1. Definition of Health and Public Health

2. Objectives Define health and public health
Discuss a new definition for dental public health practice
Discuss current and future status of dental public health
Introduce the basics of public health planning
Introduce the structure of public health systems

3. What is health? World Health Organization Is this achievable?
Health comprises complete physical, mental and social well-being, and is not merely the absence of disease.
Is this achievable?
Health is a state where humans can function socially, mentally, and physically, as active members of their families and community.

4. What is a public health problem?
Public health, according to Burt and Eklund [1999] cannot easily be defined.
There is a general consensus that public health is “…fulfilling society’s interest in assuring conditions in which people can be healthy.” (Institute of Medicine, 1988).
There is a widespread condition actual or potential cause of morbidity or mortality
There is a perception on part of the public, government, or public health authorities that the condition is a public health problem. 4

5. What is a public health problem?
This definition implies that public health planning should encompass all programs or services that can promote the health status of a targeted population.
Public health programs or services should include activities that focus on health promotion, and primary, secondary and tertiary healthcare.

6. What is a public health problem?
Dental caries is a public health problem because it is a widespread condition that is costly to treat and it impacts on the quality of life at all ages. In most of the developing world, dental caries remains untreated.

7. The Three Revolutions in Public Health
The first era-the communicable disease era-began during ancient times and continues today;
The second era--the chronic disease era--began during the 20th century, particularly among the industrialized nations.
Breslow L. AJPH 2006;96:17-20.

8. The Three Revolutions in Public Health
Substantial and growing segments of the population no longer regard disease as the only, or even the primary, health problem.
The third revolution in public health aims to achieve long and fruitful life, not simply the absence of disease.
The focus is on wellness
Health promotion is the science and art of promoting health and wellness.
Breslow L. AJPH 2006;96:17-20.

9. What is DPH? AAPHD, APHA (Oral Health Section)
Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. (Adopted May 1976) 9

10. Dental Public Health Re-defined
Dental public health is a scientifically-based specialty of dentistry and public health that integrates knowledge and experiences from dental, behavioral, public health, educational and political sciences, with experiences from business, management, marketing, and advocacy, to promote health and oral health and provide primary, secondary, and tertiary dental care for individuals and populations.

11. Many programs are seriously under-developed and under-supported.
Rozier RG. AAPHD Turns 60—Back to the Future: Whatever Became of Dental Public Health. J Public Health Dent 1997;57:3-4.
Dental public health in not well prepared to assume its role in this new, complex world.
Many programs are seriously under-developed and under-supported.
Nearly one-half of state health agencies are affected by dwindling oral health expenditures or a total lack of such expenditures.

12. Institute of Medicine (IOM) Report on the Future of Public Health
13% of the GDP goes towards health care in the USA.
Health indicators (life expectancy, infant mortality)
Infant mortality among blacks is about 2.5 times higher than white Americans
95% of expenditures are directed towards medical care and biomedical research.
Behaviors cause 70% of all chronic diseases.

13. Upstream/Downstream: Options for Oral Disease Prevention.
Watt RG. CDOE 2007;35:1-11.

14. The Implications for DPH
From
Fluoride
Sealants
Education To
Addressing the causes of inequalities and inequities in oral health
Comprehensive dental/oral care models
An integrated oral health promotion care model
Social and policy initiatives

15. Education of a DPH dentist (professional) (specialist)
Biology of oral conditions
Social and behavioral sciences
Planning, policy analysis
Administration of health programs
Clinical care and prevention

16. Education of a DPH dentist (professional) (specialist)
Environmental health sciences
Health behavior and health education
Health care financing
Epidemiology
Research design and biostatistics
Health planning and administration
Community organization

17. Levels of Preventive Care
Primary
Precedes the disease and applied in healthy individuals or groups
Secondary
Early identification and prevention/treatment
Early carious lesions
Early cancer
Tertiary
Restoration and rehabilitation to restore optimal health

18. Public Health Planning Cycle
Definition of the problem and collection of information
Establishment of long-term goals
Specific objectives
Selection and development of programs to achieve the objectives
Implementation of programs
Evaluation

19. Dental public health planning?
What programs are needed to promote oral health and healthy behaviors?
What programs are needed to prevent the development of early stages of disease?
What programs are needed to prevent the progression or reverse early stages of disease?
What programs are needed to minimally treat early irreversible disease destruction?

20. What is a public health system?
Governmental public health infrastructure
Media and communications
Health care delivery system
Employers and businesses
Academic institutions
Others

21. Essential Public Health Services
Monitor health status to identify community health problems
Diagnose and investigate health problems and health hazards in the community
Inform, educate, and empower people about health problems

22. Essential Public Health Services
Mobilize community partnerships to identify and solve health problems
Develop policies and plans that support individual and community health efforts
Enforce laws and regulations that protect health and ensure safety
Link people to needed personal health services and assure the provision of health care when otherwise unavailable
Assure a competent public health and personal health care workforce

23. Essential Public Health Services
Evaluate effectiveness, accessibility, and quality of personal and population-based health services
Conduct research to attain new insights and innovative solutions to health problems
Provide appropriate dental care

24. Now and Future Access and quality of dental care
Graying of the population
Elderly population (65+ year) will double between 1995 and 2025
Immigration
Diversity of population
Technological and scientific advances
Globalization
Cheaper and better care (health tourism)
Diseases and epidemics are global
Economic trends