Community Dentistry Lecture

1. HEALTH EDUCATION,
PROMOTION AND
PREVENTION
DR NIZAM ABDULLAH

2. OUTLINE
• Historical development and definition of health promotion
• Areas of action as outlined in the Ottawa Charter and oral health examples of each
• Health Education
• Core elements of oral health promotion
• Approaches to health promotion

3. THE “OLD” PUBLIC HEALTH
• In the 19th century:
• Poor and overcrowded working and living conditions for majority of
working class in large industrial towns-infectious diseases-threat to the
society
• Most histories of public health begin with this “sanitation phase”
• a period characterised by environmental issues such as housing, working
conditions, supply of clean water and safe disposal of waste.
Reduction in infectious diseases

4. THE RISE OF HEALTH EDUCATION
• In the early 20th century: a second phase known as the
“Personal hygiene era”.
• Prevention is better than cure!
• Local authorities extended services beyond preventing disease to
improving health through health education.
• Examples:
• School children were taught hygiene principles (i.e. teeth brushing)
• Parents (mothers) were taught hygiene, nutrition and childcare in the
home (through home visiting).
• Health Education Council created in England 1968 as an Non
Government Organisation.
• Create a climate of opinion generally favourable to health educ.
• Develop blanket programmes of education and (target) selected priority
subjects.

5. THE HEALTH PROMOTION
MOVEMENT
By the mid-1980s:
it became wider acknowledged that effective health
education involved making healthier choices easier:
• Proposing a wider agenda which involved modifying
circumstances, environment and policy to become more “health
promoting”.
• So people had opportunities to choose a healthier lifestyle.
• Recognised that people’s capacity to take action was limited by
environmental / social circumstances.
The first International Conference on Health
Promotion was held in Ottawa on November 21,
1986. It was at this conference that The Ottawa
Charter for Health Promotion was adopted.

6. THE OTTAWA CHARTER (WHO 1986)
The Ottawa Charter for Health Promotion provided a
further impetus to an emerging modern health promotion
movement.
Definition: “Health promotion is the process of enabling
people to increase control over, and to improve their health”.
Ottawa Charter for Health Promotion.WHO, Geneva,1986
Over the last 25 years, the Ottawa Charter has been highly
influential, constant point of reference for those involved in
promoting health:
http://www.who.int/healthpromotion/en/

7. HEALTH PROMOTION EMBLEM
It identified:
3 basic strategies:
"enabling, mediating, and
advocacy”
5 key themes:
1. Build healthy public
policy
2. Create supportive
environments
3. Strengthen community
action
4. Develop personal skills
5. Reorientation of health
services
Logo visualises the idea that health promotion is a comprehensive multi-strategy approach

8. THE OTTAWA CHARTER
• Build healthy public policy: Legislative and regulatory policies to influence health by
creating social environment that protects and improves health: eg: Fluoridation of public
water supply, strict regulation of processed food labelling.Costs of items on influential to
health:
• Create supportive environment: impact of the environment on health and identifying
opportunities to make changes conducive to health. Eg: establishment of non-smoking
areas, Health promoting school programs

9. • Strengthen community action: Empowering individuals and communities in the
processes of setting priorities, making decisions, and planning and implementation
strategies, to achieve better health: Establishment of support groups
• Reorient health service: Refocusing attention away from the responsibility to provide
curative and clinical service towards the goal of health gain. Dental professional require
resources to provide prevention in clinical setting
• Develop personal skills: Can be given through health education

10. HEALTH EDUCATION
Definition:
An opportunity created for learning specifically aimed at producing a health-related goal
(WHO 1984)
Objectives:
1) Cognitive: giving information and increase knowledge
2) Affective: Concerned with clarifying,forming or changing attitudes, beliefs values or
opinion
3) Behavioural: concerned with development of skills and actions

11. DENTAL HEALTH EDUCATION
• Aims to promote oral health through educational means: -provide information to
improve oral health knowledge and awareness (change in behavior is then considered
likely to occur)
• How effective is the educational approach in promoting oral health?

12. COMMON FINDINGS OF EFFECTIVENESS OF
DENTAL HEALTH EDUCATION -REVIEWS
• Improving individual’s knowledge of oral health can be achieved for short periods, but effects
on behavior are very limited
• Information alone does not produce long-term behavior changes
• Interventions at an individual level are effective at reducing plaque levels only in the short
term
• School based toothbrushing campaigns aimed at improving oral hygiene are largely ineffective
• Mass media campaigns are ineffective at promoting either knowledge or behavior change
• Very few studies have assessed the effects of dental health education on sugars consumption
(Brown,1994, Schou and locker, 1994; kay and Locker, 1996,1998; Sprod et al 1996)

13. THE NEED FOR AN “UPSTREAM APPROACH”

14. CORE ELEMENTS OF HEALTH PROMOTION
1) Focus on tackling the determinants of health and inequalities
2)Working in partnership with a range of agencies and sectors
3) Adopting a strategic approach utilizing a complementary range
of actions to promote the health of the population

15. 1. FOCUS ONTACKLINGTHE DETERMINANTS OF
HEALTH AND INEQUALITIES
• Socioeconomic, environmental and individual health related behaviours
• Making the healthy choice the easy choice
eg: optimal fluoride exposure, appropriate use of good quality dental care, smoking

16. 2.WORKING IN PARTNERSHIPWITH A RANGE OF
AGENCIES AND SECTORS
• Community participation is essential element in health promotion, local communities involvement;
• Partners in Oral Health:
- Health professionals: Doctors, nurses pharmacists
- Educational services:Teachers, school governors, parents
- Local authorities: carers, planning departments, social workers, catering staffs within carehomes, local
politicians
- Voluntary sector
- Commerce and industry: food producers, advertising industry, water industry
- Government: local national and international

17. 3. STRATEGIC APPROACH
• Should be based on appropriate assessment of local needs and resources
• Common risk factor approach: Many chronic diseases share common risks:
eg: Eating unhealthy diet high in fat and sugars and low in fibre leading to obesity, coronary
heart diseases, and dental caries
Health promotion strategies based on common risk factor approach- tackle a combination
of problems-more effective in the long run and more efficient use of resources
Sheiham 2012

18. COMMON RISK FACTOR APPROACH

19. DIFFERING APPROACHES TO HEALTH PROMOTION
• Health promotion can be practiced in several different ways depending on the philosophy,
skills of practitioner and the setting of the activity.
• 5 different approaches:
Preventive/Medical
Behavioural change
Educational
Empowerment
Social change

20. 1. PREVENTIVE /MEDICAL APPROACH
• Aim
• To reduce morbidity and premature mortality.
• To ensure freedom from disease and disability.
• In dentistry it would aimed at reducing the burden of oral problems
• Activity
• Uses medical/dental intervention to prevent poor health or premature death.
• Eg. - Immunization, screening, fluoridation.
These activities must be supported by Evidence Based Dentitry
Limitation: Does not address underlying cause of the disease therefore new cases constantly arise and
need attention
• Expert-led, Emphasizes compliance.
• Evaluation: Reduction in disease rates in case of dentistry would be reduction in dental
problem, prevalence of dental caries, reduce prevalence of missing teeth.

21. BEHAVIOUR CHANGE APPROACH
• Aim
• To encourage individuals to adopt healthy behaviours.
• Views health as the responsibility of individuals.
• Methods: Communication
Education
Persuasion, motivation
• Should be expert led
• Behaviour is very complex & Multi-factorial.
• Evaluation: Behavior change after the intervention.
• The behaviour change is only apparent after a long time.
• Difficult to isolate any behaviour change as attributable to a health promotion intervention.

22. STAGES OF BEHAVIOR CHANGE

24. EDUCATIONAL APPROACH
• Weakness
• Assumes that by increasing knowledge, there will be a change in
attitude, which leads to behavioural change. Ignores the
constraints that social, economic and environmental factors place
on voluntary change.
• Evaluation
• Knowledge, attitude and practice.

25. EMPOWERMENT OR CLIENT
-
CENTRED APPROACH
• Aim
• Helps people to identify their own needs and concerns, and gain
the necessary skills and confidence to act upon them.
Role of health promoter: facilitator

26. EMPOWERMENT OR CLIENT
-CENTRED
APPROACH
• Two types of empowerment:
1. Self-empowerment
- based on counseling and aimed at increasing people’s control over
their own lives.
2. Community empowerment
- related to community development to create active, participating
communities which are able to change the world about them through a
programme of action.
• Evaluation
• Difficult because empowerment is long term.
• Results are hard to specify and quantify.

27. SOCIETAL/SOCIAL CHANGE
APPROACH
• Aim
• To bring about changes in physical, social, and economic
environment which enables people to enjoy better health.
• Radical health promotion - makes the environment
supportive of health.
• To make the healthy choice the easier choice. (Ex: eliminate
sweets from school cafeterias)
• The focus is on changing society, not on changing the behaviour
of individuals.

28. APPROACHES IN HEALTH PROMOTION:
THE EXAMPLE OF HEALTHY EATING
Approach Aims Methods
Worker/client
relationship
Medical To identify
those at risk
from
disease.
Ex: severe
periodontal
disease
among
diabetics
Primary health
care
consultation.
e.g.:
Conducting
oral
assessments
Expert-led.

29. APPROACHES IN HEALTH PROMOTION:
THE EXAMPLE OF HEALTHY EATING
Approach Aims Methods
Worker/client
relationship
Behaviour
change
To
encourage
individuals
to take
responsibilit
y for their
own health
and choose
healthier
lifestyles.
Persuasion
through one-
to-one
advice,
information,
mass
campaigns,
e.g. Breast
cancer
campains.
Expert-led.

30. APPROACHES IN HEALTH PROMOTION:
THE EXAMPLE OF HEALTHTEETH
Approach Aims Methods
Worker/client
relationship
Educational To increase
knowledge
and skills
about
Importance
of teeth
Information.
Exploration of
attitudes
through small
group work.
Development of
skills, e.g.
Proper methods
of tooth
brushing
May be
expert led.
May also
involve client
negotiation of
issues for
discussion.

31. APPROACHES IN HEALTH PROMOTION:
THE EXAMPLE OF HEALTHYTEETH
Approach Aims Methods
Worker/client
relationship
Empowerment To work with
client or
communities
to meet their
perceived
needs.
Advocacy
Negotiation
Networking
Facilitation
e.g. food
co-op,
Health
promoter is
facilitator,
client
becomes
empowered.

32. Approach Aims Methods
Worker/client
relationship
Social
change
To address
inequalities
in health
based on
class, race,
gender,
geography.
Development of
organizational
policy, e.g.
Public health
legislation, e.g.
food labelling.
.
Entails/involve
s social
regulation
APPROACHES IN HEALTH PROMOTION:
THE EXAMPLE OF HEALTHY EATING

33. Copyright © 2005/06 The University of Sharjah
slide 33 Required reading:
1) Essential Dental Public Health
Second edition ISBN 987-0-19967937-9
Richard G Watt et al
Chapter 8
2) Prevention of Oral Diseases
Fourth Edition ISBN 109263279 5
J J Murray Chapter 15
Behavioral Dentistry Mostofsky et al. Blackwell
Munksgaard ISBN: 978-0-8138-1213-7 (wu 29
b419 2006) on HOLD IN THE MEDICAL
LIBRARY
Chapter 12