People’s Health

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

Becoming familiar with the Opening Statements will set you on the right track to begin your journey in developing an understanding of the importance of people’s health. The connection between people’s health and community oral health will become apparent throughout the text. Thinking of specific examples, such as those in the Opening Statements, will enable you to envision what is meant by the topics of health, public health, and dental public health. It is also necessary to review the more formal definitions of these terms that occur in most texts on the topics. Various definitions exist for these terms; however, the following definitions should suffice for use within the scope of community oral health practice for the dental hygienist:

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

Upon reading these definitions carefully, you are ready to view two concepts of importance to your comprehension of public or people’s health: (1) the public health problem and (2) the public health solution. The public health problem, as perceived by the public, usually brings to mind an infectious disease such as acquired immunodeficiency syndrome (AIDS) or the swine flu (N1H1). The spectrum of problems, however, is vast and more extensive than one might first realize. Examples of public health problems include the following:

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

4. An increase in violence among youth of today

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 criteria ⁶:

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

The history of public health demonstrates that once the problem is identified and knowledge and expertise have been developed to solve the problem, the community must unify to find social and political support to proceed with the public health solutions.

Public Health Solution

Examples of solutions to public health problems that most persons are familiar with include immunizations, tobacco cessation programs, fluoridation of drinking water, and seat belts and air bags in cars to prevent injuries and mortality. These public health solutions are concerned with health promotion and disease prevention. They address the problems of the community at large and are effective measures that follow seven characteristics (see Guiding Principles).

Community water fluoridation has proved to be a safe, cost-effective solution for reducing dental decay in children. It is easily implemented by adding fluoride to the water supply, and it reaches all people regardless of socioeconomic status. It is effective immediately upon initiation and costs far less than the financial burden of restorative treatment. It meets all seven characteristics to be considered an effective solution to the problem of dental decay.

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.

Community water fluoridation is the perfect example of a dental public health solution to the problem of dental decay. Organized community efforts have brought fluoridated drinking water to more than 144 million people, and the results have shown a significant reduction in the amount of dental decay. Dental disease, however, still exists as a public health problem of the twenty-first century. More community dental health education needs to be performed with the implementation of additional dental health promotion and prevention programs.

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