DENT1006 - Preventive Medicine & Introduction to Public Oral and Dental Health PDF

Sayfa 1 DENT1006 - Preventive Medicine & Introduction to Public Oral and Dental Health CONCEPTS OF HEALTH “Joseph John (2018), Textbook of Preventive and Community Dentistry, Public Health Dentistry 3rd Ed CBS Publishers CHAPTER 1 “ Kindn...

Sayfa 1 DENT1006 - Preventive Medicine & Introduction to Public Oral and Dental Health CONCEPTS OF HEALTH “Joseph John (2018), Textbook of Preventive and Community Dentistry, Public Health Dentistry 3rd Ed CBS Publishers CHAPTER 1 “ Kindness, concern and love for the art of healing earned “Hippocrates” the immortal title of “Father of Medicine”. Medicine has evolved after a series of false theories, misinformation, mistaken interpretations, inventions and discoveries. Medical knowledge in fact has been derived, to a very great degree, from the intuitive and observational propositions and cumulative experiences gleaned from others. From time immemorial, man has been interested in trying to control the disease. The medicine man, the priest, the herbolist and the magician, all undertook in various ways to cure man’s disease and bring relief to the sick. Health All communities have their concepts of health, as part of their culture. Health continues to be a neglected entity despite lip service. At the individual level, it cannot be said that health occupies an important place, it is usually subjugated to other needs defined as more important, e.g. power, prestige, wealth, knowledge and security. Health is often taken for granted and its value is not fully understood until it is lost. Definition Health is one of those terms, which most people find it difficult to define although they are confident of its meaning. One of the oldest definitions of health is “absence of disease”. Sayfa 2 Health is defined in the World Health Organization’s Constitution as “a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.” Webster defined health as “the condition of being sound in body, mind or spirit, especially freedom from physical disease or pain”. To be healthy is to be in a state of homeostasis (balance) with one’s surroundings. A healthy person, therefore, needs to maintain healthy habits such as taking regular exercise and adequate rest, adopting a high level of personal hygiene, eating a nutritionally balanced diet, abstaining from the abuse of drugs and alcohol, taking care of one’s mental well-being and developing social skills to interact in a positive manner within society. Changing Concepts of Health 1. Biomedical Concept: Health has been viewed as an “absence of disease” and if one was free from disease, then the person was considered healthy. This is known as the biomedical concept. This concept was, however, found inadequate to solve some of the major health problems like malnutrition, chronic diseases, accidents etc. 2. Ecological Concept : The ecologists put forward a hypothesis, which viewed health as a dynamic equilibrium between man and his environment, and disease a maladjustment of the human organism to environment. 3. Psychosocial Concept: Health is influenced by social, psychological, cultural, economic and political factors. These factors need to be considered while defining and measuring health. 4. Holistic Concept: Sayfa 3 This concept implies that all sectors of society have an effect on health, in particular agriculture, food, industry, education and other sectors. This view corresponds to the view held by ancients that health implies a sound mind, in a sound body, in a sound family, in a sound environment. Dimensions of Health Health is multidimensional. WHO envisages three specific dimensions, namely the physical, mental and the social. The others include, spiritual, emotional, vocational and political dimensions. Physical Dimension: The state of physical health implies the notion of “perfect functioning” of the body. It conceptualizes health biologically as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body. At the community level, such indicators, as death rate, infant mortality rate and expectation of life, may assess the state of health. Mental Dimension: Mental health is not mere absence of mental illness. Mental health is defined as “a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a coexistence between the realities of the self and that of other people and that of the environment”. Assessment of mental health at the population level may be made by administering mental status questionnaires by trained interviewers. Social Dimension: It has been defined as “quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community”. Social well-being implies harmony and integration within the individual, between each individual and other members of society and between individuals and the world in which they live. Sayfa 4 Spiritual Dimension: It includes integrity, principles and ethics, the purpose in life, commitment to some higher being and belief in concepts that are not subject to “state of the art” explanation. Emotional Dimension: Mental and emotional dimensions have been seen as one element, however, psychobiology relates emotional health, to “feeling” and mental health towards “knowing” and “cognition”. Others: A few other dimensions have also been suggested such as: Vocational dimension Philosophical dimension Cultural dimension Socioeconomic dimension Environmental dimension Educational dimension Nutritional dimension Preventive dimension. Indicators of Health Indicators are required not only to measure the health status of a community, but also to compare the health status of one country with that of another, for assessment of health care needs, for allocation of scarce resources, and for monitoring and evaluation of Sayfa 5 health services, activities and programs. Indicators help to measure the extent to which the objectives and the targets Characteristics of Indicators (ideal): 1. Valid—should measure what they are supposed to measure. 2. Reliable—answer should be the same when measured by different people in similar circumstances. 3. Sensitive—should be sensitive to the changes in the situation concerned. 4. Specific—should refl ect changes only in the situation concerned. 5. Feasible—should have the ability to obtain data needed. 6. Relevant—should contribute to the understanding of the phenomenon of interest. Classification of Indicators: 1. Mortality indicators 2. Morbidity indicators 3. Disability rates 4. Nutritional status indicators 5. Health care delivery indicators 6. Utilization rates 7. Indicators of social and mental health 8. Environmental indicators 9. Socioeconomic indicators 10. Health policy indicators 11. Indicators of quality of life 12. Other indicators Sayfa 6 1. Mortality Indicators: 1. Crude death rate: It is defined as number of deaths per 1000 population per year in a given community. 2. Expectation of life: Life expectancy at birth is ‘the average number of years that will be lived by those born alive into a population, if the current age-specific mortality rate persists. 3. Infant mortality rate: Infant mortality rate is the ratio of deaths under 1 year of age in a given year to the total number of live births in the same year, usually expressed as a rate per 1000 live births. 4. Child mortality rate: It is defined as the number of deaths at age 1–4 years in a given year per 1000 children in that age group at the midpoint of the year concerned. 5. Under 5 proportionate mortality rate. 6. Maternal mortality rate. 7. Disease-specific mortality rate. 8. Proportional mortality rate. 2. Morbidity Indicators: 1. The following morbidity rates are used for assessing ill health in community. 2. Incidence and prevalence. 3. Notification rates. 4. Attendance rates at out-patient departments, health centres, etc. 5. Admission, readmission and discharge rates. 6. Duration of stay in hospital. Sayfa 7 7. Spells of sickness or absence from work or school. 3. Disability Rates: The commonly used disability rates fall into two groups: 1. Event-type indicators 2. Person-type indicators 4. Nutritional Status Indicators: 1. Anthropometric measurements of preschool children 2. Heights of children at school entry 3. Prevalence of low birth weight. 5. Health Care Delivery Indicators: 1. Doctor-population ratio. 2. Doctor-nurse ratio. 3. Population-bed ratio. 4. Population per health/subcentre. 5. Population per traditional birth attendant. 6. Utilization Rates: Utilization of services or actual coverage is expressed as the proportion of people in need of a service who actually receive it in a given period, usually a year. Sayfa 8 7. Indicators of Social and Mental Health: These include suicide, homicide, other acts of violence and other crimes; road traffic accidents, alcohol and drug abuse, smoking, consumption of tranquilizers and obesity. 8. Environmental Indicators: Environmental indicators reflect the quality of physical and biological environment in which diseases occur and in which the people live. They include pollution of water and air, radiation, solid wastes, noise, and exposure to toxic substances in food and drink. 9. Socioeconomic Indicators: 1. Rate of population increase 2. Level of unemployment 3. Family size. 10. Health Policy Indicators : The single most important indicator of political commitment is “allocation of adequate resources.” 11. Indicators of Quality of Life: 1. Infant mortality 2. Life expectancy at age one 3. Literacy. 12. Other Indicators: 1. Social indicators 2. Basic needs indicators Sayfa 9 3. Health for all indicators.