By Michael Wilkes, M.D.
The history of public health in America is an impressive success story that includes efforts to cure and prevent diseases and injuries. Although the skills of surgeons and cardiologists are amazing, and have helped a few people enormously, they have contributed relatively little to the overall life expectancy in America.
Instead, increases in life expectancy have been primarily attributed to sanitation, diet improvement, water purification, transportation improvements and, of course, immunizations. Americans live more than twice as long as our colonial forbears.
Unfortunately, these changes have not always come without struggle. Unfortunately, not all Americans have benefited equally from public health or medicine, including women, people of color, the poor and those in rural areas.
Increasing urbanization of America has brought fresh water, sanitation, public housing and access to trained medical providers. Killers 100 years ago included infectious diseases such as TB, smallpox and syphilis. Take, as one example, Milwaukee at the turn of the last century. Smallpox attacked people of all ages, but particularly hard-hit were the young and those living in poor conditions that included overcrowding and poor sanitation. Thousands died each month of smallpox and those who survived lived a life with significant disability.
Remember that by 1900, smallpox was a preventable disease but no one was willing to take the steps to prevent its spread. A strong public health physician named Walter Kempster took on smallpox with gusto, but created a Milwaukee on the verge of civil war — the community was divided into those wanting to stop the plague and those not wanting to be inconvenienced. Kempster hired extra physicians to launch a required immunization program, he forcibly isolated infected persons by placing them in an isolation hospital, and he imposed strict quarantines for those allowed to remain in their own homes.
The wealthy and politically connected fought back, claiming these steps were against their liberties and their rights as Americans. Stone-throwing crowds protested and homes were barricaded so people could not be removed. Thugs threw scalding water at horses pulling ambulances so the infected could not be moved. Many attempts were made to both close the health department and fire Kempster. But Kempster held strong in a severely divided city. Eighteen months later, health came to Milwaukee and Kempster’s approach was vindicated.
Fifty years later, infections were being treated with amazing antibiotics, but the huge decline of these deadly diseases started 80 years earlier as a result of important public health interventions that required restrictions on human behaviors and limited personal liberties. As we cured acute illnesses, what emerged to take their place were chronic illness like diabetes, cancer, alcoholism and tooth decay. They also required public health interventions.
In many areas, the United States lagged, and still lags, behind most other developed nations. The reasons for this are complex, but are rooted in the disparities in our health care and our inability to place the health of the public above the personal liberties of a few. We have notable successes. We have chlorinated public water; required seat belts and motorcycle helmets; set speed limits on highways; forbade drinking and driving; pasteurized dairy products; added supplements like vitamin D, calcium, iron and iodine to foods to improve the health of the public; and limited where smokers can light up.
With each of these interventions came large fights. Those promoting the health of the public were opposed by those arguing it was their right as an American to have salt without iodine or milk without vitamin D or to smoke where they wanted. The response to each battle was the same. Eventually, those promoting the greater good, backed by strong science, won, and the supplement was added. Those who didn’t want exposure were, of course, encouraged to buy their ingredients without these supplements.
In Davis, we are now faced with a similar debate around fluoride. The issue isn’t the science, because I can think of nothing that is based on more rigorous research with large populations of people around the world. Fluoride works. And safety isn’t the issue. We know that claims of brittle bones, early cancers, lowered IQs and missed menstrual periods are all just smoke and mirrors to divert the discussion. If these were true, surely after 1 billion people were exposed to fluoride for decades we would have seen these events.
So, at its core, this fluoride discussion is about whether a few can block a benefit for the many. The opposition has made their argument and it holds no water. Like with vitamin D in milk, chlorine in public water and iodine in salt, the benefits to the public are enormous, the costs to society are tiny, and the liberties for those opposed are preserved in that if they want fluoride-free water they can go and purchase it.
— Michael Wilkes, M.D., Ph.D., is a professor of medicine and public health at UC Davis and chairs the Yolo County Health Council.