Special Report

Greatest Public Health Achievements of the 21st Century

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10. Lead exposure prevention
> Notable statistic: Over 1.4 million fewer children with elevated blood lead levels

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.

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9. Health insurance coverage
> Notable statistic: An estimated 19,000 lives saved due to coverage under the Affordable Care Act.

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.

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8. HIV control
> Notable statistic: Over 136,000 fewer HIV deaths

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.

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7. Motor vehicle safety
> Notable statistic: An estimated 165,000 lives saved since 2000

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.

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6. COVID-19 vaccine
> Notable statistic: 240,000 lives saved in the first half of 2021

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.

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