Result of Poll 'Most important public health publication'

On Januari 10 we posted a small poll on the Facebook page: 'what do you consider the most important public health publication ever?'

Two weeks later we closed the poll and count the submissions. The poll reached 11.164 Facebook users, received 238 likes, and harvested 12 submissions of publication titles. Two titles received most votes, and seven additional titles were submitted only once. These are the results:

1. The Mortality of Doctors in Relation to Their Smoking Habits (Richard Doll and A Bradford Hill, 1954) - most votes
2. The etiology, concept, and prophylaxis of childbed fever (Ignaz Semmelweis,1861) - runner up

Other publications proposed once:

• Epidemics I, II and III by Hipppocrates
• The English Public Health Act 1848 (By E. Chadwick)
• An Inquiry Into the Causes and Effects of the Variolæ Vaccinæ, Or Cow-Pox. (Edward Jenner, 1798)
• An Essay on the Most Effectual Means of Preserving the Health of Seamen (James Lind, 1762)
• The Framingham Study: the epidemiology of atherosclerotic disease (Dawber, 1980)
• Publications on the North Karelia Project (Finland, started 1972).
• On the communication of cholera by impure Thames water (John Snow, 1854)

Reflections

No publications from the last 35 years were proposed, even though the people submitting to the poll are clearly of the 'modern generation'. What does this mean? Did we achieve all major public health progress? Perhaps... Still, there is lots to do in my view.

In addition, it seems to me that many of the proposed publications have been at the centre point of much scientific and social controversy. The Doll and Hill study provided convincing evidence of association, yet the causality would be debated for decades. In fact, Bradford Hill formulated 'viewpoints on causality' (not 'criteria', mind you), where he described the challenges of attributing causality very well.

I wonder what Sir Bradford Hill would say of the current trend in society to ignore facts, and embrace 'alternative facts'

The runner up, an impressive set of accurate observations of an intelligent young doctor, has never in his lifetime provided him with the credit due. Ignaz Semmelweis was branded a fool, and was committed to a mental hospital, where he died a miserable death. And most of us are well aware of the scepsis that John Snow had to confront, with his theory of waterborne spread of cholera in the mid-nineteenth century. At least his findings were strengthened thanks to his most fierce opponent, William Farr, who was determined to prove that Snow's conclusions where incorrect. Farr ended up proving independently, that Snow's conclusions made sense statistically.

The number of submissions is lower than I had expected, especially considering the wide distribution of this poll (over 10.000 readers). Yet I have to admit to have expected at least one reference to civil engineering, a professional field with profound impact on primordial prevention of communicable diseases in modern society.

Finally, it was a pleasant surprise to see the Public Health Act by Edward Chadwick (1848) as a proposed candidate. I agree that scientific, peer-reviewed publications, though of essential importance, are the sole achievement of public health progress, contrary to what some scientific institutes may wish to believe. And it is a nice timing, considering we could celebrate the 216th birthday of Chadwick yesterday.

Conclusion

The public health value of the submitted titles is undisputed, and it is good to see how much our current generation is still aware of this. Still, in the recent four decades, much public health impact has been achieved, and I wonder if there is not yet a contender to the title 'most valuable public health publication', that we have missed in this poll.

If we did, please let me know.