Q. Do life expectancy rates keep increasing?

A. Life expectancy in the United States has been increasing steadily throughout our history.

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Major increases were made during the 50-year period from 1900 to 1950. Age-adjusted mortality rates estimated by the Social Security Administration provide evidence.

In 1900, there were 2,544 deaths per 100,000 people (age adjusted). At midcentury, there were 1,435 deaths per 100,000. This is an astonishing decline.

The Centers for Disease Control and Prevention documents a corresponding improvement in life expectancy. A person born in 1900 could be expected to live an average of 47.3 years. By 1950, life expectancy was 68.2 years. This increase in life span has not been exceeded in the United States in any previous period.

The improvement in life span during the first half of the 20th century was due in large part to control of infectious diseases. By midcentury, people were dying later in life and from different causes than their parents and grandparents.

In 1900, infectious diseases such as pneumonia and influenza, tuberculosis, and intestinal infections, were the three leading causes of death in the United States. These "big three" accounted for over 31 percent of all deaths.

Q. Water is a big issue in the Red River Valley, but drinking water is rarely the focus. How has clean drinking water contributed to longevity?

A. The provision of clean water for drinking, cooking and hygiene was one of the most important of the large-scale public health initiatives of the 19th and early 20th centuries.

Growth of towns and cities led to widespread degradation of drinking water. Sources were often contaminated by sewage, which spread waterborne infectious diseases and -- it is hypothesized -- weakened the immune system.

People were susceptible to other infectious agents. When cities and towns began treating drinking water and ensuring that it was not also contaminated by sewage, death rates dropped dramatically.

"The Golden Ounce," a history of public health in North Dakota written by Dr. Stephen McDonough, recounts the story of the great typhoid epidemic in fast-growing Grand Forks in 1893 to 1894, which resulted in the death of "one out of every 25 residents of Grand Forks."

Its cause was contamination of the Grand Forks water supply by sewage emptied into the Red Lake River from Crookston. The first response of many was to deny the source of disease. "Once typhoid fever had been established as the cause of the Grand Forks epidemic, the Herald quickly began a campaign to obtain a safe water supply."

As a result, "In the fall of 1894, Grand Forks installed a modern water supply using a sand filtering system. Although the city outgrew the sand filter in 1910 when a mechanical filter was installed, typhoid fever cases dropped dramatically. Chlorination also began in 1910. The Grand Forks water supply became the first fully enclosed, sand filtering device in the United States."

Large-scale public health projects such as those to purify drinking water have made major contributions to human longevity and quality of life.

Goldsteen is director of the UND School of Medicine and Health Sciences Master of Public Health degree program, which is jointly offered with NDSU. He has devoted most of his professional life to advancing public health and holds a doctorate in public health.

Submit questions to healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037.

The content of this column is for informational purposes only and should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider.