Public Health
Question 1. Write short note on changing concepts of health.
Answer.
Changing Concepts of Health
Ecological Concept
Ecologists view health as a dynamic equilibrium between a man and his environment, and disease—a maladjustment of the human organism to environment. Human ecological and cultural adaptations do determine not only the occurrence of disease but also the availability of food and the population explosion.
Biomedical Concept
As per this concept, health means, “absence of disease”. It was felt that human body is a machine and disease is an outcome of the breakdown of the machine, and one of the doctor’s tasks is to repair the machine. Developments in medical and social sciences lead to the conclusion that the biomedical concept of health was inadequate.
Holistic Concept
Holistic concept recognizes the strength of social, economic, political and environmental influences on the health. It has been variously described as a unified or multidimensional process involving the wellbeing of the person as a whole in context of his environment. The emphasis is on the promotion and protection of the health.
Psychosocial Concept
Advances in social sciences showed that health is not only a biomedical phenomenon, but the one which is influenced by social, psychological, cultural, economic and political factors of the people concerned. Thus, health is both a biological and social phenomenon.
Read And Learn More: Public Health Dentistry Question And Answers
Question 2. Write short note on positive health.
Answer. Positive health is the perfect functioning of the body and mind.
- According to the positive health, the health biologically is a state in which every cell and every organ function at its optimum capacity and is in perfect harmony with the rest of the body.
- Psychologically, it is the state in which individual feels a sense of perfect wellbeing and of mastery over his environment.
- Socially, it is the state in which an individual’s capacity for the participation in social system is optimal.
- These days the above three ideas appear slight ridiculous.
- As per Dubos “Concept of positive health cannot become a reality because man will never be so perfectly adapted to his environment that his life will not involve struggle, failure and sufferings”.
- Positive health, therefore, remains a mirage because everything in our life is subject to change.
Question 3. Write short note on epidemiological triad.
Answer. Occurrence and manifestation of any disease, either communicable or non-communicable, is determined by interaction between agent, host and environment which form epidemiological triad.
Significance of epidemiological triad is that it helps epidemiologists to focus on different classes of factors especially with regard to infectious diseases.
The Agent
- It is defined as “an organism, a substance or a force, presence or lack of which may initiate a disease process or may cause it to continue.
- It is classified as living or biological agent and non-living or inanimate agent.
- The non-living agents are classified into:
- Nutrient agent, e.g. protein, fat and carbohydrate
- Chemical agent: They are external, i.e. protein, fat and carbohydrate; and internal, i.e. ketone bodies in diabetics
- Physical agent: e.g. Atmospheric pressure and temperature
The Host
- It is the man himself.
- Host factor is the characteristic of a human beingwhich determines how he reacts to the agents in the environment.
- Host factors are classified as:
- Demographic characteristics, i.e. age, sex and ethnicity
- Biological characteristics, i.e. genetic background,physiologic and biologic characteristics, immune status and nutritional status.
- Socioeconomic characteristics i.e. social class, religion,education, marital status.
- Lifestyle, i.e. living habits and food habits, physical exercise and personality traits.
The Environment
- It acts as a source for agents of the disease.
- It leads to transmission of agents to the host, bringing abouttheir contact and interaction.
- During the interaction, environment may be favorable to man and unfavorable to the agent.
- So within the same environment, there is constant attempt towards the adjustment and readjustment between host and the agent.
Question 4. Write short note on risk factors.
Answer. The term risk factor means the attribute or exposure that is significantly associated with the development of a disease.
- A determinant that can be modified by intervention, thereby reducing the possibility of occurrence of disease or other specified outcomes.
- Risk factors are observable or identifiable prior to the event they predict.
- Combination of risk factors in an individual can be purely additive or synergistic, e.g. Smoking and occupational exposure were found to have additive effect as risk factor for bladder cancer.
- Risk factors can be truly causative or they merely contribute to undesired outcome or they are predictable in statistical sense.
- Various risk factors can be modified, i.e. smoking, hypertension, etc. while some are unmodifiable i.e. age, race, sex etc.
- Risk factors can characterize an individual, a family, a group, community or environment.
- Detection of risk factors should be considered for prevention and intervention.
- Various risk factors are:
- Age: Prevalence of a disease increases with increasing age.
- Sex: Some diseases have higher prevalence and severity for male and some for female.
- Race: The disease prevalence is different for different races, e.g. Blacks have more severe periodontal disease than whites. White individuals have incidence of cancer of skin.
- Education: Much disease is inversely related to increasing level of education.
- Income: Oral disease is inversely related to increasing level of income.
- Place of residence: In general, the prevalence and severity of oral diseases is slightly higher in rural areas than in urban areas.
- Geographical areas: There is geographical variation in prevalence and severity of oral disease.
- Psychological and cultural factors: Anxiety, fear of dentist, lack of knowledge about the disease and their treatment are some of the relevant psychological factors.
- Diet: Decrease in dietary fiber contents increase in sugar consumption increases the prevalence and severity of oral disease.
- Nutrition: The nutrients, specially associated with oral diseases are Vit. A, B complex, C and D, calcium and phosphorus.
- Oral hygiene practice: Oral hygiene practice has a major influence on prevalence of disease.
Question 5. Write short note on risk factors and risk groups.
Answer.
Risk Groups
- Risk groups are those who are exposed to risk factors.
- Risk groups are defined as total number of mothers, infants, and families at risk in the population.
- Modern epidemiology is concerned with the identification of risk groups in the population.
- It helps to define priorities and points to those in need of attention not.
- The knowledge of risk groups can be used to prevent the disease and in so far as to remove or minimize the risk.
Question 6. Write notes on iceberg of disease.
Or
Write short note on iceberg phenomenon.
Answer. It is also known as iceberg phenomenon.
- As per the concept, disease in community is compared an iceberg.
- Floating tip of the iceberg represents what the doctor seen in the community, i.e. clinical cases.
- Vast submerged portion of iceberg represents the hidden mass of the disease, i.e. latent, inapparent, presymptomatic and undiagnosed cases and carriers in the community.
- Waterline represents demarcation between apparent and inapparent diseases.
- In various diseases such as diabetes and hypertension the submerged portion of an iceberg far exceeds the known morbidity.
- Hidden part of iceberg thus constitutes an important, undiagnosed reservoir of the disease in community, its detection and control is a challenge to modern techniques in preventive medicine.
- The major deterrents in study of chronic diseases of unknown etiology is absence of methods to detect subclinical state, i.e. bottom of an iceberg.
Question 7. What is primary health care? Explain in detail the principles of primary health care with an emphasis on primary healthcare delivery in India.
Or
Define primary health care. List principles of primary health care. Describe primary healthcare delivery in India.
Or
Define primary health care. Describe the primary health care set up in India.
Or
Define primary health care. Describe primary health care delivery system in India.
Answer. Primary health care comes under force following joint WHO–UNICEF International Conference at Alma-Ata, USSR on 12th September, 1978.
Primary health care is defined as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self determination”.
Principles of Primary Health Care
Following are the principles of primary health care:
Equitable Distribution
- By equitable distribution of health services, we mean that the health services should be shared equally by all people.
- Such health services are independent of people’s ability to pay.
- All rich and poor, urban and rural must have access to health services.
- In present scenario, health services are concentrated to major towns and cities while the needy and vulnerable people in rural areas and urban slums do not get these services. It is known as social injustice.
- Primary health care shifts the concentration from urban to rural areas and bring services to people’s home if possible.
Community Participation
- Essential ingredient of primary health is involvement of families individuals and communities in promotion of their own health and welfare.
- Besides maximum reliance on local resources, such as manpower, money and materials, community should involve in planning, implementation and maintenance of health services.
Intersectoral Coordination (Multisectoral Approach)
- Planning is an important element of intersectoralcoordination.
- Alma Ata declaration states that “primary health care involves the addition to health sector, all related sectors and aspects of national and community development in particular agriculture and animal husbandry, food, industry, education, housing public works, communication and other sectors”.
- For achieving the above mentioned coordination, the administrative system of a country is reviewed, resources should be reallocated and good legislation should be provided for ensuring that coordination can take place.
Appropriate Technology
- It is defined as “technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and which is maintained by the people themselves in keeping with the principle of self-reliance with the sources the community and country can afford”.
- It implies to the concept of using costly equipments, procedures as well as techniques, even if cheaper and acceptable techniques are available.
Focus on Prevention
- Illness should be treated and rehabilitation should be carried out.
- As communities expect the right treatment services and are very less interested in other services.
- Health services should not be curative but they should instill health and healthy lifestyle and should emphasize over the prevention.
Primary Health Care Delivery in India
Primary health care in India consists of Village level workers, Sub-centers and primary health centers.
Village Level workers
Village level workers consist of following i.e.
- Village health guide scheme
- Local dais
- Anganwadi worker (ICDS scheme)
- Accredited social health activist
Village Health Guide Scheme
- The scheme was introduced on 2nd October 1977 under integrated rural health program with nomenclature ‘community health worker scheme’. After two years name of the scheme was changed in 1979 to ‘Community health volunteer scheme’ and the persons working under this scheme are the volunteers and are not employed by the government.
- Main objective of the scheme was to provide preventive, promotive and curative health services to the people of village via a volunteer from the village itself.
- health guide is a person with an aptitude for the social service and is not a government functionary.
- Health guides are now mostly the women which are chosen by the community in which they work efficiently and act as a link between the community and governmental infrastructure.
- One village health guide is present for each of the village per 1000 rural population. Till date, there are 4.10 lakhs village health guides functioning in the country.
- Village health guides are selected on the following points:
- They must be the permanent residents of local community.
- They should be able to read and write and have a minimum formal education of at least upto VIth standard.
- They must be acceptable to all sections of community.
- They should be able to spare 2 to 3 hours every day for community health work.
- As they get selected, they should undergo training in nearest primary health centre for 200 hours spread over a period of 3 months and should receive 200/- per month as their stipend.
- Duties of village health guide are:
- Treatment of the simple ailments and activities in first aid.
- Care of mother and child health which also include family planning.
- To take care of health education and sanitation.
- Village health guides do community health work of about 2 to 3 hours daily. They get honorarium of Rs 50 per month and drugs worth Rs 600/- per annum.
- Target of village health guides is to have one village health guide for each village or 1000 rural population.
Local Dais
- Under rural health scheme, an extensive programme was undertaken to train local dais for improving their knowledge in elementary concepts of maternal and child health as well as sterilization.
- Training of local dais should be held at public health center, sub-center or maternal and child health centre for 2 days a week and remaining 4 days they accompany female health workers to villages for 30 days.
- Each Dai should get stipend of Rs 300 during their training period.
- At the time of training each Dai should conduct 2 deliveries in supervision of a health worker, main emphasis should be on asepsis, so that home delivery is conducted in hygienic environment which reduces both maternal and infant mortality.
- As training of Dai get completed, she should be provided by the delivery kit and is entitled to receive the monetary compensation per delivery and for each of the infant which is registered by her.
Anganwadi Worker
- Under the integrated child development services scheme Anganwadi covers population of 1000 in rural and urban and 700 in tribal areas.
- An Anganwadi should be run by Anganwadi worker who is selected from the community, she is trained for 4 months in aspects of health, nutrition and child development.
- An Aganwadi worker should be paid Rs 1500 per month as honorarium for services rendered which includes health check up, immunization, supplementary nutrition, health education, non-formal preschool education and referral services.
- Services provided by Anganwadi workers are:
- To provide supplementary nutrition for children less than 6 years and pregnant and lactating mothers.
- Immunize children less than 6 years and also the pregnant and lactating mothers.
- Check-up of health for children less than 6 years and also the pregnant and lactating mothers.
- Referral services for children less than 6 years and also the pregnant and lactating mothers.
- To provide pre-school education for children between 3 to 6 years.
- To provide nutrition and health education for women aged 15 to 45 years.
Accredited Social Health Activist (ASHA)
National rural health mission (NRHM) provides each village in India with a trained female community health activist or accredited social health activist.
- ASHA should be selected from village itself.
- It is trained and work as interface between community and public health system.
- ASHA should receive training of 23 days in five episodes.
- One ASHA works for the population of 1000 in a village.
- After her work, experience of six months she is introduced to the HIV/AIDS issues.
- Key components of ASHA are:
- ASHA should primarily a woman resident of village preferably between the age of 25 to 45 years.
- ASHA should be a literate woman with formal education till class V3. This can be relaxed only if no suitable person with this qualification available.
- ASHA will be chosen via rigorous process of selection which involves various community groups, self help groups, Anganwadi institution, block nodal officer, district nodal officer, village health committee and Gram sabha.
- ASHA should undergo series of training episodes to acquire necessary knowledge, skills and confidence for performing spelled out roles.
- Incentives should be given to ASHA based on the performance for promoting universal immunization, referral and escort services for reproductive and child health, other health care programs, and the construction of other household toilets.
- ASHA should be empowered with the knowledge and a drug kit to deliver first contact healthcare, every ASHA should be fountain head of the community participation in the public health program in her village.
- ASHA should be the first port of call for any of the health related demands of the deprived section of population mainly the woman and children, to whom it is difficult to access the health services.
- ASHA should be health activist inside the community and should create awareness on the health and its social determinants and mobilize the community towards local health planning and increase in utilization and accountability of existing health services.
- ASHA would be the promoter of good health practices and provide the minimum package of curative care as appropriate and feasible for that level and should make time bind referrals.
- ASHA should provide information to community over the determinants of health such as nutrition, basic sanitation and the hygiene practices, healthy living and the working conditions, information of the existing health services and need for the timely utilization of health and family welfare services.
- ASHA should council women on the birth preparedness, importance of the safe delivery, breast feeding and the complimentary feeding, contraception, immunization and prevention of common infections.
- ASHA mobilizes the community and facilitate them in accessing health and health related services present at Anganwadi/sub-center and primary health centers. i.e. immunization, antinatal and post-natal checkups, sanitation and the other services provided by the government.
- ASHA should act as a depot holder for essential provisions being made available to all habitations such as oral rehydration therapy, iron folic acid tablet, pill and condoms etc.
Sub-centers
- A sub-centre is the most peripheral and is the first contact point between the primary health care system and community.
- As per the population one sub-center is established for every 5000 population in the plain areas and every 3000 population in hilly/desert/tribal areas.
- Sub-center mainly provides the interface with community at the ground level and provide primary health care services such as mother and child health care, family planning and immunization, adolescent health care etc.
- Sub-centers are of two types i.e. Type A and Type B. Type A provide all of the recommended services except the facilities for conducting delivery is not present here. If requirement of delivery services is there, sub-center should be considered for upgradation to Type B.
- Recommended staffing pattern for sub-centers is two ANM i.e. one essential and one desirable and one health worker male for Type-A which is essential. For Sub-center Type-B two ANMs i.e. both of them are essential and one health worker male which is essential.
- One staff nurse or ANM is provided, if number of deliveries at sub-centre is 20 or more in a month.
- Sanitation services should be provided via outsourcing on part time basis at Type-A and full time basis at Type-B.
- There are 1,48,366 sub-centers in India.
Primary Health Center Level
- Bhore committee in 1946 gave the concept of a primary health center as a basic health unit, to provide, as close to the people as possible, and integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care.
- Health planners in India had understood that public health centers and its subcenters are the proper infrastructure for providing health services to rural population.
- A primary health center is established for every 30,000 rural population in the plains and one public health center for every 20,000 population in hilly, tribal and backward areas has been proposed for effective coverage with 4 to 6 indoor/observation beds.
- One primary health center functions as a referral unit for 6 subcenters and referral cases to community health centers.
- Presently one primary health center cover a population of one lakh and is spread to 100 villages.
- In India, primary health centers are setup and maintained by state government. Under minimum need program and basic minimum services program.
- As the data available in September 2005 there are 23,236 primary health centers running in India as compared to 23,109 health centers in September 2004.
Question 8. Describe in detail about different levels of prevention and their importance.
Or
Define preventive dentistry. State in detail about different levels of prevention at mass level.
Or
Write short answer on levels of prevention.
Answer.
Definition of Preventive Dentistry
It is defined as “that phase of dentistry concerned with prevention of healthy teeth and maintenance of oral structure in a state of optimum health for a longest period of time possible”.
Levels of Prevention
Primary Prevention
- It is defined as “action taken prior to the onset of disease which removes the possibility that a disease will ever occur”.
- Primary prevention is prevention of occurrence of disease and prolonging the life, it includes concept of positive health.
- Primary prevention is the holistic approach designed to promote health or to protect against specific disease “agents” and hazards in the environment.
- Following are the approaches of primary prevention recommended by the WHO:
- Primordial Prevention: Primordial prevention is the emergence or development of risk factors in countries or population groups in which they have not yet appeared. Main intervention is by individual and mass education.
- Population or mass strategy: It is directed at the whole population irrespective of individual risk levels so as to bring behavioral and lifestyle changes.
- High-risk strategy: It aims to bring preventive care to individuals at special risk.
- Modes of intervention in primary prevention are health promotion and specific protection.
- Health promotion: It is the process of enabling people to increase control over and to improve health. It is not directed towards the particular disease, and provides strength to host by variety of interventions such as health education, nutritional intervention, behavioral changes.
- Specific protection: It is the provision of conditions for normal, mental and physical functioning of human being individually and in the group. Specific protection includes the promotion of health, prevention of sickness and curative and restorative medicine in all aspects.
Secondary Prevention
- It is defined as an “action which halts the progress of a disease at its incipient stage and prevents complications”.
- Interventions in secondary prevention are early diagnosis and adequate treatment.
- Earlier the disease is diagnosed and treated, it is better from the point of view of prognosis and preventing further complications of long-term disability.
- Main advantage is that it reduces high morbidity and mortality of certain diseases.
- Main disadvantage that is it is expensive.
Tertiary Prevention
- It is the intervention done in the late pathogenesis phase.
- Tertiary prevention is defined as “all measures available to reduce or to limit impairments and disabilities, minimize suffering caused by existing departures from good health and to promote patient’s adjustment to irremediable conditions”.
- Modes of intervention are disability limitation and rehabilitation.
- Disability limitation: Its objective is to prevent or halt the transition of disease process from impairment to handicap. Impairment is the loss or abnormality of psychological, physiological or anatomical structure or function. Disability is any restriction or lack of ability to perform an activity in a manner or within the range considered to be normal for a human being.
- Rehabilitation: It is the combined and coordinated use of medical, vocational, social and educational measures for training and retraining the individual to the highest possible level of functional ability. It leads to the reduction of impact of disabling condition and help the person in participate actively and join main stream.
Question 9. Describe prevention. What are the different levels of prevention? Describe in detail measures adapted for preventing periodontal disease at the community level.
Answer.
Definition of Prevention
Prevention is defined as the efforts made to maintain normal developmental, physiological function and to prevent disease of the mouth and adjacent part.
Measures Adopted for Preventing Periodontal Disease at Community Level
Following are the measures which should be adopted for preventing periodontal disease at community level:
- Toothbrushing
- Interdental oral hygiene aids
- Adjunctive aids
Toothbrushing
- Toothbrushes are either manual or electrically powered devices.
- A manual toothbrush is made up of bristles, a head, and a handle.
- Bristles are the most important part of the toothbrush and are either artificial or natural in origin.
- A brush that is soft, round ended, or polished with artificial nylon bristles is recommended.
- A soft bristled brush is more effective in removing plaque with less harm to soft and hard tissues than a brush with hard bristles because soft bristles are more flexible and thus can reach subgingival and proximal areas.
- A hard-bristled brush may cause 3 to 6 times more abrasion than soft brushes.
- Round ended bristles are recommended because they have been shown to cause 30 to 50 percent less soft tissue trauma than course-cut bristles.
- The size and shape of a toothbrush head is one of themost important parts of a toothbrush. A small head is recommended because it allows the patient to reach into places in the mouth that would be inaccessible to a large head toothbrush.
- The toothbrush handle should be firm, resilient, and resistant to fracture.
- It is very common that small brushes are recommended for children. It should be considered that neuromuscular coordination in young children is not yet fully developed. Therefore, brushes with large handles are more suitable for them.
- Special patients with limited arm or finger movement require modification of the handles such as enlarging or extending them.
- Objective of plaque control in prevention of periodontal disease is therefore, the periodic removal of the accumulated plaque at interval which is sufficiently frequent to prevent pathologic events arising from recurrent plaque formation. The frequency of brushing depends on the effectiveness of the patient in removing plaque.
- Generally, the patients need two thorough brushings a day. However, the thoroughness of tooth cleaning is more important than the specific method of toothbrushing and the frequency important than the specific method of tooth brushing and the frequency.
- Individual with healthy gingival and no history or periodontal disease can prevent gingivitis by complete plaque removal in every 48 hours. But if the inflammation is already present, colonization of cleaned tooth surface occur much sooner and plaque grows and matures more rapidly. To control gingivitis rather than prevent its onset, more frequent plaque removal may be necessary.
- Thoroughness of technique is an important factor inprevention of gingivitis and the periodontal diseases.
- Duration of brushing was found to have a greatest influence on plaque removal than either its frequency or pattern.
- The ideal tooth brushing technique is the one that remove; plaque, food debris and stain, and stimulates the gingiva tissues with the least time and effort, and does not damage oral tissues.
- It appears that a short stroke of vibrating scrub technique is the recommended method for the general public. With this method, the toothbrush can clean only one or two teeth at a time, and it will probably take about three minutes of brushing to clean all the teeth adequately.
Interdental Oral Hygiene Aids
- Dental floss is available in various styles and sizes. Generally they consist of very small continuous multifilament thread or tapes of either unwaxed or waxed synthetic fibers, usually nylon.
- Patients with tight teeth contact areas need thin unwaxed floss that can be slipped easily between the contact areas whereas in patients with crowded teeth, heavy calculus deposits, or defective and overhanging restorations, a bonded unwaxed floss or waxed floss is the dental floss of choice because they do not fray as easily as unwaxed floss.
- Dental tape is recommended when there is considerable interdental space resulting from gingival recession and bone loss.
- In interproximal areas, routine brushing is not adequate, but interdental brushes (manual or electric) with soft bristles that bend and conform to surface irregularities may be useful.
- Flossing or use of toothpicks can disrupt interproximal plaque formation and, if performed daily, may control interproximal gingival inflammation and prevent the onset of progressive periodontal disease.
- However, dental flossing may not be effective in patients exhibiting exposed root surface concavities, grooves or furcations. Also, most patients are unable or unwilling to comply with the need for daily flossing.
- Numerous devices are available to facilitate manipulation of dental floss, which may improve compliance in some patients. For all anti-plaque measures, it is important to remember that overzealous and improper use of the toothbrush or dental floss can damage the teeth and the periodontium.
- Brushing, rinsing, flossing and interdental brushing do not reach periodontal pathogens at the bottom of deep periodontal pockets.
Mechanical plaque removal by dental professional
- Professional care has been shown to successfully control plaque deposits and gingivitis and seen as to control the progress of periodontitis.
- The traditional approach to dental health education and instruction in oral hygiene was carried out by dental professional at chair side which was labor intensive. Repetition could affect the mood of instruction and effect the instructions.
- Oral hygiene instruction needs to be periodically reinforced to have a long term effect. The biggest challenge in the prevention of periodontal disease is how to motivate the individual to follow prescribed effective and health care programs throughout the life.
- Scaling is sufficient to remove plaque and calculus from enamel completely.
Adjunctive Aids
- Mechanical methods of plaque removal need a lot of manipulation, manual dexterity and time. These problems lead to the development of chemical methods which supplement mechanical cleaning.
- These consist of chemicals and antibiotic mouthwashes.
- ADA accepts two of the agents as plaque control agents i.e. prescription chlorhexidine rinse and non-prescription essential oil rinse.
- Chlorhexidine should not be used for long term, so for long term cases non prescription essential oil rinses shows satisfactory plaque reduction.
- Various other plaque control agents which can be used are triclosan, delmopinol, metallic ions, quaternary ammonium compounds, sanguinarine, enzymes, antibiotics etc.
Question 10. Discuss the importance of public health dentistry. How will you prevent the periodontal diseases and dental caries in our country at mass level?
Answer.
Importance of Public Health Dentistry
- Adoption and continuing regular application of prescribed oral hygiene and nutritional practices.
- Periodic dental care either for early treatment for disease or for application of specific preventive measures such as topical application of fluoride for dental caries, prevention or professional cleansing of the teeth to prevent periodontal disease.
- Application of community-wide measures such as fluoridation of water supply.
- For educating individuals with malocclusion, and emphasis should be placed on obtaining corrective treatment as early as possible.
- Providing education to dentist to recognize earliest signs and symptoms of oral cancer and other tumors and to refer, patients to appropriate diagnostic facilities.
- The dental health education guides the people to useproperly fitted mouth/guards while driving and during playing sports to avoid trauma.
Question 11. Write in brief on:
- Handicapped people
- Delinquent people.
Or
Write short note on handicapped people.
Or
Write short note on delinquent people.
Answer.
Handicapped People
Handicap is disadvantage for a given individual resulting from an impairment or disability that limits or prevents the fulfillment of a role for that individual.
- A handicapped individual child is prevented by participation in his normal activities for his age.
- Handicapped persons require more time, thought and care in oral hygiene training and many of them will need more efficient plaque removal than their more fortunate contemporaries.
- Oral handicapped lesions are cleft palate, mucosal lesion and cleft lip.
- For the patient with cleft palate, it is essential to use all preventive measures possible to preserve the remaining teeth.
- Deafness: Deaf will benefit by visual aids and carefully written instruction sheets for home reading.
- Blindness: Blind will benefit by use of large tactile teaching aids such as model with large tooth brushes will help considerably.
- Mental handicaps: Mentally retarded patients may require a great deal of patience to overcome fears of the dentist’s environment, therefore, the approach must be gradual and in terms the patient can cope with. The brushing and other oral care may be best accomplished by nurses or other personnel if the patient is hospitalized.
Delinquent People
- Delinquent people are those, especially a juvenile whose behavior is criminal or antisocial or the nature is of a criminal or antisocial.
- Criminal behavior carried out by a juvenile.
- Young males makeup the bulk of the delinquent population.
- Theories regarding delinquency’s causes focus on the social and economic characteristics of the offender’s family, the values communicated by the parents, and the nature of youth and criminal subcultures, including gangs.
- In general, both “push” and “pull” factors are involved.
- Most delinquents apparently do not continue criminal behavior into their adult lives but rather adjust to social standards.
- The most common punishment for delinquent offenders is probation, whereby the delinquent is given a suspended sentence and, in return, must live by a prescribed set of rules under the supervision of a probation officer.
Question 12. Write short note on changing concepts of public health.
Answer. In the whole history of public health, following four distinct phases can be demarcated:
- Disease control phase (1880-1920)
- Health promotional phase (1920-1960)
- Social engineering phase (1960-1980)
- Health for all phase (1981-2000)
Disease Control Phase (1880-1920)
In 19th century, disease control phase was a matter which is aimed to control a man’s physical environment. For example, water supply, sewage disposal, civic sense, etc. Such measures were not aimed for controlling of any specific disease but they had improved health of people because of disease and death control. This phase was the matter of sanitary legislation and sanitary reforms which were aimed to control physical environment for humans.
Health Promotional Phase (1920-1960)
During the beginning of 20th century, control of health promotion was arising. It was felt that public health had neglected the
citizen as individual. So to overcome this, along with the disease control, health promotion is added. It was started as personal health services, i.e. mother and child health services, school health, mental health services etc. Expansion of public health departments had begun towards the health promotional programs. During the first half of 20th century two great movements were initiated for human development i.e.
- First one was provision of basic health services via the primary health centers and subcenters for rural and urban areas.
- Second was community development program for promoting village development via active participation of whole community and on initiation of community.
Social Engineering Phase (1960-1980)
Due to advancement in preventive medicine and practice of public health, disease pattern began to change in the developed world. At this period, acute illnesses resolved and new health problems in form of chronic diseases started emerging. For example diabetes, cancer, etc. These problems were neither handled by sterilization, immunization and disinfection nor they were explained on the basis of Germ theory of disease. A new term, i.e. “Risk factor” as determinant of above diseases come under existence. Chronic diseases put a chronic burden over the society. This causes public health to enter in social engineering phase. Under this social and behavioral parts of disease were taken on priority. Public health is now under the preventive and rehabilitative aspects of chronic diseases and behavioral problems.
Health for All Phase (1981-2000)
- People in developed countries enjoy all aspects of good health but in developing countries only 10 to 20% of population enjoy ready access for health services of any kind. So the neglected 80% of population has right to equally claim health care and protection from killer diseases. Against this, the 30th World Health Assembly resolved in May 1977 that “main social target of governments and WHO in the coming decades should be the attainment by all citizens of the world by year 2000 of a level of health that will permit them to lead a socially and economically productive life”. So this was mentioned in international objective of health for all by year 2000.
- In 1981, 34th World Health Assembly formulated and adopted Global Strategy for Health for All.
Question 13. Write short note on principles of primary health care.
Or
Write short answer on principle of primary health care.
Answer.
Principles of Primary Health Care (PHC)
Following are the principles of primary health care:
Equitable Distribution
- It refers the distribution of equitable distribution of health services.
- By equitable distribution of health services we mean that the health services should be shared equally by all people.
- Such health services are irrespective of people’s ability to pay.
- All rich and poor, urban and rural must have access to health services.
- In present scenario health services are concentrated to major towns and cities while the needy and vulnerable people in rural areas and urban slums do not get these services. It is known as social injustice.
- Primary health care shift the concentration from urban to rural areas and bring services to people’s home if possible.
Community Participation
- Essential ingredient of primary health is involvement of families. Individuals and communities in promotion of their own health and welfare.
- Beside maximum reliance on local resources such as manpower, money and materials community should involve in planning, implementation and maintenance of health services.
Intersectoral Coordination (Multisectoral Approach)
- Planning is an important element of intersectoralcoordination.
- Alma Ata declaration states that “primary health care involves the addition to health sector, all related sectors and aspects of national and community development in particular agriculture and animal husbandry, food, industry, education, housing public works, communication and other sectors”.
- For achieving the above mentioned co-ordination the administrative system of a country is reviewed, resources should be reallocated and good legislation should be provided for ensuring that coordination can take place.
Appropriate Technology
- It is defined as “technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and which is maintained by the people themselves in keeping with the principle of self reliance with the sources the community and country can afford”.
- It implies to the concept of using costly equipments, procedures as well as techniques even if cheaper and acceptable techniques are available.
Focus on Prevention
- Illness should be treated and rehabilitation should be carried out.
- As communities expect the right treatment services and are very less interested in other services.
- Health services should not be curative but it should instill health and healthy lifestyle and should emphasis over the prevention.
Question 14. Define primary health care. Describe the primary health care setup in India. How will you incorporate oral health into primary health care?
Answer.
Definition of Primary Health Care
Primary health care is defined as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination”.
Incorporation of Oral Health into Primary Health Care
- Integration of oral health in primary health care is a promising avenue to improve oral health and dental care of people, and specifically rural and remote indigenous communities.
- Health centers play a crucial role in reducing oral health disparities and improving access to oral healthcare services. As a major provider of primary care services for people, many health centers offer oral health services to their community. In fact, federally qualified health centers are required through their federal funding agreement to “ensure” access to specified preventive dental services.
- The Oral Health Delivery Framework is a conceptual framework for how to address oral health in the primary care setting.
- Incorporation of oral health in primary health care is done by incorporating a dentist at primary health center and their subcenters. This helps in providing oral care at primary health center in rural areas.
Question 15. Define primary health care. Discuss the levels and principles of primary health care in India.
Answer.
Levels of primary health care in India
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