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Chapter II
' I'rom <he I'"bhe H~,hh I'"n "noll! l'roJec< (1994_1999). d"ec<ed by " S<ecron!:
Co"'n"tt~c eI,,,,,,,, by the A$$""'" SccrC<1ry of He,hh .nd Smgcon Gener;1l wnh
th. p.rtiripJnon of CDC ond 0 hO$1 of pllhlic hClhh '1Io<:i,"ions. fo""d~non$ .""
<>'1:>1"""0"'.
Case Study
The Creation of CDC
The Communicable Disease Center (CDC) opened in
the old Office of Mabria Control in War Areas in Atlanta,
Georg ia, on Ju ly I, 1946. As a part of the U.S. Public
Hea lth Service, the original C D C mission was to work
with state and local health offic ials in the fi ght :tgainst
malaria, then sti li prevalent in several Somhern states,
as well as typhus and other comlllunicable diseases. Its
fOllndcr,Josepb W. Mountin, MD, a visio nary public
health leader, had high hopes for this small and compara-
tively insi gnificant branch of the Publi c Health Service.
Dr. M OlitHin received his medical degree from Marquette
University in Milwaukee, Wisconsin, in 1914. H e bcg:lIl h is
ca reer with the Public Health Service durmg World War I
working in sanitation in the temporary living quarters
specially built by the U.S. Army for soldiers in military
arC:lS throughout the United States. In his distinguished
C:lrecr with the Publi c H e:lh h Service, Motlntin became
widely known as the f:1ther of many servIce progr:lms.
In bte Novembe r 1951, he was appointed to the post of
bureau c hi ef with the r:lnk of Assistant Surgeon General.
MOllntin died ullcxpectedly the following YC:lr at the
Naval M edic:l1 Cclltcr in Octhesda .
During the first years of CDC, medical epidemiologists
were scarce. It was nor umil 1949 that Dr. Al exander
Langmuir, now known as rhe f:1 th er of infectious disease
epidemiology, arrived to head th e epidemiology branch. He
launched the first-(:ver disease survei llan ce program and
co nfirm ed hi s sllspicions tbat malaria co ntrol. the largest
part of rhe C D C budget, had lon g since become unn eces-
sary. Subsequently, disease sur vei ll:l.1l ce becal1lt" the corn er-
stone o f C D C "s mission of service and. in time, ch:mged
the practice of public health . Langmuir was C D C's chief
epidemiologist from 1949 to 1970 . He spellt the rest of
hi s life teachin g at Harvard Medi ca l School and at Johns
H opkins, where he had earned his degree in public ht"alth .
In 1993. he died of kidney cancer at the age of83.
Vignette
Surgeon General's Report of 1964
More than 40 years ago on January 11, 1964, Luther L. Terry, M D,
Surgeon Gem: ral of the U.S. Publi c Health Service, released the
report of the Surgeon General's Advisory Commi ttee on Smoking
and Health. This landmark document, now referred to as th e first
5urgeol/ GCI/I'ra/'s Rcport Oil 51110kill}; alit! I-lea/rll, had a tremendous
impact on pllblic attitudes and policy for three important reasons.
First , an official U.S. agency recognized for the first time that cigarette
smokin g caused cancer and other seriOllS diseases. Second , it prompt-
ed a series of public health actions reflecting changes in societal
att itudes toward the health hazards of tobacco usc. Third, the Surgeon
General's report was the fir st to rece ive widespread media and public
attention. Although evidence that smoking caused harm had acculllu -
lated since the 19305, official so urces did not recognize the ill effects
at rhe time. E pidemiolog ists used statistics and large-scale, long-term
case control surveys [Q link the increase in hmg cancer mortality to
smoking. Pathologists and laboratory scientists confir med the statisti-
cal relationship of smoking to lung cancer as well as to other serious
diseases, such as bronc hitis, emphysema and coronary heart di sease. In
1957, then- Surgeon General Leroy E.13urney declared as the official
position of the U.S. Publi c Health Service dut smoki ng caused
lu ng cancer.
The impulse for an official report 011 smoking and health did not
come until 1961, however, pushed by an alliance of pro min ent private
health organizations. Th e American Cancer Society, the American
Heart Association , rh e National Tuberculosis ASSOC iation, and the
Amer ican Public Health Association called for a national comm ission
on smoking In a letter addressed to President John F. Kennedy. Th e
letter sought a commission dedicated to "seeking a solution to this
health problem that would interfere least with the freedom of indlls-
try o r rhe happiness of individuals."
Among the steps that followed the report were banning tobacco
advertising on broadcast media, placing mandatory health warnings
all cigarette packages and developing effective treatments for tobacco
dependence. The Office of the Surgeon General has issued 27 subse-
quent reports on tobacco lise, cove rin g su ch topics as environmental
(i.e., secondh and) tobacco smoke. These reports helped lead the way
to smo ke-free public places, restaurants and bars .
Looking Ahead
Public Health - A 21st Century
Perspective
The: 21 st century prt'st'llts a new set of challenges to the
nation's health. Whether confronting bioterrorism attacks,
emerging infccrions, lifestyle bch:tvlOrs, disparities in he:thh
status, or increases in chrOllic disease and injury ratcs, th e
Biotcrrorisl11
AII/hm.\' was spread Ihrm/.r:/1 IIII' pos/1I1 sys/rlll i/l Ihe fall (12 00 I.
Lifesty le an d Be h avior C h an ge
While this ce ntury's medica l advances and publi c health
efforts have dramatically reduced the threat of infectiollS
disease in the U.S., poor hC:llth due to lifestyle behaviors
remains a threat co public health. Poor lifestyle behaviors
arc linked to chronic diseases, the heaviest burden on the
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