Government’s role in dental health

ANY population should be aware that the recognition of the importance of the environment and structural issues to health has led to the development of health promotion programmes. Health promotion has been defined as the process of seeking to improve or protect health through a range of activities, including behavioural, socioeconomic and environmental policy change. More specifically, the range of health promotion activities includes the following:

1. Health education. This includes giving information about health, offering advice and trying to encourage the development of personal self-confidence. Opportunities for this exist in group situations, such as schools, and dentist-patient contact. Radio, television or newspapers may also provide information and advice. The latter group is non-personal, however, and cannot be focused on an individual’s specific needs.

2. Personal preventative health services, such as immunisation or oral cancer screening, and positive health services, such as smoking cessation programmes. Special initiatives might be planned for those patients who are unable to access professional dental care, whether for reasons of anxiety or distance.

3. Environmental measures, such as making the physical environment more conducive to health. This might include designing buildings better to reduce the chance of dental trauma in children or optimal adjustments of the fluoride content of water to prevent dental caries. The adjustment of fluoride in public water supplies to the optimal level of one part per million has been shown to be an effective method of reducing dental decay.

4. Involving the community, either to develop local services or to form self-help or pressure groups.

5. Organisational development, involving the implementation of policies that promote the health of staff and their clients, such as providing no-smoking areas or healthy catering services.

6. Economic and regulatory activity. This might involve changing the taxation to make products intended for oral health less expensive or the development of a code of practice that may, for instance, control the advertising of health-compromising products.
The fundamental issue is to make healthy choices easier. Health education is an important part of overall health promotion activity. Interventions may not have long-term acceptability without public understanding of the reasoning behind them. On the other hand, knowing what a healthy diet should contain will not be very helpful to those people without the resources to purchase the diet, and will not affect the availability in shops of the products that constitute it.

Health promotion activity provides several difficult challenges for the dentist, whose training has usually been limited to the teaching of small groups or individuals in the dental surgery. Communication skills are an important asset to build upon, but they would need to be developed for use in activities such as lobbying for regulatory change or promoting water fluoridation. Additional skills would also be required, for example, in planning and implementing strategies and identifying organisations and groups with whom these strategies can be implemented.

There are several recent examples of the development of this range of activity. Governments of countries such as Guyana have begun to realise that it costs a whole lot more to promote preventative measures rather than bear the onerous economic burden of treatment for their population, especially as it relates to oral health which previously was considered as relatively non-essential.

Doctors and pharmacists have been successfully encouraged to prescribe and dispense sugar-free paediatric medicine, whilst health visitors have been involved in campaigns to improve dental registration for preschool children. In Canada, for example, to enter an elementary school, a Dental Health History card is a requirement. The government provides it free.

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