introduction to dental public health Flashcards
what are major health concerns today?
- general health antibiotic resistance;
- Oral health caries – globally prevalent issue;
Communicable and non-communicable diseases (NCDs), (NCDs are the global problems)
features of the developing Public Health Scotland
april 2020
- 6 priorties
how can we improve sugar advice?
more defined (like alcohol and smoking)
need to clarify how to assess (diet diaries: vague, difficult to implement, trusting patient honesty)
- Complex to assess – hidden, added, natural, frequency
need to develop better motivational messages and interventions.
awareness campains
Social marketing trying to address public health challenges (obesity, smoking).
Helps point less widely known links.
Critics say fuels a blame culture slightly – targets peoples lifestyle choices. Socieo economic factors are often the cause of the cause of the condition (e.g. poor, inequalities drive obesity sometimes)
what types of services are required to tackle these problems? (3)
treatment - Provision of care Primary: GPs, GDPs Secondary: hospitals Tertiary care: Highly specialised units e.g. cleft palates
screening/anticipatory care
(breast/bowel cancer vans – early detection. Dentists have role in early detection for oral cancer and caries (white spot lesions))
prevention: social/environmental
(3 levels: policy, community, clinical)
primary care
GPs, GDPs
secondary care
hospitals
tertiary care
highly specialised units e.g. cleft palates
inverse care law
deprived groups often suffer
most health care provided to those who need it least
highest need, have less access (can be other barriers not just geographical e.g. socieo-economic)
what health care do deprived people often access?
inappropriate services as go straight to emergency care due to inverse care law
- high cost
national reports recommendation for the future
reorienting services
Primary care system to be focused on prevention of ill health and detection & management of problems at early stage
- Less drill and fill and more anticipatory model
Preventive, anticipatory care where possible rather than only reactive management
anticipatory care definition
“Planned intervention to achieve early diagnosis and/or treatment of a condition which may not yet be producing symptoms or recognised as producing symptoms”
“Can take many forms. Helps reduce avoidable unscheduled acute admissions for people with pre-existing conditions”
“Care with an eye to the future”
features of realistic medicine and dentistry
- Patient centred
- Shared decision making
- Reduce harm and waste
- Reduce unwarranted variation in practice and outcomes
- Manage risk better
- Become improvers and innovators
public health definition
“The science and practice of preventing diseases, promoting health and improving quality of life through the organised efforts of society”
It is about improving population health rather than treating individuals
But, it is also about putting the practice of dentistry in context within society
2 activities of public health
improving health of population and improving equality of services
what does oral health consist of?
means more than ‘good teeth’ - it is integral to general health, is essential for wellbeing, and is a determinant of quality of life.
It allows us to speak, smile, kiss, touch, taste, chew, swallow and cry.
Conversely, oral disease can lead to significant time lost from school, work and other activities.
features of individual clinical practice
- history and examination
- diagnosis
- treatment planning
- treatment
- follow up and review
features of public health practice
- assessment of need for population
- analysis of data
- planning of services to meet needs
- programme implementation ‘
- evaluation of outcome
dental public health aims
To improve and tackle inequalities in oral health and health care through appropriate preventive, health promotion, anticipatory care and treatment services
Driven by inequalities, cannot ignore this – will widen inequalities and create more issues
4 challenges in dental public health
Reducing oral health inequalities – reduce gap
Improving oral health
Oral health importance to general health
Ageing population (improving: edentulous patients drop, retaining teeth to longer age - challenges)
what is now recommended for oral health care?
preventative and anticipatory care over reactive management
In general, causes of main dental diseases known
- Numerous preventive measures exist
diseases still prevalent
- In UK, very small % of NHS budget on prevention (health economics)
main roles of dental public health
- epidemiology
- (oral) health needs assessment
- preventing disease & (oral) health improvement
- addressing (oral) health inequalities
- policy development
- development and implementation of local (oral) health strategies
- service development the development of clinical pathways
- patient safety
- improving governance systems (for dentistry) and quality improvement
- evaluating (oral) health services
- teaching and training;
- research
role of epidemiology in dental public health
Monitoring infectious diseases
- e.g. cancer registries
Monitoring non-infectious diseases
- e.g. dental caries surveys
Measuring health & inequalities in health
Determine risk factors associated with diseases
Strategic planning
Evaluation of effectiveness of service provision
(Burden and risk factors of disease)
what does prevention and oral health improvement require?
understanding of social, political, economic and environmental factors
what level is prevention and oral health improvement implemented at?
community and individual patient level
determinants of oral health status
Factors influencing eating habits and use of fluoride products major determinants of dental health status:
- not always within control of individual
- financial restraints
- access issues
(e. g. consumables & health services ) - family, peer pressure
- education
influences on health
life circumstances
- general education
- commercial influences
- peer pressure
- social isolation
- environment
- access
- culture
- housing
Lifestyle
- eating
- smoking
- alcohol
- physical activity
- drug miss-use
deprivation/inequalities
commercial determinants influence on health
determine what we eat (commercials, offers, product placement, targeting – very unregulated industry currently. Need to tackle like tobacco and alcohol)
what does developing public health policy require? (3)
lobbying
negotiation
facilitating change
- influencing policies with impact on oral health, eg:
involved in drafting regulations for new Schools Health Promotion and Nutrition Bill (2007) - Healthy Eating in Schools (2008)
tobacco control - UK: regulation to provide 15 new health warning on cigarette packages, effective 1st October 2008
NHS dental primary care service for children
what is the objective for dental public health?
produce health gain for population
what is the root of tackling public health issues
Price i
- tax (sugar (milk and fruit juices are exempt),
- minimum unit price (alcohol),- - - ban 2 for 1 promotion
- Progressive income tax – redistribution income (drives behaviours and risk)
6 dimensions of healthcare quality
- Person-centred
- Safe
- Effective
- Efficient
- Equitable
- Timely
way of viewing in a range of ways
developing guidelines and guidance
large part of public health
- creating evidence base
priorities of NGS service provision
- Demands on health care systems always greater than resources
- Major financial constraints in next few years
- One response to increasing demands and limited resources is to direct resources to particular problem areas – cost restraints
Public health criteria
Prevalence of the condition
Impact of the condition on an individual level
- e.g. fatal, debilitating etc
Impact on wider society
- e.g. economic costs to country – hospital bed is expensive
Condition is preventable and effective treatments are available
how to decide if a public health issue?
use public health criteria
