Silent Victories

The History and Practice of Public Health in Twentieth-Century America

Americans' health improved dramatically over the twentieth century. Public health programs for disease and injury prevention were responsible for much of this advance. Over the century, America's public health system grew dramatically, employing science and political authority in response to an increasing array of health problems. As the disease burden of the old scourges of infection, perinatal mortality, and dietary deficiencies began to lift, public health's mandate expanded to take on new health threats, such as those resulting from a changing workplace, the rise of the automobile, and chronic and complex conditions caused by smoking, diet and other lifestyle and environmental factors. Public health measures almost always occur on contested ground; accordingly, controversies and recriminations over past failures often persist. In contrast, public health's many successes, even the imperfect ones, become part of the fabric of everyday life, a fact already apparent early in the last century, when C.E.A. Winslow reminded his peers that the lives saved and healthy years extended were the "silent victories" of public health. In its exploration of ten major public health issues addressed in the 20th century, Silent Victories takes a unique approach: for each issue, leading scientists in the field trace the discoveries, practices and programs that reduced morbidity and mortality from disease and injury, and an accompanying chapter by a historian or social scientist highlights key moments or conflicts that shaped public health action on that issue. The book concludes with a look toward the challenges public health must face in the future. Silent Victories reveals the lessons of history in a format designed to appeal to students, health professionals and the public seeking to understand how public health advanced the country's health in the 20th century, and the challenges to protecting health in the future.