8.oral health promotion.ppt

HEALTH PROMOTION
Presented by :DR.AESHA ZAFNA
2ND YEAR POST GRADUATE
2

Contents3
 Introduction
 Historical development
 Principles of health promotion
 Strategies of oral health promotion
 Elements of oral health promotion
 Approaches for oral health promotion
 Oral health promotion in action
 Oral health promotion evaluation
 OHP in India
 Conclusion
 References
 Questions

Origin of Oral Health
Promotion
 Health promotion is referred to as new public health
(Nutbeam 1998).
 Origin dates back to the work of public health pioneers in
late eighteenth and early nineteenth century.
5
Daly, Origin of Health Promotion. Essential of Dental Public Health.0xford 2002. pages –
133-152

Promotion
Rapid
industrializati
on led to
creation of
poor and
overcrowded
working and
living
conditions for
majority of
working
classes.
Epidemics of
infectious
diseases which
spread through
the population
and were
considered a
threat to social
stability.
EDWIN
CHADWIK &
SOUTHWOOD
SMITH –
highlighted
need to
improve social
condition
through
municipal
reforms.
1875 – public
health act was
passed to control
water supply,
sewage disposal
and animal
slaughter within
industrialized
towns and cities. –
decrease in
infectious diseases.
6

Promotion
After 2nd world
war, threat shifted
from environmental
measures for
improving health to
measures that
highlighted
importance of
education and
preventive
intervention.
Educational
approach –
dominated by
medical profession
& as a result more
disease specific.
Targeted mainly
high risk groups to
change personal
habits and
behaviors.
Govt – developed
health services like
PHC & hospitals.
UK 1948 –
founding of NHS
Canada 1960 –
Health insurance
schemes
1968 – health
education council
7

Promotion
1974 – Marc Lalonde
• A new perspective on
health of Canadians
• Major causes of
death & disease were
environment causes,
individual behaviors
& lifestyle factors
rather than
biomedical
characteristics.
• Shifted the focus to
wider public health
agenda once again.
WHO
• WHO organized a
series of international
health promotion
conferences which
facilitated the
development and
practice of modern
health promotion
movement.
• First was in
OTTAWA in 1986.
8

Ottawa Charter
 First international conference on health promotion.
 21st Nov 1986.
 A charter was prepared for action to achieve HEALTH
FOR ALL by the year 2000 and beyond.
 Was primarily a response to growing expectations for a
new public health movement around the world.
9

Ottawa Charter
Logo
 It incorporates five key action areas in Health Promotion
and the three basic Health Promotion strategies.
10

Adelaide Recommendations
 The following recommended strategies for healthy public
policy action reflect the consensus achieved at the Conference.
1. The value of health
2. Equity, access and development
3. Accountability for Health
4. Moving beyond health care
5. Partners in the policy process
http://www.who.int/healthpromotion/conferences/7gchp/en/

Adelaide Recommendations
 The Conference identified four key areas as priorities for
health public policy for immediate action:
1. Supporting the health of women
2. Food and nutrition
3. Tobacco and alcohol
4. Creating supportive environments

Sundsvall Statement
 Social dimension
 Political dimension
 Economic dimension
 Women's skills and knowledge

Jakarta Declaration
 The Fourth International Conference on Health Promotion was titled “ New
Players for a New Era - Leading Health Promotion into the 21st Century”
 It was held in Jakarta from 21 to 25 July 1997
 Priorities for health promotion in the 21st Century
1. Promote social responsibility for health
2. Increase investments for health development
3. Consolidate and expand partnerships for health
4. Increase community capacity and empower the individual
5. Secure an infrastructure for health promotion

Mexico Conference
 Health Promotion: Bridging the Equity Gap
 5-9th June 2000 at Mexico City
 Theme for the conference
1. Evidence Base for Health Promotion
2. Investment for Health
3. Social Responsibility for Health
4. Building Community Capacity and Empowerment of
the Individual
5. Securing an Infrastructure for Health Promotion
6. Reorienting Health Services

Bangkok Charter
Make the
promotion of
health
global
development
agenda
core
responsibility
for all of
government
key focus of
communities
and civil
society
good corporate
practice

7th Health promotion conference Nairobi
Kenya
 Using multiple participatory processes
 Call To Action
 Key strategies and commitments urgently required to close the
implementation gap in health and Development through health
promotion.http://www.who.int/healthpromotion/conferences/7gchp/en/

8th Health Promotion Conference
 Health in All Policies (HiAP)

9th health promotion conference-
shangai 2016

Principles of
health Promotion

Build Healthy Public Policy
 Joint action contributes to ensuring safer and healthier
goods and services, healthier public services, and
cleaner, more enjoyable environments.
 Health promotion policy requires the identification of
obstacles to the adoption of healthy public policies in
non-health sectors, and ways of removing them.
Pine C. Community Oral Health. Quintessence Pub Co Ltd. London
Daly B. Essential Dental Public Health. Oxford university press. London

Reorient Health Services
 This must lead to a change
of attitude and organization
of health services which
refocuses on the total needs
of the individual as a
whole person.

Develop Personal Skills
 Health promotion supports personal and
social development through providing
information, education for health, and
enhancing life skills.
 This increases the options available to
people to exercise more control over
their own health and over their
environments, and to make choices
conducive to health.

Strengthen Community Actions
 Health promotion works through concrete and effective
community action in setting priorities, making decisions,
planning strategies and implementing them to achieve better
health.

Create Supportive Environments
 Changing patterns of life, work and leisure have a
significant impact on health. Work and leisure should
be a source of health for people.
 Health promotion generates living and working
conditions that are safe, stimulating, satisfying and
enjoyable.

STRATEGIES IN ORAL HEALTH
PROMOTION

1. Social strategy
2. Preventive strategy
3. Common risk factor approach
4. Up stream approach

Social strategy
 Life style is not freely chosen
 Oral health promotion is targeted towards the
“causes of the causes”
 Social
 Economic
 Environmental

Preventive Strategy
 Preventive strategy may be
 High risk
 Population approach
 A combination of high risk and population
approach should be used.

Common risk factor approach
 The common risk factor approach addresses risk factors
common to many chronic conditions within the context of
wider socio-environmental milieu.
 Oral health is determined by diet, hygiene, smoking, alcohol
use, stress and trauma. As these causes are common to a
number of other chronic diseases, adopting a collaborative
approach is more rational than one that is disease specific.
Sheiham A, Watt RG: The Common Risk Factor Approach: a rational
basis for promoting oral health. Community Dent Oral Epidemiol 2000;
28: 399–406.

 Promoting general health by controlling a small number of
risk factors may have a major impact on a large number of
diseases at a lower cost, greater efficiency and effectiveness
than disease specific approaches
 There is a shift from vertical programmes towards a more
horizontal approach, thus enlarging their scope to cover
other non-communicable disease.

Up stream approach
 The universal social gradient in both general and oral health
highlights the underlying influence of psychosocial,
economic, environmental and political determinants.
 The dominant preventive approach in dentistry, i.e.
narrowly focusing on changing the behaviours of high-risk
individuals, has failed to effectively reduce oral health
inequalities, and may indeed have increased the oral health
equity gap.

 A conceptual shift is needed away from this biomedical /
behavioural ‘downstream’ approach, to one addressing the
‘upstream’ underlying social determinants of population oral
health.
 ‘interventions aimed at reducing disease and saving lives
succeed only when they take the social determinants of health
adequately into account.’

Strategies in oral
health promotion
 Health promotion strategies should have the following
qualities:
37
Empowerment Participatory Holistic
Intersectoral Equity Evidence base
Sustainable Multistrategy Evaluation

Strategies in oral
health promotionLocal level actions
 Encourage schools to become part of the Health
Promoting Schools Network
 Develop oral health and nutrition policies in preschools
and nurseries
 Encourage sales of subsidized toothbrushes and
toothpastes through community clinics
 Encourage nurseries and schools to provide subsidies on
healthy snacks and drinks
38

Strategies in oral
health promotion
 Encourage the engagement of community action groups in
oral health projects
 Support development of local infant feeding policies and
ensure oral health messages included
 Encourage development of oral health policies in older
peoples residential homes and care centres
39

Strategies in oral
health promotionNational level actions
 Support regulation on content and timing of television
adverts promoting children’s foods and drinks
 Encourage tighter legislation on food labeling and food
claims on products
 Encourage greater availability of sugar-free pediatric
medicines
 Support removal of VAT and other taxes on fluoride
toothpastes and toothbrushes
40

Strategies in oral
health promotion
 Support legislation on water fluoridation
 Support food and nutrient standards for school meals, and
other foods and drinks sold in schools
 Encourage safety standards for school play areas and
other leisure facilities
 Support legislation on wearing of seat belts, helmets and
mouth guards
41

Approaches to Health
Promotion
 The practice of health promotion can operate in several
different ways, depending upon the philosophy and skills
of the practitioner and the setting of the activity:
42
1. Preventive
2. Behavior
approach
3. Educational
4. Empowerment
5. Social
change

Preventive approach
 The aim of this approach is to decrease the disease
level
 It is top down, authoritative style of working
 The patients are passive recipient of preventive
care
 Preventive care includes both screening and
clinical activities
 It does not address the underlying causes of
disease

Behavioral change
 It aims to encourage individuals to take
responsibility for their health and adopt healthier
lifestyle.
 It assumes that the provision of information will
lead to sustained change in behavior
 It can be one either on one to one advice or mass
media campaign
 The desired change in lifestyle is imposed on
patient

Educational approach
 It aims to provide people knowledge as well as
skills and attitude to make informed choices
about their health related behavior
 It provides individuals with choices
 However experts ignore a wide range of
factors that determine the patients attitude
towards a practice

Empowerment
 It aims to assist people in identifying their own concerns and
priorities and in developing the confidence and skill to address
these issues
 It is a bottom up approach where health care professional acts
only as a facilitator
 Individuals and communities identify their problems and seek
solutions for the same

Social change
 It aims in changing the physical, social and economic
environment to promote health and well being
 Requires change in policy and political support
 Lobbying and policy planning need to be done

48
Oral Health Promotion
in Action
 Policies are made at
 International level
 National level
 Local level
 Setting based

49
Principles of
oral health
promotion
Dental
Caries
Periodontal
Disease
Oral
Cancer
1) Creating
supportive
environment
2) Building
healthy public
policy
1)Providing tooth
brush and paste.
1) Sugar in
medicine
campaign
2) Fruit in school
3) Water in school
4) Water
fluoridation
1)Legislation
required to
fluoridate public
water supplies.
2)To provide
1) Providing
tooth brush
and paste
1)Health
programmes to
develop
toothbrushing
methods
1)Establishme
nt of non-
smoking areas
1) Legislation
for cessatinon
of tobacco and
alcohol
consumption

50
Principles of
oral health
promotion
Dental
Caries
Periodontal
Disease
Oral
Cancer
3) Reorienting
health services
4) Strengthening
community action
5) Developing
personal skills
1) Health education
of health
professionals to
emphasis on
prevention
2) To monitor
trends in
diseases and
health.
1) Use of mass
media and one to
one approach
1)Regular check up
atleast once in 6
months.
Oral prophylaxis.
1) Altering
beahaviours and in
particular oral
cleaning
effectiveness to
1) Screening
for oral
cancer at
regular
periods.
1)Provide
education
and create
awareness
to people

51
approaches of
health promotion
dental caries periodontal
disease
oral cancer
1) upstream
approach
1) national or
local policy for
tooth brushing .
2) Healthy eating
habits
1) national or local
policy for tooth
brushing
1) Legislation
for cessation
of tobacco
smoking and
alcohol
consumption.
2) Mid stream
approach
1) School dental
health education
1) Chair side
dental
education.
1) Interventions
such as screening
for oral cancer
3) Down stream
approach
1) Clinical
prevention
2) Treatment
1) treatment 1) Treatment

Formation
of planning
Identification of
resources
Needs
assessment
and priority
setting
Strategic
aims
Goal settingPlan actions
Plan
evaluations
Implementat
ions
Reviews
Planning oral health promotion intervention

 Process evaluation has been broadly defined as
measuring the activities of an intervention, or
dimensions of programme quality and descriptions of
who it is reaching.
Hawe P, Degeling D, Hall J. (1990) Evaluating Health Promotion: a health worker’s
guide (Sydney, Australia, MacLennan+Petty).
Health Promotion Evaluation

 Evaluation of health promotion is important for a variety
of reasons:
54
1.
• As a means of developing effective interventions
2.
• Sharing and disseminate examples of good practice
3.
• Making best use of limited resources
4.
• Providing feedback to staff and participants
5.
• Informing policy development and implementation
Oral Health Promotion
Evaluation

Guidelines for
evaluation:
 Health promotion programs are evaluated on the
following guidelines:
1. Planning process
2. Resource requirements
3. Partnerships
4. Capacity building
5. Pluralistic methodologies
55

•Achievable yet challenging objectives help to
motivate those involved in delivering the intervention.
•It is essential that a time scale is specified to
assess changes achieved.
• Focus and precision are essential in
setting objectives.Specific
• Objectives must be easily assessed to
guage progressMeasurable
• The needs of the population group
should be the central focus in the
objectives of any intervention.
Appropriate
Realistic
Time - related
56

Oral Health
Promotion In
India

National Oral Health Care
Programme
 National Oral Health Policy has been formulated by the
"Dental Council of India", through the inputs of two
national workshops organized way back in 1991 and
1994 at Delhi and Mysore respectively.
 These workshops considered the recommendations of
national workshops on oral health goals for India,
Bombay 1984 and a draft oral health policy prepared by
Indian Dental Association in 1986.
58

Proposed plan for oral
health care programme
Oral Health Care
Programme
Oral health
education
1. Training of the
trainers
2. Oral health
education chapters in
school curriculum
3. Oral health
education through
mass media
Preventive
programme
Curative service
programme
1. Oral health care
setup
2. School dental
health programmes
3. Manpower
requirement
4. Equipment
requirement
1. Promotion of
toothpastes
2. Legislation
against tobacco
products
3.Manufactire of
sugar free
chewing gums
59

60
'National Oral Health
Care Programme' has
been launched as
"Pilot Project" to
cover five States
(Delhi, Punjab,
Maharashtra, Kerala
and North eastern
States) for its
implementation.

 To begin with, one district in each of these States has
been chosen to test run the strategies evolved through 2
national and 4 regional workshops organized in the
country, to achieve the following goals:
61
Oral Health for all by the year 2010.
To bring down the incidence of oral and dental
diseases to less than 40% from the existing
prevalence of 90%.
To bring down the DMFT in school children
between 6-12 years of age to less than 2 which is
approximately 4 at present

To reduce high prevalence of periodontal diseases to
lower prevalence.
At the age of 18 years, 85% should retain all their teeth.
To achieve 50% reduction in edentulousness between the
age of 35-44 years
To achieve 25% reduction in edentulousness at the age
of 65 years and above.
To achieve 50% reduction in the present level of
malocclusion and dento-facial deformities.
To reduce the number of new cases of Oral Cancers and
precancerous lesions from the existing levels.
62

Strategies for
implementationORAL HEALTH EDUCATION
 It is recommended that to spread the message of oral
health to the masses, all the three media of
communication i.e. audio-visual, print and folk media
should be utilized to the maximum.
 Central Health Education Bureau shall be involved to
formulate the education material.
 It is recommended that to spread oral health awareness,
existing infra-structure should be strengthened.
63

 Multipurpose health workers (MPW) should be trained
to impart oral health education, provide basic pain relief
and be able to refer the cases for further investigation and
treatment.
 PHC:
64
• 30,000 people1 Doctor
• 50,000 school children1 Doctor
• 20,000 people1 Dental
hygienist

 Interpersonal and group communication by:
 Health workers,
 Anganwadi workers and
 School teachers
65

 MID - DAY MEAL PROGRAMME ACTIVITIES
(k.kamaraj, Tamil Nadu 1960)
can be used as spring board to develop other behaviors such as
 Washing of hands
 Rinsing of oral cavity after each meal
 Avoiding cariogenic foods,
 Eating balanced diets,
 Drinking clean water and eating clean food.
66

 School children can be used as ambassadors of health
messages to their homes and neighborhood and can act as
change agents.
 Child to child programme in the school or out of school
is yet another approach to build healthy life styles.
67

ORAL HEALTH SET UP
 Administrative set-up at the Centre, State and District
levels should be strengthened for planning,
implementation, monitoring and evaluation of oral and
dental health care services at the Centre & State levels.
 At least one Dental Clinic for every 30,000 population in
the rural areas at the PHC level should be established in a
phased manner.
68

 Fully equipped Mobile Dental Clinics to provide on-
the-spot diagnostic, preventive, interceptive and curative
services to the people and school children in far-flung
rural areas of the state should be made available.
 There should be at least 3-4 mobile dental clinics at each
district level catering to a population of 4,50,000 to
5,00,000.
69

 Local Practitioners should be involved on contractual
basis for imparting Oral Health Education and to perform
Interceptive treatment like ART etc.
 Intensive Dental Health Care Programme for the
Public in the form of Free Dental Check-ups and Special
Oral Health Campaigns should be organized frequently.
 Dental Marathons, Long marches, Smile and Healthy
Teeth Competitions should also be organized.
70

ROLE OF LEGISLATION
 Anti – tobacco Campaigns
71
Statutory warning on
each pack.
Smoking at public
places has been
banned and so is the
advertisement on
tobacco.
Advertisement on Pan
Masala have been
banned
Role of parents and
peer group

ADDITIONAL SUGGESTED MEASURES:
 Continuing dental education Programmes
 Adoption of 1 whole district so as to take care of the
preventive oral (dental) health services to the rural and
the urban communities of the district effectively using the
internship programme.
72

Oral Health Campaigning
In India
TOBACCO AWARENESS (since 1997)
 Duration of trip: Six weeks every summer
 Locations: Various states and cities in India including
Baroda, Indore, Pune, Jaipur, Ahmedabad, Mumbai.
 Target groups : Students from 7th to 12th standards
 Mobilization: College students and doctors
73

 Method: Peer-to-Peer Interactive Awareness Campaign
45 minute slide presentation focusing on:
 Associated Health Concerns
 Quitting Methods
 Social and cultural influences
 Myths and misperceptions
 Media and industry tactics
 Quiz Bowl / Q & A / Discussion
 Emphasis: Prevention
74

Barriers in Oral Health Promotion in India
• Oral health is given last priority.
• Inadequately informed about burden of oro-dental problems and its
connection with the systemic health
• Financial burden
• Health care is looked after by the private sector and individual practices
• We do not have organized school oral health education programmes
• Over population
• Lack of resources

CONCLUSION :
76
 Effective action to tackle oral health inequalities can only be
developed when the underlying causes of the problem are
identified and understood.
 Rather than implement narrowly focused preventive and
educational ‘downstream’ interventions, future ‘upstream’
action is needed to create a social environment that supports
and maintains good oral health.
 A range of complementary public health actions can be
implemented at levels to promote sustainable improvements

Referneces
 A textbook of public health dentistry – C.M .MARYA
 Pine C. Community Oral Health. Principles of oral health promotion.
Chapter 11. pages 177-186
 Daly B. Essential Dental Public Health. Prevention and oral health
promotion, part 3 . Pages 133- 233
 Sheiham A, Watt RG: The Common Risk Factor Approach: a rational
basis for promoting oral health. Community Dent Oral Epidemiol 2000;
28: 399–406.
 Watt RG. Emerging theories into the social determinants of health:
implications for oral health promotion. Community Dent Oral Epidemiol
2002; 30: 241–7.
 Watt RG. From victim blaming to upstream action: tackling the social
determinants of oral health inequalities. Community Dent Oral Epidemiol
2007; 35: 1–11.
 Watt RG, Fuller SS. Oral health promotion--opportunity knocks! Br Dent
J. 1999 Jan 9;186(1):3-6.
77

PREVIOUS YEAR QUESTIONS:
78
 LONG ESSAY :
 DISCUSS OPTION FOR PROMOTING ORAL HEALTH
(MANIPAL DEC 2005)
 SHORT ESSAY
 HEALTH PROMOTION (RGUHS NOV 2013)
 OTTAWA CHARTER (RGUHS NOV 2005)

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