Vaccines， immunizations, sulfa drugs, the discovery of anesthesia, and modem surgqry are widely credited with having eliminated many of the epidemics and diseases that plagued our great-grandparents and their parents.

More careful study of mortality patterns both here and in England, however, shows chat the miracles of modem medicine have had little to do with this transformation. First, most of the decline in the death rate occurred before the-discovery of effective drugs and vaccinations. For instance, the U.S. death rate firom tuberculosis dropped from 200 per 100,000 Americans in 1900 to 70 per 100,000 in the 1930s 一 before lung-collapse therapy or even rest in sanatoriums was widely prescribed. The rate dropped to 30 per 100,000 before effective chemotherapy became available in the1950s. Second, in many cases the rate of decline did not increase much after the introduction of effcctivc medicine, suggesting that only part of the subsequent declines can be credited to medicine. What, then，caused the great decline in death rates and the elimination of most infectious diseases as msyor killers? In the case of water — and food 一 borne diseases such as cholera and typhoid, the key was dean water, safe milk, and public sanitation. In the case of air-borne diseases the key was a better-fed, better-housed, better-clothed, and thus stronger and more resistant population.

And what of health today? Modem medicine surely eases the pain and shortens the course of many illnesses. However, the incidence of such illnesses as heart disease, cancer, and stroke are increased by personal habits and environmental factors that are little affected by strictly medical advances. In particular, Americans arc harmed by their rich, fatty diet (and the obesity that often accompanies it), their tendency to smoke too much and exercise too little, their polluted environment, and the stresses of modem life. The other major causes of disease, about which we can as yet do little, are genetic，geriatric, and psychiatric.

Poverty and Health

Poverty is linked to poor health throughout the world. The United States is no exception. The medical carc rcccivcd by the rural and urban ^ietto poor is often inferior to that received by more advantaged Americans. The health of the poor is often undermined by less adequate diets, poorly heated homes, and the stress of strug^ing to get by, which weaken them and make them more vulnerable to disease.

Americans spend more on health care than any other nation in the world, yet statistically we are not the world’s healthiest nation. Althou^hi our overall infant mortality rate has continued to fall, it is edging upward again in some areas, pardcularty in the states where reductions in government aid have forced cutbacks in prenatal, maternal, and preventative health services. During the eariy 1980s, when unemployment in Michigan reached depression levels, hard hit cities like Warren reported a 53 percent increase in its infant mortality rate. And in cities such as Washington, D. C” with the substantial underclass of poor and disadvantaged £uniliesy the infant mortality rates are hi^ier than in such nations as Jamaica, Cuba, and Costa Rica.

Unfortunately for the poor, there is a cycle of poverty and illness. The poorer you are, the sicker you are likely to become. And the sicker you are, the poorer you are likely to become. Moreover, the poor not only get the diseases of poverty, such as tuberculosis and other infectious diseases; they also suffer more from the so-called diseases of affluence — cancer and heart disease. Why? Because their diet is more &tty and they are exposed to more pollutants and other cancer-causing agents. And above all, their life is frequently more stressful.