Promoting Oral Health in the 21st Century

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CONSIDERATIONS & POLICY ISSUES
FOR ORAL HEALTH PROMOTION

Professor Cecily Kelleher
Centre for Health Promotion Studies
National University of Ireland, Galway

Professor Kelleher commenced her presentation by outlining the difficulties faced by those responsible for formulating policy documents and stressed policy makers must consider the implications of the health initiatives they introduce for all members of society.

The changing economic climate in Ireland, from high unemployment and emigration in the 1980s to the recent emergence of the Celtic Tiger was, according to Professor Kelleher, an additional factor to consider when formulating policy. She cautioned that despite the strength of the economy, health inequalities remain.

Outlining her presentation, Professor Kelleher identified three key aims:

GENERAL PRINCIPLES OF THE HEALTH PROMOTION STRATEGY

The Health Promotion Strategy is characterised by three factors. Firstly, it offers a holistic approach to health promotion. Secondly, it has a broad socio-demographic focus. Thirdly, it offers a strategic approach to target specific populations.

An examination of the global nature of health promotion, in addition to more specific health issues, embraces the holistic approach adopted by the strategy. Such an approach promotes the interaction of qualitative data, quantitative data and other sources of knowledge, which Professor Kelleher believes is essential to the health promotion movement.

The broad socio-demographic focus adopted by the strategy addresses the huge demographic variations that exist both within and between countries. "The specifics of the social context of different groups must be implemented in strategy," said Professor Kelleher.

Turning to the strategic approach of the strategy, Professor Kelleher commented that population-specific, setting-specific and topic-specific aims allow a more practical approach to health promotion.

The Health Promotion Strategy has three major challenges:

Turning specifically to oral health, Professor Kelleher outlined the five recommendations of good oral health cited in 'The Health Promotion Strategy' which are:

Examining the goals of the 1995 Health Promotion Strategy pertaining to oral health, Professor Kelleher identified the overall goal as one of improving the level of oral health in the general population. More specific objectives included:

Professor Kelleher noted that while quantitative 'output' measures are an index of the success of achieving these goals, emphasis should also concentrate on the 'process' and day-to-day practice of oral health. She concluded by stating that one of the pilot projects of the strategy will be completed in October 2000, at which time 62 people from the public sector will be trained in oral health promotion. Six of these have completed a diploma in health promotion, one of which is completing a master's degree in health promotion.

ORAL HEALTH BEHAVIOURS FROM SLAN AND HBSC

The Survey of Lifestyles, Attitude and Nutrition (SLAN) collated oral health data from over 6,500 adults in the Republic of Ireland by means of a self-completed questionnaire. Respondents were asked questions regarding their dental status, the amount of toothpaste used, gender, age, general medical services (GMS), locality, dietary habits and smoking.

Oral health data from the survey indicated that only 23% of respondents reported having all their own teeth, while 33% of the sample reported having dentures. The use of a pea-sized amount of toothpaste was reported by 14% of respondents, with women having significantly higher rates than men (17% versus 11%). This may reflect a 'cohort effect' relating to educational messages targeted at these populations when they were younger.

The Health Behaviour in School-aged Children (HBSC) survey of school-going children provides another rich source of data. Findings indicated that while gender did influence the frequency with which children brushed their teeth on a daily basis, (68% girls versus 47% boys); age and socio-economic status were not influential.

Professor Kelleher commented that the findings from surveys such as SLAN and HBSC would be beneficial in guiding health promotion initiatives to specific populations.

HEALTH EDUCATION INITIATIVES

Turning to health education initiatives, Professor Kelleher reviewed a recent oral health initiative targeting primary school children. The initiative combined school visits with a television advertising campaign. Professor Kelleher commented that multi-faceted approaches to oral health were highly successful with this target audience and made reference to the 'Mighty Mouth' project supported by the Dental Health Foundation, Ireland, which seeks to increase parents' and teachers' knowledge of nutrition and oral health.

In conclusion, Professor Kelleher commented on the recent fluoridation debate. "I see the issue of fluoride and public dialogue as a challenge that must be met, as it captivates what health promotion is about." She finished by saying that this controversy highlights the need to address issues of civil liberty, public consultation and accountability as in any public health campaign. In this regard, Professor Kelleher urged health professionals to make scientific/public health cases more coherently, to facilitate genuine public consultation and to assimilate the conclusions into public policy.

References

Friel S, Nic Gabhainn S, Kelleher CC. Results of the National Health and Lifestyle Surveys. SLAN and HBSC Centre for Health Promotion Studies, NUI Galway and Department of Health and Children, 1999.

Department of Health and Children National Health Promotion Strategy 2000 - 2005. Dublin: The Stationary Office 2000.