People’s Health
Upon completion of this chapter, the student will be able to:
• Define the terms health, public health, and dental public health.
• Define the term population health.
• Identify public health problems within a community.
• Identify public health measures or solutions.
• Define dental disease as a public health problem with public health solutions.
• Explain the role of the government in public health solutions.
• Discuss the 10 greatest public health achievements of the twentieth century.
• Identify core functions of public health and the essential public health services.
• Describe the relation of public health to the roles of the dental hygienist.
Opening Statements
What Is Public Health?
• Influenza immunizations save lives and money.
• Vaccine research of the human immunodeficiency virus (HIV) is a top priority to end the epidemic.
• Community water fluoridation is listed as one of the 10 greatest public health achievements of the twentieth century.
• Evidence links dental disease to life-threatening systemic diseases such as heart disease, respiratory ailments, and diabetes.
• The website of the world’s largest tobacco company acknowledges that smoking tobacco causes serious health risks.
• Improved water sanitation controls infectious diseases.
• The White House and the American Dental Hygienists’ Association (ADHA) team together to provide dental insurance to children.
• Bioterrorism has put public health officials on alert for unusual diseases.
Health, Public Health, and Dental Public Health
Health has been described by the World Health Organization (WHO) as follows: “Health comprises complete physical and social well-being and is not merely the absence of disease.”1
Public health, as described by Winslow, is “the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts.”2 It is concerned with lifestyle and behavior, the environment, human biology, and organizations of health programs and systems.3 The public pertains to the community, state, or nation. Public health is people’s health.4
Dental public health has been described by the American Board of Dental Health as the science and art of preventing and controlling dental disease and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as the patient rather than the individual. It is concerned with the dental education of the public, applied dental research, and the administration of group dental care programs, as well as prevention and control of dental diseases on a community basis.2
In this text, the terms public health and community health are used synonymously, and both refer to the “effort that is organized by society to protect, promote and restore the health and quality of life of the people.”3
The term population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”5 It is an approach to health with a goal to improve the health of the entire population. One major step in achieving this goal is to reduce the health disparities among population groups. The field of population health includes health outcomes, patterns of health determinants, and policies and interventions. These topics and their correlations are discussed further in the book in various chapters.
The Public Health Problem and the Public Health Solution
Public Health Problem
1. Diseases caused by the pollution of the country’s air and water systems
2. Chronic diseases of the expanding population of older adults
3. Inadequate funding for dental disease in indigent children
Studying examples of public health problems appears to be the easiest means of developing an understanding of what constitutes public health. Public health problems, as described by Burt and Ecklund, must meet the following criteria6:
1. A condition or situation that is a widespread actual or potential cause of morbidity or mortality
2. An existing perception that the condition is a public health problem on the part of the public, the government, or public health authorities
Dental Disease as A Public Health Problem
Dental Caries
Dental disease is a universal problem that does not undergo remission if left untreated. For many Americans, especially children from minority, racial, and ethnic groups, dental caries is common and widespread. About 99% of adults have had tooth decay by the time they reach their early 40s. Sixty percent of adults older than 75 years of age have had root caries.7 The extent and severity of dental caries warrant the need for treatment and prevention programs throughout the United States. Dental decay, if left untreated, continues to escalate and results in expensive surgical procedures. Therefore it is important to focus on prevention of the disease.
Chapters 6 and 8 describe various programs and health promotion efforts that can be implemented and expanded upon within communities nationwide. The 2000 Surgeon General’s report on oral health emphasizes the need for these programs and addresses the importance of oral health to the general health of the public.8 Dental disease is discussed as a dental public health problem of universal prevalence that can be alleviated, and even prevented, with future public health measures. Dental professionals, both those employed in the field of public health and those employed in private practice, must work together to educate the community and to provide the necessary programs to treat and prevent further disease.
Public Health/Private Practice
Programs to treat dental disease can be conducted on a community (public health) or individual (private practice) level. On the community level, the dental professional treats the community as a patient rather than as an individual. Table 1-1 demonstrates the similarities of community oral health practice to private practice. The community oral health steps parallel steps conducted in the private practice. Community oral health practice extends the role of the dental hygienist in private practice to include the people of the community as a whole. The public health facility (e.g., hospital, community clinic, school, or agency), rather than the private dental office, becomes the environment in which the service of oral health care is provided. The patient’s dental examination parallels the community survey as a means of assessment of the situation or problem.
Table 1-1
Comparison of Components in Private Practice and Public Health
Private Practice | Public Health |
Patient | Community |
Examination | Survey |
Diagnosis | Analysis |
Treatment planning | Program planning |
Treatment | Program implementation |
Fee/payment | Budget/financing |
Patient evaluation | Program evaluation |
Evaluation of the treatment is similar to the program appraisal and should occur during the implementation and at the end of the treatment or operation.6 This comparison should help the private practice hygienist become comfortable with the concepts of community program planning, implementation, and evaluation (see Chapter 6).
Government’s Role in Public Health
Government Agencies
As a dental hygienist, you may contribute to the health of people in the community through participating in community health promotion activities. You may choose to present an educational program at a school or conduct a cancer screening at a facility for older residents (see Chapter 8). The more formal public health programs, however, generally fall under the aegis of the government. Both prevention and the delivery of services are concerns within the programs developed by government agencies.
The federal government’s role in participating in dental health-related activities falls under the jurisdiction of the US Department of Health and Human Services (DHHS). Healthy People 2020, a publication of the DHHS, lists health objectives for the United States, including oral health, that need to be achieved by the year 2030 (see Chapter 4).