ABSTRACT
Public health has a long and, some might say, glorious history of bringing about large-scale social change. Human life expectancy has doubled over the last 150 years in large part due to public health.(1) Longer span of life certainly is the result of multiple factors, including advances in technology and increased prosperity, but a key driver has been the brilliant thinking and action of public health pioneers like Ignaz Semmelweis, who identifi ed iatrogenic infection as a cause of childbirth-associated maternal death and fought to reform hospital practices; and John Snow, who demonstrated that cholera in London was transmitted by sewage-contaminated drinking water and fought to establish modern sewer and water systems. The construction of public health systems to vaccinate those in need, in an effective time, place and manner, brought to full fruition the revolutionary science invented by Jenner, Pasteur, Salk and Sabin. Identifi cation of vitamin and mineral defi ciencies led to fortifi cation of salt with iodine, milk with vitamin D and drinking water with fl uoride, benefi ting millions. And in the late twentieth century, public health led the struggle to reduce deaths by motor vehicle injury and smoking-related cancers and lung disease.(2)
Historically, there are many examples of public health making large-scale social changes by increasing life span and life quality. But are we still capable of doing so? And is our role taking on new nuances?
