Greatest Public Health Achievements of the 21st Century

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.