THEORIES OF DISEASE, ICEBERG PHENOMENON OF DISEASE, HEALTH & ITS CONCEPTS, CHANGING CONCEPTS IN PUBLIC HEALTH, LANDMARK COMMITTEES IN THE HISTORY OF PUBLIC HEALTH IN INDIA, RECENT ADVANCEMENTS IN PUBLIC HEALTH *videos, animations may not play

1. HISTORY
OF
PUBLIC HEALTH DENTISTRY
Dr. Siddharth Dutta (PGT)
Supervised by Dr. Shitanshu Malhotra (Reader)

3. CONTENTS
✣ INTRODUCTION
✣ HISTORY
✣ THEORIES OF DISEASE
✣ ICEBERG PHENOMENON OF DISEASE
✣ HEALTH & ITS CONCEPTS
✣ CHANGING CONCEPTS IN PUBLIC HEALTH
✣ LANDMARK COMMITTEES IN THE HISTORY OF
PUBLIC HEALTH IN INDIA
✣ RECENT ADVANCEMENTS IN PUBLIC HEALTH

4. INTRODUCTION
✣ Dental Public Health (DPH) is a non-clinical specialty of dentistry that
deals with the prevention of oral disease and promotion of oral health.
DPH is involved in the assessment of key dental health needs and
coming up with effective solutions to improve the dental health of
populations rather than individuals.
✣ Prevention is becoming increasingly important. Dental related diseases
are largely preventable and there is a growing burden on health care
systems for cure. Dental public health looks beyond the role of a dental
practitioner in treating dental disease, and seeks to reduce demand on
health care systems by redirection of resources to priority areas.

5. HISTORY

6. 16th century
Barber dentists were sent from England to U.S.

7. 1640
Toothbrush was introduced into the western world.

8. 18th century A.D
✣ Pierre Fauchard emphasized the need
to keep the teeth clean if diseases were
to be prevented.

9. 1890
✣ British Dental Association
formed a committee for
appointment of dentists to
elementary schools for carrying
oral hygiene works.

10. 1901
✣ Dr. Fredrick McKay discovered and coined word
COLORADO STAIN in Colorado springs, USA.
✣ Dr. Black & McKay & associates (1908) termed Colorado
Stains as DENTAL FLUOROSIS.
COLORADO BROWN STAIN
Dr. Fredrick McKay

11. 1912
✣ The powerful slogan ‘A clean tooth never decays’ was
popularised among the mass.

12. 1925
✣ First dental college in India was named after
Dr. R.Ahmed father of dentistry in India as
Dr. R.Ahmed Dental College in Calcutta

13. 1945
✣ In 1945, Grand Rapids, Colorado became
the first city in the world to fluoridate its
drinking water. The Grand Rapids water
fluoridation study was originally sponsored
by the U.S. Surgeon General

14. 1948
Dentist Act was passed by Indian parliament on 29th March 1948.
This act was introduced to regulate profession of dentistry in India.
The Act contains five chapters and their sub-sections.
✣ Chapter – 1: INTRODUCTION
✣ Chapter – 2: DENTAL COUNCIL OF INDIA
✣ Chapter – 3: STATE DENTAL COUNCILS
✣ Chapter – 4: REGISTRATION
✣ Chapter – 5: MISCELLANEOUS

15. Advertisement in
the 60s

16. THEORIES OF
DISEASE

17. Miasma Theory
✣ The Miasma Theory (also called the miasmatic theory) is an obsolete
medical theory that held that diseases such as cholera, chlamydia, or
the Black Death were caused by a miasma (ancient Greek: "pollution"),
a noxious form of "bad air", also known as night air. The theory held
that the origin of epidemics was due to a miasma, emanating from
rotting organic matter.

18. Germ Theory
✣ The Germ Theory of Disease is the currently accepted scientific theory of disease.
It states that many diseases are caused by microorganisms. These small organisms,
too small to see without magnification, invade humans, animals, and other living
hosts. Their growth and reproduction within their hosts can cause a disease. "Germ"
may refer to not just a bacterium but to any type of microorganism, especially one
which causes disease, such as protists, fungi, viruses, prions, or viroids.

19. ICEBERG PHENOMENON
OF
DISEASE

20. ✣ Disease in a community may be compared with an iceberg.
✣ Tip of iceberg denotes what the physician sees in the community [clinical cases].
✣ The vast submerged portion of iceberg
denotes hidden mass of disease
- Latent
- Inapparent
- Presymptomatic
- Undiagnosed
- Carriers
✣ The water line denotes demarcation
between apparent and inapp-
-arent disease.
ICEBERG PHENEMENON OF DENTAL CARIES

21. Health, as defined by the World
Health Organization (WHO), is "a
state of complete physical, mental and
social well-being and not merely the
absence of disease or infirmity."

22. ✣ Biomedical concept
✣ Ecological concept
✣ Psychosocial concept
✣ Holistic concept
CONCEPTS OF HEALTH

23. Biomedical concept
“Absence of disease”
✣ Human body = machine
✣ Disease = break down
✣ Doctor’s task = repair of machine
✣ Limitation: it has minimized the role of environmental,
social, psychological & cultural determinants of health.
PHYSICIAN
BREAKDOWNBODY

24. Ecological concept
✣ Health: is a dynamic equilibrium between man &
his environment
✣ Disease: maladjustment of the human organisms
to the environment.
✣ The concept supports the need for clean air, safe
water, ozone layer in the atmosphere, etc. to
protect us from exposure to unhealthy factors.

25. Psychosocial concept
Health is not only a biomedical phenomenon, but also influenced by
social psychological, cultural, economic factors of the people
concerned.
They are:
 feeling good about yourself
 feeling comfortable around other people
 controlling tension and anxiety
 maintaining a positive outlook
 thank for simple things
 being able to meet goals
 respect and appreciate nature

26. Holistic concept
Biomedical + Ecological + Psychosocial
✣ It has been defined as multidimensional process
involving the well-being of the whole person in his
environment.
✣ Holistic concept includes that, all sectors of society
have an effect on health

27. ✣ Disease control phase (1880-1920)
✣ Health promotional phase (1920-1960)
✣ Social Engineering phase (1960-1980)
✣ Health for all phase (1981-2000)
CHANGING CONCEPTS IN
PUBLIC HEALTH

28. Disease control phase
(1880-1920)
✣ Public health during the 19th century was largely a matter
of sanitary legislation and sanitary reforms aimed at the
control of man's physical environment, e.g., water supply,
sewage disposal, etc.

29. contd.
✣ Clearly these measures were not aimed at the control of
any specific disease, for want of the needed technical
knowledge.
✣ However, these measures vastly improved the health of the
people due to disease and death control.
CENTRE OF DISEASE CONTOL & PREVENTION

30. Health promotional phase
(1920-1960)
✣ It was realized that public health had neglected the citizen as an
individual, and that the State had a direct responsibility for the health
of the individual. Consequently, in addition to disease control activities,
one more goal was added to public health, that is, health promotion of
individuals.
✣ It was initiated as personal health services such as:
 mother and child health services
 school health services
 industrial health services
 mental health and rehabilitation
services

31. contd.
Mother and child health services
School health services
Mental health and rehabilitation services
Industrial health services

32. contd.
Basic Health Services
 PHCs and Sub centers
were established.(Bhore
Committee)
 Highly Successful - Rural
population benefitted a lot.
Community Development
Programme
 For Village Development through
active community participation.
 Failure - Due to Inadequate
resources.
✣ Since the State had assumed direct responsibility for the health of
the individual, two great movements were initiated for human
development during the first halt of the present century, namely:

33. Social Engineering phase
(1960-1980)
✣ Social and Behavioural aspects of Disease and Health were
prioritized to lessen Chronic Diseases burden on the society.
✣ However, as old problems were solved, new health problems in
the form of chronic diseases began to emerge, e.g., cancer,
diabetes, cardiovascular diseases, alcoholism and drug addiction
etc. especially in the affluent societies which gave rise to the
concept of Risk Factor

34. contd.
RISK FACTORS FOR LUNG CANCER

35. Health for all phase
(1981-2000)
✣ A Health Gap between Rich & Poor, Within and In-between
Countries was realized upon the release of John Bryant’s
book:
“Health and the Developing World”
✣ The book presented a gloomy picture and a challenge of
inequalities in health by saying: "Large numbers of the
world's people, perhaps more than half, have no access to
health care at all, and for many of the rest the care they
receive does not answer the problems they have".

36. contd.
✣ In the year 1981, WHO pledged to Provide Health for All by
the year 2000.
✣ In order to eliminate Inequalities in health care, the Three
Tier System of Health Care was implemented.

37. Health for all in
21st Century

38. WHO focused on 8 Millennium Development
Goals:

39. 2025

40. LANDMARK COMMITTEES IN THE
HISTORY OF
PUBLIC HEALTH IN INDIA
✣ Bhore committee (1946)
✣ Mudaliar Committee (1962)
✣ Kartar Singh Committee (1973)
✣ Shrivastav Committee (1975)
✣ Rural Health Scheme (1977)

41. Bhore committee,1946
✣ This committee is aka known as the “Health Survey
& Development Committee”.
✣ Sir Joseph Bhore was appointed in 1943 as its
Chairman.
The report, submitted in 1946, suggests:
one primary health centre as suggested for a
population of 40,000. Each PHC was to be manned by 2
doctors, one nurse, four public healthnurses, four midwives,
four trained dais, two sanitary inspectors, two health
assistants, one pharmacist and fifteen other class IV
employees.
Sir Joseph Bhore

42. Mudaliar Committee, 1962
✣ This committee is aka as the “Health Survey and
Planning Committee”.
✣ Dr. A.L. Mudaliar, was appointed to assess the
performance in health sector since the submission of
Bhore Committee report.
The committee emphasised:
a PHC (Primary Health Centre) should not be made to
cater to more than 40,000 population and that the curative,
preventive and promotive services should be all provided at the
PHC. The Mudaliar Committee also recommended that an All
India Health service should be created to replace the erstwhile
Indian Medical service.
Dr. A.L. Mudaliar

43. Kartar Singh Committee, 1973
✣ This committee is aka “Committee on multipurpose workers
under Health and Family Planning”.
✣ Mr. Kartar Singh was appointed in 1972 as its chairman.
The report, submitted in 1973, suggests:
One Primary Health Centre should cover a population of
50,000. It should be divided into 16 subcentres (one for 3000 to 3500
population) each to be staffed by a male and a female health worker.

44. Shrivastav Committee, 1975
✣ This committee is aka “Group on Medical Education and
Support Manpower”.
✣ Mr. Shrivastav was appointed in 1974 as its chairman.
The committee recommended:
 creation of health workers from within the community itself. It also
felt that one male and female health worker should be available
for every 5,000 population.
 it recommended that Primary Health Care should be provided by
specially trained workers from within the community itself.
Acceptance of this recommendations lead to the the launching of the
Rural Health Service.

45. Rural Health Scheme, 1977
✣ The rural health scheme which emerged out of
the recommendations of the Shrivastav
Committee is based on a four tier system of
services:
-TheVillage,
-The Subcentre (SC),
-The Primary Health Centre (PHC) and
-The Community Health Centre (CHC).

46. Recent Advancement
In Public Health

47. ✣ Modern Public Health advocates in enhancing Inter-Sectoral
& Inter-Disciplinary Education and training.
✣ Public Health operated in several ways, implementing
various new programmes.
Revised National TB
Control Program (RNTCP)
Integrated Child
Development Services
(ICDS)
Universal Immunisation
Programme (UIP)
National Rural Health
Mission (NRHM)

48. ✣ To Overcome Political, Economic and Social Obstacles, A New
Movement called PUBLIC HEALTH 2.0 came forward.
✣ This aims to make field make more accessible to general public
and more User-Driven.
✣ It works by reaching out through Social media and Health
blogs.
Using Twitter, researchers were able
to predict influenza in their population.
 Red line is predicted rates,
 Black line is the actual rate.
 Vertical line separates training
from predicted data.

49. Achievements of Public Health 2.0
✣ Immunizations
✣ Motor-Vehicle Safety
✣ Workplace Safety
✣ Fluoridation of H2O
✣ Control of Infections
✣ Decline in Heart Disease
and Stroke
✣ Safe & Healthier Foods
✣ Family Planning
✣ Healthier Mother And Child
✣ Tobacco as Health Hazard

50. REFERENCES
 Essentials of Public Health (5th Edition) – Soben Peter
 A Textbook of Public Health Dentistry – CM Marya
 https://en.wikipedia.org/wiki/Dental_public_health
 https://en.wikipedia.org/wiki/Public_health
 http://www.nihfw.org/
 http://nhm.gov.in/nhm/nrhm.html
 http://www.iaphd.org/