OUTLINE• INTRODUCTION• WHAT IS A PUBLIC HEALTH PROBLEM?• FACTORS CAUSING INCREASING DEMAND ONHEALTH CARE• CRITERIA FOR PUBLIC HEALTH PROBLEMS• DEFINITIONS OF HEALTH, DISEASE, ILLNESS,ILL HEALTH.• CONCLUSION.
INTRODUCTION• Public health is the science and art ofpreventing disease, prolonging life andpromoting health through the organized effortsof society (Acheson 1988)• Dental public health is the science and art ofpreventing oral disease, promoting oral healthand prolonging life through the organizedefforts of the society (Downer et al., 1994)
• The focus of public health intervention is toprevent rather than treat a disease throughsurveillance of cases and the promotion ofhealthy behaviors. In addition to theseactivities, in many cases treating a disease canbe vital to preventing it in others, such asduring an outbreak of an infectious disease.Vaccination schedules and distribution ofcondoms are examples of public healthmeasures.
• It also promotes the establishment of healthyenvironments by working in settings such asschools and cities; aimed at strengtheningcommunity action & personal skill for healthprotection.
WHAT IS A PUBLIC HEALTH PROBLEM?• It is now widely recognized that demands onhealth care systems will always be greaterthan the resources available to meet theseneeds.• This dilemma is not confined to thedeveloping world where resources are limited.
• The richest countries in the world, such as theUSA, Germany, and the UK are faced with similarproblems of increasing demands and escalatinghealth care expenditure.• For example, expenditure on health care in theUSA rose from 3.6% of gross domestic product in1929 to 13.6% in 1995,and was as high as 16% in2012 and there is a prediction that it may reach20% in the next few decades (Burt and Eklund1999). In the UK spending on the General DentalServices has risen steadily over recent years. In1977/78 the figure was £270 million and by1997/98 the figure was £1528 million, a six-foldincrease over a 10-year period (Dental PracticeBoard 1998).
FACTORS CAUSING INCREASEDDEMAND ON HEALTH CARE• Population increase• Ageing• Increased awareness• Unhealthy environment• Epidemic/pandemic• Increased health risk factors
CRITERIA• The solution to this problem is toprioritize, pushing resources to those areas ofmore pressing need. Those areas can bedetermined using the following criteria:-– PREVALENCE OF CONDITION– IMPACT OF CONDITION ON INDIVIDUAL– IMPACT OF CONDITION ON SOCIETY– CONDITION IS PREVENTABLE & EFFECTIVETREATMENTS ARE AVAILABLE
• The first criterion relates to the prevalence ofthe health problem, in essence Is the diseasewidespread? Who has the disease?• What percentage of the total population isaffected? What is the distribution of thedisease within the community?• Is the prevalence of the condition increasingor decreasing?
• The second aspect relates to the impact of thecondition at the individual level.• How severe are the effects of the disease to thepatient? For example, do people die as a result ofit?• Do they suffer pain, discomfort, or loss offunction?• Can they perform their normal social roles? Arethey prevented from going to school or becomingemployed because of the problem?
• The third aspect relates to the effects of thedisease across society.• What are the costs to the health service oftreating the condition? How much time dopeople take off work to get treatment andcare?• What effect does the condition have oneconomic performance and productivitycountry?
• Finally, it is important to consider the potentialfor prevention and treatment of the disease.• Is the natural history of the disease fullyunderstood?• Can the early stages of the condition berecognized?• If so, are there interventions that can beimplemented to stop the disease progressing?• If it does progress, are there effective treatmentavailable?
DEFINITIONS OF HEALTH, DISEASE,ILLNESS & ILL HEALTH.• HEALTH– Many attempts have been made to define healthand to explore individuals’ perceptions of theconcept. After the Second World War, the WHO(1946) proposed a definition:• Health is a complete state of physical, mental& social well being and not merely theabsence of infirmity
• A pioneering French study (Herzlich 1973)identified that health was described in a varietyof ways by lay people:As a state of being, and the absence of illness.• As something to have, an inner strength orresistance to ill health.• As a state of doing and being able to fulfil themaximum potential for life.• Blaxter (1990), based upon a review of theconcept, had another description:
• Health can be defined negatively, as theabsence of illness, functionally as the ability tocope with everyday activities, or positively, asfitness and well-being• Ewles and Simnett (1999) have outlined thedimensions that they consider to be part of acomplete view of health, termed ‘a holisticconcept of health’ described in six separateareas called the dimensions of health
DIMENSIONS OF HEALTH• PHYSICAL HEALTH: concerned with thefunctioning of the body.• MENTAL HEALTH: the ability to think clearlyand coherently.• EMOTIONAL HEALTH: to recognize and expressemotion such as fear, joy, grief.• SOCIAL HEALTH: to form and maintainrelationships.• SPIRITUAL HEALTH: concerned with eitherreligious beliefs and practices or personalcreeds and principles of behavior.• SOCIETAL HEALTH: a person’s health is closelylinked to the environment he or she lives .
• It is very important to note that these areas arenot separate but are in fact part of a whole. Wemay feel that not all of them apply to us as anindividual.• The importance of each is likely to vary atdifferent times in our life. For example, the needto form social relationships is of particularimportance when leaving home for the firsttime, while for the majority of people theirphysical health is of little concern at this time butbecomes more so later in life.
• So, modern concepts of health have movedfrom an ‘absence of disease focus’ to aconcept that has a number of dimensions, andhealth has become defined in terms of social,psychological and physical functioning.(Reisine 1985). Health is a dynamic subjectiveconcept which is influenced by an array offactors.
• A more recent WHO (1984) definition ofhealth summarizes well the nature ofcontemporary understanding of the concept:• Health is the extent to which an individual orgroup is able, on one hand to realizeaspirations and satisfy needs; and on theother hand, to change or cope with theenvironment
DISEASE• Disease can be described as namedpathological entities diagnosed by means ofclinical signs and symptoms, for examplecancer or caries.• Diseases are determined by professionalsbased upon information collected in historytaking and through clinical investigations andtests.
ILLNESS• Illness refers to the subjective response of thelay individual to being unwell. It refers to howthe person feels and what effect this has ontheir normal every day life(Naidoo and Wills1996).
ILL HEALTH• Illness and disease are clearly not the same. Aperson can have a disease and have nosymptoms. for example, periodontal disease.• However, if that person reports bleeding gumsand loose teeth then they have symptoms andperiodontal disease may be confirmed byevidence of attachment loss clinically and boneloss on radiographs.• The disease and the illness coincide. Ill health isan ‘umbrella term used to refer to the experienceof diseases plus illness’ (Naidoo and Wills 1996).
CONCLUSION• The problem of public health can bedrastically reduced if governments formulatepolicy whereby the population can bereduced, commit reasonable amount ofresources to the health sector to build wellequipped health centre, and if individual canmaintain healthy environment and maintainhis health