Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 21st Congress of the European Association of Dental Public Health (1 October 2016 Budapest)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the School of Public Health Management (Chisinau, Republic of Moldova, 24 November 2016)
Presentation by Dr Zsuzsanna Jakab,WHO Regional Director for Europe, at the Third High-level Meeting of the Small Countries Initiative, in Monaco, on 11–12 October 2016
Contemporary health policy context in Europe: some opportunities and challenges
Presentation by Dr Zsuzsanna Jakab, WHO Regional Director for Europe. 8 March 2017, Israel
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the Advanced Training and Conference on Health Economics (24 June 2015, Budapest, Hungary)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the School of Public Health Management (Chisinau, Republic of Moldova, 24 November 2016)
Presentation by Dr Zsuzsanna Jakab,WHO Regional Director for Europe, at the Third High-level Meeting of the Small Countries Initiative, in Monaco, on 11–12 October 2016
Contemporary health policy context in Europe: some opportunities and challenges
Presentation by Dr Zsuzsanna Jakab, WHO Regional Director for Europe. 8 March 2017, Israel
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the Advanced Training and Conference on Health Economics (24 June 2015, Budapest, Hungary)
Presentation – The Issue-based Coalition on Health and Well-being
12 May 2017, Geneva, Switzerland
By Dr Zsuzsanna Jakab, WHO Regional Director for Europe
Presentation - Advancing health literacy and social mobilization for the United Nations 2030 Sustainable Development Goals
18 May 2017, Geneva, Switzerland
By Dr Zsuzsanna Jakab, WHO Regional Director for Europe
Presented by Piroska Östlin, Director and Åsa Nihlén, Technical Officer, Division of Policy and Governance for Health and Well-being, WHO/Europe, at the 66th session of the WHO Regional Committee for Europe.
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe (Positioning the Veneto Region at the core of global and European health policies, 3-4 December 2015, Scuola San Giovanni Evangelista, Venice, Italy)
Health literacy in the WHO European Region, Dr Bente Mikkelsen, Director, Noncommunicable Diseases and Promoting Health through the Life-course / Kristina Mauer-Stender, Acting Director, Information, Evidence, Research and innovation (WHO Regional Office for Europe)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 7th Meeting of the European Advisory Committee on Health Research (Copenhagen, Denmark, 6 April 2016)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 67th session of the WHO Regional Committee for Europe (Budapest, Hungary, 11–14 September 2017)
Presentation – The Issue-based Coalition on Health and Well-being
12 May 2017, Geneva, Switzerland
By Dr Zsuzsanna Jakab, WHO Regional Director for Europe
Presentation - Advancing health literacy and social mobilization for the United Nations 2030 Sustainable Development Goals
18 May 2017, Geneva, Switzerland
By Dr Zsuzsanna Jakab, WHO Regional Director for Europe
Presented by Piroska Östlin, Director and Åsa Nihlén, Technical Officer, Division of Policy and Governance for Health and Well-being, WHO/Europe, at the 66th session of the WHO Regional Committee for Europe.
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe (Positioning the Veneto Region at the core of global and European health policies, 3-4 December 2015, Scuola San Giovanni Evangelista, Venice, Italy)
Health literacy in the WHO European Region, Dr Bente Mikkelsen, Director, Noncommunicable Diseases and Promoting Health through the Life-course / Kristina Mauer-Stender, Acting Director, Information, Evidence, Research and innovation (WHO Regional Office for Europe)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 7th Meeting of the European Advisory Committee on Health Research (Copenhagen, Denmark, 6 April 2016)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 67th session of the WHO Regional Committee for Europe (Budapest, Hungary, 11–14 September 2017)
Д-р Florence FUCHS, Штаб-квартира ВОЗ - Шестьдесят пятая сессия Европейского регионального комитета ВОЗ (Вильнюс, Литва, 14–17 сентября 2015 г.) / Presentation delivered by Dr Florence Fuchs, WHO Headquarters, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
Presentations delivered by Dr Nedret Emiroglu (Director, Division of Communicable Diseases and Health Security at the WHO Regional Office for Europe) - High-level meeting on refugee and migrant health (23-24 November 2015, Rome, Italy)
Presentation delivered by Claudia Stein, Director - Division of Information, Evidence, Research and Innovation at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
Presentation delivered by Tim Nguyen, Unit leader - Tanja Kuchenmüller, Technical Officer at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
Dr Gauden Galea, Director, Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe - Dr Jo Inchley, HBSC International Coordinator, University of St Andrews
Dr Caroline Brown, Programme Manager, Influenza and Other Respiratory Pathogens, Thomas Hofmann, IHR Area Coordinator, Communicable Diseases and Health Security
Presentation delivered by Dr Zsuzsanna Jakab, Regional Director WHO Europe, at the international health forum (Ashgabat, Turkmenistan, 21-22 July 2015)
Presentation delivered by Claudia Stein, Director, Division of Information, Evidence, Research and Innovation, on 15 September 2015, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting on Interdepartmental Plan for Public Health of Catalonia (PINSAP) Strategy and Programme, held in Barcelona, Spain on 14 February 2014.
Presentation delivered by Zsuzsanna Jakab, WHO Regional Director for Europe, at the Meeting of the European Environment and Health Ministerial Board (24 February 2015, Madrid, Spain)
Franco Sassi: Obesity and the Economics of PreventionTHL
Franco Sassi, Ending Childhood Obesity in the Nordic Countries workshop, 16-17.11.2016. Nordic Welfare States and Public Health - A Need for Transformative Change? -conference.
Professor Sir Michael Marmot's Charles Cully Lecture on health inequalities a...Irish Cancer Society
The Irish Cancer Society hosts the annual Charles Cully Lecture in memory of one of the Society's founding members. Professor Sir Michael Marmot, one of the world's leading international experts on health inequalities, was the recipient of the Charles Cully Medal and gave the 2013 lecture on health inequalities and cancer.
Presented by Philip James of the London School of Hygiene and Tropical Medicine at the WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 on 4 July 2013 in Vienna, Austria.
Disclaimer: WHO is not responsible for the content of presentations made by external speakers at its meetings and conferences. This presentation is published here with the speaker's consent, only for information purpose.
This presentation is part of the report presented by the WHO Regional Director Zsuzsanna Jakab at the 63rd session of the WHO Regional Committee for Europe in Çeşme Izmir, Turkey, on 16 September 2013.
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Reported measles cases for the period November 2020—October 2021 (data as of 02 December 2021).A monthly summary of the epidemiological data on selected vaccine-preventable diseases in the WHO European Region
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Inequalities in health: challenges and opportunities in Europe
1. Inequalities in health:
challenges and
opportunities in Europe
Dr Zsuzsanna Jakab
WHO Regional Director for Europe
21st Congress of the European Association of Dental
Public Health
1 October 2016 Budapest
8. What is Health 2020?
Health is a political choice
• Public health policy framework to improve
health and reduce inequities
• Focus on upstream actions and
addressing root causes of ill health –
addressing all determinants systematically
early on, before diseases emerge
• Higher and broader reach
10. Main aims:
• to report on progress
towards the Health 2020
targets (since 2010 baseline)
• to highlight new frontiers in
health information and
evidence, including
subjective well-being
measurements
European health report 2015
11. Premature mortality
Although the European Region is on track to
achieve the Health 2020 target to reduce
premature mortality, much more can be
done to address the determinants for faster
progress
Regional Health 2020 target: a 1.5% relative annual reduction in
premature mortality from cardiovascular diseases, cancer, diabetes
and chronic respiratory diseases until 2020
12. Regional trend
Indicator: age-standardized death
rate per 100 000 in people aged
30–69 for cardiovascular diseases,
cancer, diabetes mellitus and
chronic respiratory diseases
combined
13. Country performance
0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0
Belarus
Russian Federation
Ukraine
Kazakhstan
Kyrgyzstan
Republic of Moldova
Latvia
Bulgaria
Hungary
Lithuania
Armenia
Romania
Serbia
TFYR Macedonia
Slovakia
Poland
Estonia
Bosnia and Herzegovina
Regional Average
Croatia
Czech Republic
Georgia
Turkey
Slovenia
Belgium
United Kingdom
Denmark
Malta
Germany
Ireland
Netherlands
Austria
Finland
France
Portugal
Greece
Luxembourg
Italy
Spain
Norway
Cyprus
Sweden
Switzerland
Israel
Premature mortality
Premature mortality
from four major
noncommunicable
diseases (NCDs),
latest available value
for 2010–2012
15. • Across Europe, a high relative risk of oral disease is
related to socioeconomic determinants.
• The major oral diseases are avoidable through
effective prevention and health promotion.
• Reducing social inequities in oral health depends solely
on political will.
Challenges and opportunities
16. Inequities in health and health care
• Between countries
• Within countries
• Income
• Education
• Occupation
• Gender
• Age
• Residence
• Ethnicity
19. Within-country inequalities in oral health
Percentage of Scottish 5-year-olds "free" of dental caries by deprivation
(DEPCAT) score
Pitts NB et al., 2000
20. 0 10 20 30 40 50 60 70
Ukraine
Russia
Georgia
Bosnia-…
Sweden
Spain
Portugal
%
Percentage of people aged 65–74 having lost all
natural teeth, western and eastern European
countries
24. Within-country inequalities in oral health
Percentage of Danes aged 65+ years having lost all
natural teeth, by years of schooling
0
20
40
60
80
100
7 yrs 8-9 yrs 10 yrs High
school
1994
2000
2005
2010
Petersenetal,2012
%
25. Within-country inequalities in oral health
Percentage of Danes aged 65+ years with 20+
teeth, by years of schooling
0
20
40
60
80
100
7 yrs 8-9 yrs 10 yrs High
school
1994
2000
2005
2010
Petersenetal,2012
%
30. Tackling inequities in oral health through:
• shared modifiable risk factors
• chronic diseases
• settings for health
• environment
• health systems
• structural factors of society
WHA60.17 (2007)
Oral health – action plan for promotion and
integrated disease prevention
31. Settings for health
• Health-promoting schools
Oral health through schools: children–youth–school
teachers–family–community
• Settings for older people
Age-friendly primary health care and quality of life
32. Environment for public health
Automatic fluoridation
• Vehicles are water, salt or milk
• Proper oral hygiene and effective
use of high-quality fluoridated
toothpaste (1000–1500 ppm)
33. Upstream interventions
• National policy for oral health
• Legalization and regulation
• Directives for oral health care
• Financially fair primary oral health care
• Universal coverage
• Integration of oral health with NCD
prevention
36. Universal primary oral health care
*
• Oral health care provided by dentists must
be financially fair
• Health is a public good, guaranteed by
government
• National health insurance
• Dentists must give priority to prevention
and health promotion
• Outreach to people and communities
37.
38. Challenges for reducing inequities
in health
• Lack of political interest
• Lack of political will
• Neglect of health inequities
• Blaming the victims
• Lack of recognition by private dental
practitioners
• From ministries of health care administration
towards ministries of health
• Financially fair oral health care
39. Opportunities for equity in oral health
• Healthy diet and reducing sugars
• Tobacco and alcohol control
• Organizing public health and primary oral health care
• Health care in the workplace
• Outreach to people in low-resource settings and
disadvantaged groups
• Outreach to vulnerable groups, including poor and
marginalized groups, homeless people, refugees,
disabled people and people living in institutions
• Strengthening surveillance
We live in uncertain and demanding times. Last year brought many political and social challenges, globally and within the European Region, including inequities in global development, poverty, civil unrest, migration, terrorism, complex emergencies and climate change with extreme weather events.
All had a profound impact on our work.
We must rise to the public health demands flowing from these challenges, pursuing our goal of better health: more equitable and sustainable.
In responding to these challenges, we must also change the way we work.
We have strategies and action plans in place, now supported by a new global framework, the United Nations 2030 Agenda for Sustainable Development, and the Sustainable Development Goals (SDGs). In our Region, Health 2020 is fully aligned with the SDGs.
What is Health 2020? It is the European Policy Framework for Health and Wellbeing – adopted in 2012 by all the 53 European countries in consensus which puts emphasis on upstream approaches, like determinants of health, new type of governance which is more integrated, emphasizing the WOG, WOS approaches. Its aim is to further improve health outcomes in our region and reduce inequities in health.
During 2016 and 2017, I intend to develop a roadmap for the implementation of the SDGs, together with Health 2020 and a new vision of public health – which will co-cluster and integrate the various determinants so that we can address them simultaneously. I will bring this to the Regional Committee in 2017, describing how, with political commitment, we can accelerate progress.
In Europe health outcomes have continuously improved in recent decades: we live longer and healthier than ever before and inequities in health started to decrease for the first time and premature mortality is also decreasing. We are on track to reach the Health 2020 targets. Differences in life expectancy and mortality between countries are diminishing. This shows that our strategies work. I will return to this in a minute with more details.
Yet profound challenges remain. The absolute differences in health status between countries remain substantial, and within-country inequities also continue.
In addition, we must rise to the challenge of all health determinants, including health behaviour. If current rates of smoking, alcohol consumption and obesity do not decline substantially, our gains in life expectancy could be lost.
But we also have to address the determinants of health, such as lifestyle, social determinants, environmental, commercial and cultural etc Social determinants are the most pressing now ( like unemployment, wages, housing, social care ) as they result in social inequalities which hinder economic growth but also trigger and sustain health inequities and unhealthy behaviors.
For this we have to reach higher and broader, reach out to Presidents and Prime Ministers, and adopt a new type of governance, with shared goals and objectives and joined up government action and make the case for whole-of-government and whole-of society approaches.
Health and well-being are political choices – which we cannot emphasize enough. There is a bidirectional relationship between health/equity and development. Those countries are doing the best which make health and equity a priority as they contribute to economic productivity and thus to development.
All our work in WHO/EURO is aligned with this conceptual framework: NCD, Tobacco Control, Harmful Use of Alcohol, Food and Nutrition, Physical Activity, Mental Health, Aging, Child and Adolescent Health Strategy, Social Determinants, Environment and Health, AMR, TB/MDR TB, Immunization- and obviously also oral health etc.
Countries listed on this slide are taking up the H2020 challenge. The SDGs will provide tremendous support in this work - a most powerful tool. The objective is “Leave no one behind “ . Health and well-being are central to development; health has a goal itself in the sustainable development agenda but health is also integrated into all the other 17 SDG’s as a target. We now have to renew the national development policies and ensure the rightful place for health and align the national health policies accordingly.
Ireland (Cabinet of Ministers holding the new health policy “Healthy Ireland”)
Switzerland (Cover of Swiss Health 2020 policy)
Latvia (Cover of national public health strategy 2011-2017, with foreword by RD)
Lithuania (Picture of draft Lithuanian National Health Programme 2020 as submitted to Parliament for consideration)
Austria (Cover of the Austrian target documents, a whole-of-government and whole-of-society product and the first step towards national health policy process)
Turkey (Cover of the Turkish national health strategic plan drawing on Health 2020).
Hope that soon Hungary will also be on the list of countries that has reviewed and renewed its national public health programme with due consideration to the new challenges of our days.
Every 3 years we develop a European Public Health report to review the health status of the Europeans and 2015 was the year when our most recent report was presented to the European Member States in September this year.
This is important as we report on progress towards the Health 2020 targets implementation ( using the monitoring framework agreed with the European countries. The baseline year is 2010.
Let me quote 1 target of the jointly agreed monitoring framework
There is good progress in the Region due to improvements in the countries with the highest values.
You can see which countries in our region are lagging behind and need more investment in health. The first six are from the NIS countries ( Belarus, Russia, Ukraine, some Central Asian countries) and within the the European Union, BUL, HUN and LVA have the highest levels of premature mortality. Many less developed countries are ahead of these countries which is a sign that more work needs to be done on all health determinants and this is why a new coherent policy framework is required to ensure that health becomes a priority in the government programs - as an investment into the overall development and economic development of the country.
In Europe, the burden of oral diseases is high, these diseases have negative impact on quality of life, and the diseases are costly to the individual and society. Because of common risk factors and socioeconomic determinants of health the major oral diseases are linked to key chronic diseases/NCDs.
The good news is that the major oral diseases are preventable.
The inequalities in oral health are large, if a political will exists reducing inequalities is possible.
We therefore have to put oral health on our priority list in Health 2020 policy framework and the related national health policies as well as in our work on NCDs.
The inequity problems in oral health relate to social inequalities between countries and within countries. This presentation will focus on this observation from WHO regional data and a few country examples will be used as illustration.
The WHO EURO HFA data base includes information about the number of children aged 5-6 years who are free of dental caries. The WHO EURO target for 2020 for the age group 5-6 years implies that 80% of children should be without dental caries, this is realistic for many countries in western Europe. Unfortunately, in Eastern Europe the challenges are extremely high and the chances to attain the target much lower.
The EURO HFA Database also includes country information about the amount of dental caries among 12 year olds, this is indicated from the average number of permanent teeth affected by caries (Decayed, Missing due to caries and Filled Teeth index). The European target for the year 2020 reads 1.5 DMFT or less, by now this has been achieved in several western countries having established disease prevention programmes, an improvement of healthy lifestyles and better self-care for oral health. In Eastern Europe and Central Asia the burden of dental caries scores high and there are substantial challenges on the way towards the attainment of the Health 2020 targets.
The patterns of oral disease in Europe reflect socio-economic and environmental risk profiles, differences in living conditions; existing oral health systems and the culture towards health promotion and disease prevention.
Let me bring a few country examples which also reflect within country inequalities in oral health of children. Many countries have documented diversities in oral health of children.
For example, in Scotland, the number of caries free 5-year-old children vary significantly by deprivation, from more than 60% caries free children living in most affluent environments to 20% of children of least affluent areas.
Variations between the countries are also found for the major oral diseases of adult populations.
Based on epidemiological data reported to WHO, the proportion of older people having lost all their natural teeth varies across Europe, the diversity is found in west and east of the European Region alike.
As regards the adult population, the prevalence of complete tooth loss varies by education in western European countries like Belgium, France, Sweden and in the UK.
The pattern is similar in Southern Europe
….. and in Central and Eastern Europe
And now examples of within country inequalities:
Inequalities are found in countries across Europe, even in countries with advanced oral health systems with public health programmes and comprehensive third party systems. Denmark is one of the few European countries having established oral health surveillance as part of the national NCD surveillance scheme. The information system indicates a general decline in the proportion of older people with complete tooth loss because of the disease prevention and health promotion, however socio-economic inequalities persist also there.
These inequalities are also linked to the level of education…. As you can see on this slide a large difference by education persists.
This figure highlights the diversity in Europe as regards incidence and mortality of oral cancer. Hungary scores high on the European top-20 list of incidence of oral cancer.
And now examples of within country inequality in oral cavity cancer linked to socio-economic differences:
The existence of inequalities as regards oral cancer is well documented for Scotland; the incidence rate is higher among men than among women. Men living in deprived areas show significantly high incidence rates of oral cancer.
This WHO document - published in 2010- on equity, social determinants and public health programmes highlights the burden of significant NCDs and the importance of socio-behavioural risk factors. The potential of public health programmes for breaking health inequities is emphasized and several practical suggestions are provided. Oral health is discussed in the Chapter 9 of this publication and you are invited to consult it. (Kwan S, Petersen PE. Oral health: equity and social determinants (pp159-176). In: Blas E, Kurup AS. Equity, social determinants and public health programmes. Geneva: World Health Organization, 2010.
In this publication as in all the work of WHO, we link oral disease prevention to intervention programmes to the prevention of main NCDs and their risk factors, particularly health behaviours.
But with the strong link between oral health and the socio-economic conditions, it is equally important to make the link with the social determinants of health.
The strategies for tackling inequities in oral health builds on the WHA60.17 resolution on Oral health-action plan for promotion and integrated disease prevention. The resolution emphasizes six platforms relevant to public health intervention for oral health.
Population based intervention such as HPS for children and youth should be organized. Similarly, as a priority various settings for older people should be considered as well as Age-friendly PHC. More and more attention is devoted in our work to the setting networks. Like Healthy Cities and Regions for Health Network as they are close to the people and on oral health issues ( as on many other health related issues ) we have to reach out to people in the settings where they live, work, love relax.
Therefore the settings, like schools and workplaces and communities, PHC - are ideal to engage with people on preventive and health-promotive initiatives.
As regards dental caries whole population strategies are most important, automatic fluoridation through water, salt or milk benefits all population groups and is an effective preventive tool in breaking the inequalities in dental caries prevalence. In several countries fluoridated toothpaste is less often adopted by the underprivileged population groups.
WHO recommends to countries to adopt several upstream interventions ranging from implementation of national policies and targets for equity in oral health and matching the needs of underprivileged population groups , legislation (e.g. healthy diet, limitation of sugars consumption), setting directives for dental care of disadvantaged population groups, ensuring financially fair PHC and universal coverage in oral health care, and avoiding the isolation of dentistry from national health programmes (oral cancer must be part of national cancer programmes).
Due to existing social inequalities in oral health care coverage, strategies on better care applies to western countries as well as …
……to countries of Eastern Europe and Central Asia.
In Europe, some major challenges in providing universal oral health care comprises many important issues as you can see it on the slide. It ranges from the performance of work by dentists as the providers of essential oral care services, the responsibilities of the public services ( role of state/government ) the need to have prevention oriented health insurance schemes, and outreach to people and community.
These upstream strategies, application of common risk factors approaches and efforts for ensuring effective universal PHC are well integrated in the most recent Action plan for the prevention and control of noncommunicable diseases in the WHO European Region.
Oral health is important component of the Health 2020.
The Regional Oral Health Programme is part of the work carried out by the Division of NCD prevention.
In conclusion, major challenges in reducing inequalities in oral health relate to the need for actions at political level, at the level of health systems, including oral health care personnel, and provision of oral health care.
There are several obvious opportunities for ensuring equity in oral health which relate to public health intervention, control of risk factors, identification of appropriate settings for oral health care of the disadvantaged population groups, and learning from integrated surveillance systems.
This is a good time to make oral health a higher priority in the countries health agenda thank it is the case now.
Count on WHO’s full support in this area.