized by U.S. doctors in 1981, with cases in California and New York. The first cases were found among gay men, then injecting drug users. The name, “Acquired Immune Deficiency Syndrome,” or AIDS was created the following year, and in 1983 this disease was reported among non-drug using women and children. By 1984, scientists identify HIV (initially called HTLV-III or LAV) as the cause of AIDS. As late as 2007, around 33 million people are living with HIV, according to revised estimates. According to the Avert site, more than 25 million people have died of AIDS since 1981. Africa, where it is agreed that the disease originated, has over 14 million AIDS orphans.

9 1989-90 — Flu: In the last official epidemic during the winter of 1989-90, 600 people per 1,000 fell ill and 26,000 people died in the UK. Influenza is a highly contagious viral infection which can have very serious complications, especially in ‘at-risk’ populations. These groups are more likely than the general population to experience complications following influenza, such as bronchitis, pneumonia, otitis media (ear infection) and sinusitis that may require hospitalization. Many flu strains can be prevented by vaccination, but there is no cure.

10 1989-1991 — Measles: This pandemic started in Maryland and spread rapidly throughout all the states within the continental U.S. It was a resurgence that occurred among pre-school aged children and it increased sixfold to nine fold over the median annual incidence (1.3 per 100,000 population) reported from 1981 through 1988. The measles epidemic is a consequence primarily of the failure to vaccinate preschool-aged children at appropriate ages; among children aged 16-59 months who developed measles during this resurgence, only 15 percent had received measles vaccine as recommended (CDC, unpublished data).