definition of health and public health

U N I V E R S I T Y O F M I C H I G A N

S C H O O L O F D E N T I S T R Y1

Definition of Health and Public Health



Objectives

• Define health and public health• Discuss a new definition for dental public

health practice• Discuss current and future status of dental

public health• Introduce the basics of public health planning• Introduce the structure of public health

systems



What is health?

• World Health Organization– Health comprises complete physical, mental and

social well-being, and is not merely the absence of disease.

• Is this achievable?• Health is a state where humans can function

socially, mentally, and physically, as active members of their families and community.



What is a public health problem?

• Public health, according to Burt and Eklund [1999] cannot easily be defined.

• There is a general consensus that public health is “…fulfilling society’s interest in assuring conditions in which people can be healthy.” (Institute of Medicine, 1988).

• There is a widespread condition actual or potential cause of morbidity or mortality

• There is a perception on part of the public, government, or public health authorities that the condition is a public health problem.




• This definition implies that public health planning should encompass all programs or services that can promote the health status of a targeted population.

• Public health programs or services should include activities that focus on health promotion, and primary, secondary and tertiary healthcare.



• Dental caries is a public health problem because it is a widespread condition that is costly to treat and it impacts on the quality of life at all ages. In most of the developing world, dental caries remains untreated.




The Three Revolutions in Public Health

• The first era-the communicable disease era-began during ancient times and continues today;

• The second era--the chronic disease era--began during the 20th century, particularly among the industrialized nations.

Breslow L. AJPH 2006;96:17-20.



The Three Revolutions in Public Health

• Substantial and growing segments of the population no longer regard disease as the only, or even the primary, health problem.

• The third revolution in public health aims to achieve long and fruitful life, not simply the absence of disease.

• The focus is on wellness• Health promotion is the science and art of

promoting health and wellness.

Breslow L. AJPH 2006;96:17-20.



What is DPH?

• AAPHD, APHA (Oral Health Section)• Dental public health is the science and art of

preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. (Adopted May 1976)



• Dental public health is a scientifically-based specialty of dentistry and public health that integrates knowledge and experiences from dental, behavioral, public health, educational and political sciencessciences, with experiences from business, management, marketing, and advocacy, to promote health and oral health and provide primary, secondary, and tertiary dental care for individuals and populations.

Dental Public Health Re-defined



Rozier RG. AAPHD Turns 60—Back to the Future: Whatever Became of Dental Public Health. J

Public Health Dent 1997;57:3-4.

• Dental public health in not well prepared to assume its role in this new, complex world.

• Many programs are seriously under-developed and under-supported.

• Nearly one-half of state health agencies are affected by dwindling oral health expenditures or a total lack of such expenditures.



Institute of Medicine (IOM)Report on the Future of Public

Health• 13% of the GDP goes towards health care in

the USA.• Health indicators (life expectancy, infant

mortality)– Infant mortality among blacks is about 2.5 times

higher than white Americans

• 95% of expenditures are directed towards medical care and biomedical research.

• Behaviors cause 70% of all chronic diseases.



National and/or Local Policy Initiatives

Fiscal Measures

Legislation/Regulation

Healthy Settings-Healthy Promoting Schools

Media Campaigns

Chairside Dental Health Education

Training of Other Professional Groups

Community Development

School Dental Health Education

Clinical Prevention

Upstream/Downstream: Options for Oral Disease Prevention.

Watt RG. CDOE 2007;35:1-11.



The Implications for DPH

• From– Fluoride– Sealants– Education

• To– Addressing the causes of inequalities and

inequities in oral health– Comprehensive dental/oral care models– An integrated oral health promotion care model – Social and policy initiatives



Education of a DPH dentist (professional) (specialist)

• Biology of oral conditions

• Social and behavioral sciences

• Planning, policy analysis

• Administration of health programs

• Clinical care and prevention



Education of a DPH dentist (professional) (specialist)

• Environmental health sciences

• Health behavior and health education

• Health care financing

• Epidemiology

• Research design and biostatistics

• Health planning and administration

• Community organization



Levels of Preventive Care• Primary

– Precedes the disease and applied in healthy individuals or groups

• Secondary– Early identification and prevention/treatment

• Early carious lesions• Early cancer

• Tertiary– Restoration and rehabilitation to restore optimal

health



Public Health Planning Cycle

• Definition of the problem and collection of information

• Establishment of long-term goals• Specific objectives• Selection and development of programs

to achieve the objectives• Implementation of programs• Evaluation



1. What programs are needed to promote oral health and healthy behaviors?

2. What programs are needed to prevent the development of early stages of disease?

3. What programs are needed to prevent the progression or reverse early stages of disease?

4. What programs are needed to minimally treat early irreversible disease destruction?

Dental public health planning?



What is a public health system?

• Governmental public health infrastructure

• Media and communications

• Health care delivery system

• Employers and businesses

• Academic institutions

• Others



Essential Public Health Services

• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health problems




• Mobilize community partnerships to identify and solve health problems

• Develop policies and plans that support individual and community health efforts

• Enforce laws and regulations that protect health and ensure safety

• Link people to needed personal health services and assure the provision of health care when otherwise unavailable

• Assure a competent public health and personal health care workforce




• Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Conduct research to attain new insights and innovative solutions to health problems

• Provide appropriate dental care



Now and Future • Access and quality of dental care• Graying of the population

– Elderly population (65+ year) will double between 1995 and 2025

• Immigration• Diversity of population• Technological and scientific advances• Globalization

– Cheaper and better care (health tourism)– Diseases and epidemics are global– Economic trends

definition of health and public health

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