This commentary was adapted from episode 217 of the Health & Veritas podcast. The views expressed are the author’s own. Subscribe for weekly doses of expert insight on health and the healthcare industry.
We hear a lot about what’s going wrong with health in this country—and in the world. But step back 200 years, and the story is one of the most extraordinary triumphs in human history. Life expectancy in 1800 was roughly 35 years. Today it’s over 70, globally. That doubling didn’t happen by accident. It happened because of public health.
Here are some of the greatest achievements that got us here.
Let’s start with something we take completely for granted: clean water. In the 19th century, cities were killing machines. Cholera, typhoid, and dysentery swept through urban populations year after year. The fix wasn’t a drug; it was sewers. When London overhauled its sewage system after the so-called Great Stink of 1858, cholera cases collapsed to near zero within a decade. Cholera once killed roughly 1 in 20 Londoners. After the sanitation overhaul, it essentially disappeared.
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Edward Jenner’s smallpox vaccine in 1796 launched the most powerful tool in medicine. From one insight—that exposure to a mild disease could protect against a deadly one—we built a platform that now prevents more deaths each year than almost anything else. The WHO estimates that vaccines prevent 4 to 5 million deaths every single year.
Of all those vaccines, none produced a more dramatic result than the one against smallpox. A coordinated global campaign—the largest international health effort ever undertaken at the time—hunted the virus down country by country. The last natural case on Earth occurred in 1977. Three years later, the WHO made it official: smallpox was gone.
Smallpox killed an estimated 300 million people in the 20th century alone. We eradicated it. It is the only human disease ever fully eliminated.
When we decide, as a society, that preventable death is unacceptable, we can actually do something about it.
Before antibiotics, a scratch could kill you. Pneumonia was a near-death sentence. Childbirth fever routinely claimed young mothers. Then penicillin arrived, entering mass production in the 1940s, and the calculus of infection changed overnight. Before penicillin, pneumonia killed roughly 30% of people infected. Afterwards, that rate fell below 5%.
In 1900, for every thousand babies born in the United States, about 165 died before their first birthday. Today that number is around 5. That’s not a rounding error—that’s a revolution. Better obstetric care, antiseptic practice, prenatal nutrition, and neonatal medicine rewrote what it means to be born.
Smoking was once glamorized by Hollywood and endorsed by doctors in ads; it was the most significant preventable cause of death. In 1964 the Surgeon General published a report linking cigarettes to lung cancer and heart disease. That report triggered a decades-long campaign: warning labels, advertising bans, smoke-free laws, cigarette taxes. U.S. adult smoking fell from 42% in 1965 to under 11% today, averting millions of premature deaths.
Sometimes the intervention is invisible. Adding iodine to table salt essentially eliminated goiter and iodine-deficiency brain damage across the developed world. Adding folic acid to flour beginning in 1998 reduced neural tube defects in newborns by more than a third. These were regulatory decisions—not medical breakthroughs—that saved millions of lives.
Cars killed at a staggering rate in mid-century America. The response was systematic: seatbelts, airbags, speed limits, drunk-driving enforcement, road engineering. The result is one of public health’s quieter victories. Traffic deaths per 100 million miles traveled fell from 5.1 in 1960 to under 1.3 today—even as the number of drivers exploded.
None of these happened on their own. They required science, policy, political will, and public cooperation. They’re a reminder that when we decide, as a society, that preventable death is unacceptable, we can actually do something about it. The story of public health is the story of a world that chooses to survive.
“The Yale School of Management is the graduate business school of Yale University, a private research university in New Haven, Connecticut.”
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