Population Health©

Beyond Clinical Practice

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MouthMouth

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Community and FriendsCommunity and Friends

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Society and EnvironmentSociety and Environment

Community and FriendsCommunity and Friends

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Society and EnvironmentSociety and Environment

Community and FriendsCommunity and Friends

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Provincial, National and Global ForcesProvincial, National and Global Forces

If dental hygienists look only at disease etiology and clinical services, they are missing most of the picture.

What are the implications for the way we practice dental hygiene?

We must look beyond the behavior to the social environment where that behavior is developed and sustained.

The social determinants of health must be taken into consideration when reorienting dental hygiene care.

Social Determinants of Health

Where we live and work Support we receive from family and friends Opportunities for development that we have as very

young children Access to health services Aspects of our culture that may affect our behaviour Gender

Preventing Oral Disease

Health education

Health Promotion

Population–based prevention

Targeted prevention

Health Education vs. Health Promotion

Health Education: Increases the oral health knowledge of individuals or groups.

– It is not sufficient alone to change behavior. – Downstream approach.

Health Promotion: Supports the individual to turn health knowledge into positive behavior through a variety of strategies (health education being one of them).

– Directed at social determinants of health.– Upstream approach.

Population Health

Aims to make the healthy choice the easy choice!

Population Health

Looks at health in broad terms (big picture) Focuses on preventing disease by reducing inequities

in health Benefits all the population and improves the health

standards for everyone. Can take a “common risk factor” approach Social, economic and public health measures are used

to decrease the overall level of risk for the whole population.

Targeted Prevention

Focuses on high risk individuals who have been identified through screening, or higher risk groups, communities or sub-populations identified through epidemiological studies.

Limitations to taking a “high risk” approach:– Better risk assessment tools are needed– Must have services in place to be able to treat after identifying– Is palliative in nature and doesn’t change the underlying

causes so there is a never-ending need– Most individuals do not continue to seek dental care after

initial treatment

Consideration for Targeted Approaches:

In the general population a small group has the highest needs.

The largest group has moderate needs.

Where should resources be focused? On the high need group where a few people will

benefit? On the moderate need group where the majority of the

population will benefit but the needs of the high risk may not be met?

Activities higher up the pyramid have a greater impact on health inequities in relation to the time and energy spent.

Upstream/downstream options for preventing oral disease:

Challenges:

Financial: Shifting the mindset from “fee for service” to salaried.

More training is needed on accessing funding (such as writing grant proposals).

Public health and community agencies can not offer private practice salary compensation.

Challenges

Education: Are diploma level DHs prepared for community practice? Where do DHs get the training needed to do advanced

community practice work?– Business skills - Human resource management– Fundraising - Community development– Epidemiology - Program planning– Research

Should community practice be designated a “specialty”?

Challenges:

Creating competent community health dental hygienists: Can private practice DHs make the shift to community

practice? Can DHs work as part of a interdisciplinary team? Can they also work autonomously? Do we have DHs ready to replace an aging workforce? Is this work only for public health hygienists or do

clinical hygienists have a role?

What still needs to be done?

Improved training opportunities for DHs interested in working in community settings.

Opportunities for dental hygienists to learn and work collaboratively with other professions.

Better skills to research, analyze epidemiological data, evaluate and publish our work confidently.

High quality intervention studies. Greater leadership and lobbying from provincial and

national DH bodies around oral health issues.

Population Health is not just for public health!

How can all dental hygienists make the healthy choice the easy choice in their communities?