Introduction to public health.

Health and Lifestyle

Dental Students Dental Hygiene Students
Dental Nurse Students Year 1
 Learning objectives
 Define health, and define public health
 Understand what the most common causes of death are, both in the developing and the
developed world
 Understand the differences in obesity, malnutrition, cancer, HIV and smoking in the developing
and the developed world
 Understand the change in demographics relating to the aging population
 Understand the reasons why public health has improved in both the 19th century and list four
examples
 Understand the reasons why public health has improved in both the 20th century and list four
examples
 Understand what social determinants of health mean and how it affects health
 Be able to define and describe the social determinants of health, the common risk approach, and
health promotion
 Name two universal approaches to public health, and two targeted/high risk approaches
 Understand the difference between equality and equity
 List the items in the Ottawa Charter for health promotion and be able to apply to health
promotion areas such as alcohol, drugs, tobacco, sexual risk taking
 WHO Definition of Health (1948)

”Health is a state of complete physical, mental and social

well-being and not merely the absence of disease or
infirmity”
Public Health; a Historical View
Population of Ireland (2018)
Infant mortality 19th and 20th centuries
Public health initiatives in the 19th
Century
https://youtu.be/XITRYH1GD88

Examples of 19th Century public health initiatives

Clean water; in part to stop diseases like cholera

Sewerage system improvements
Pasteurization
Public health acts 1848
Public health acts 1875
Better housing
Cholera
Public Health Act
Public Health Act of 1848 established a General Board of
Health to furnish guidance and aid in sanitary matters to local
authorities, whose earlier efforts had been impeded by lack
of a central authority. The board had authority to establish
local boards of health and to investigate sanitary conditions
in particular districts.
public health acts have been passed to regulate sewage and
refuse disposal, the housing of animals, the water supply,
prevention and control of disease, registration and inspection
of private nursing homes and hospitals, the notification of
births, and the provision of maternity and child welfare
services.
Pasteurization
Public Health

“the science and art of preventing

disease, promoting health and
improving the quality of life through
the organised efforts of society”
Mortality rate, or death rate, is a measure of the
number of deaths (in general, or due to a specific
cause) in a particular population, scaled to the size
of that population, per unit of time.
Death
rates by
country
https://www.pri.org/stories/2014-09-08/these-maps-show-where-world-s-
youngest-and-oldest-people-live
Causes of death in Ireland
Age standardised death rate in Ireland
Life Expectancy at Birth in the EU
https://health.gov.ie/publications-
research/statistics/
Life Expectancy and Healthy Life Years
at 65 years Ireland and EU27

Health in Ireland, Key Trends 2014, Dept of Health

Smoking Prevalence and Cigarette
Consumption in 187 Countries, 1980-2012
Obesity
Obesity in the EU (2012)
Undernourished percentage population

http://www.fao.org/3/a-i4646e.pdf
Per capita alcohol consumption
1960-2016
High risk
drinking in
those age 18
years and
over
Boys and alcohol
Girls and alcohol
Public Health: Definition

Public health, the art and science of preventing disease,

prolonging life, and promoting physical and mental
health, sanitation, personal hygiene, control of infection,
and organization of health services
Public Health
Prevents epidemics & spread of disease
Protects against environmental hazards
Prevents injuries
Promotes & encourages healthy behaviours
Responds to disasters & assists recovery
Assures quality & accessibility of health services
Public Health activities
Assessment

”The regular collection and

dissemination of data on health status,
community health needs and
epidemiologic studies”
The Institute of Medicine 1988
 Health Behaviour of School Aged
Children

WHO Regional Office for Europe

Cross national study - 18 countries
Carried out every 4 years
Age groups 11, 13, & 15 years
Standardised methodology
Website: http://www.nuigalway.ie/hbsc/
Latest Survey 2014
 Areas investigated

Demographic characteristics
Health related behaviour
Psychosocial adjustment
Peer relations, including bullying
Perceptions of school & its influence
Food and Dietary Behaviours
Brushing
Current issues in Public Health
Role of Government - costs
Accountability
Accessibility
Equity
Quality
Methods of delivery
Government/private/insurance
Functions of Public Health Agencies
Assessment
Data on health status
Community health needs
Epidemiology
Policy Development
Use of data to inform policy
Assurance
Services available to achieve goals
Equity versus Equality
Distinguish between Equity and Equality
The terms can be used interchangeably
Concepts are related but important distinctions
Equity, as we have seen, involves trying to understand
and give people what they need to enjoy full, healthy
lives. 
Equality, in contrast, aims to ensure that everyone gets
the same things in order to enjoy full, healthy lives.
Like equity, equality aims to promote fairness and
justice, but it can only work if everyone starts from the
same place and needs the same things.
 http://sgba-resource.ca/en/concepts/equity/distinguish-between-equity-and-equality/
Equality and Equity
Factors influencing Health

“Lifestyle”
Environment/Social Determinants
Health Services

Which of the three are the most important?

 What is “Lifestyle”?

Health related behaviour that determine a person’s

health status

Choice of actions which may increase or decrease risk

of health problems

How much control does an individual have over

social and economic conditions?
Lifestyle and Oral Disease

Diet/Nutrition/Exercise
Oral Hygiene
Smoking/chewing tobacco
Alcohol consumption
Sexual risk taking
 Health Promotion - WHO definition

“Any process which enables individuals

or communities to increase control over
the determinants of their oral health”
 Health Promotion

“ Any combination of educational,

organisational, economic and environmental
supports for behaviour conducive to health”

Green & Johnson (1983) Handbook of health,

healthcare and the health professional.
 Health promotion policy

Combines diverse but complementary approaches

Including legislations, fiscal measures, taxation and
organisational change.
It is coordinated action which leads to health,
income and social policies that foster greater equity
Contributes to safer goods, services, healthier
public services, cleaner more enjoyable
environments
Health Promotion Principles - WHO 1984

Whole population
Action on determinants of health
Organisational change, community
development
Effective and concrete public participation
Not medical activity
Ottawa Charter (WHO 1986)

Supportive environments
Healthy public policy
Community Action
Develop personal skills
Reorient health services
Question
What is the Ottawa Charter; What
are its five principles?
Thinking of a health promotion
programme give a description for
each principle of the Ottawa Charter
Examples of Ottawa Charter for oral
and general health promotion
Promoting Oral Health
A toolkit to assist the development, planning,
implementation and evaluation of oral health promotion
in New Zealand

http://www.health.govt.nz/publication/promoting-oral-he
alth-toolkit-assist-development-planning-implementation
-and-evaluation-oral-health
Ottawa Charter
Build healthy public policy 
Health promotion policy combines diverse but compleme
ntary approaches, including 
legislation, 
fiscal measures, 
taxation 
organisation change. 
Health promotion policy requires the
identification of obstacles to the adoption of healthy publi
c policies and the development of ways to remove them.
Build healthy public policy 
Policies are essential at all levels to improve oral health.
Policies can be made by
The Government,
The Ministry of Health,
Local governments,
Health or organisations,
Communities and individuals.
Schools
Primary health care settings
Create supportive environments 
The protection of the natural and built environmen
ts
The conservation of natural resources must be
addressed in any health promotion strategy
.
Create supportive environments
 Providing subsidies to promote access to toothpaste that
has an appropriate concentration of fluoride.
 Supporting healthy supermarket practice, for example,
removing sweets from checkout displays.
 Encouraging the use of smoke-free environment
advertising and sponsorship to promote oral health.
 Including oral health in media advertising about healthy
food choices.
 Promoting social marketing campaigns that aim to raise
oral health awareness.
 Promoting the sale of water only at community events.
Strengthen community actions
Community development draws on existing human and
material resources to enhance self-help and social
support,and to develop flexible systems for
strengthening public participation in, and direction of,
health matters. This requires full and continuous access
to information and learning opportunities for health, as
well as funding support.
Strengthen community actions
 Community organisations and groups
 community leaders, local councillors, church ministers
 health professionals, for example, dental therapists, dental
hygienists, dentists, doctors,, nurses
 health organisations,
 professional organisations, for example, Dental Association
 media
 schools, early childhood centres,
 public health units
 Health boards
Strengthen community actions
Engaging the community to support water fluoridation
Developing tooth brushing programmes with
community participation and leadership in high-need
areas.
Developing healthy eating programmes that support
oral health.
Supporting the development of community-led and
culturally appropriate oral health services.
Working with community groups to advocate for
healthy playgrounds with safe play equipment.
Develop personal skills
Enabling people to learn (throughout life) to prepare
themselves for all of its stages and to cope with chronic
illness and injuries is essential. This has to be facilitated
in school, home, work and community settings.
Develop personal skills
Promoting regular self care with brushing and fluoride
toothpaste.
Oral health professionals opportunistically discussing
smoking cessation.
Including oral health messages in education
programmes and materials focused on good nutrition.
Working with sports organisations to ensure that sports
people wear mouthguards in appropriate situations.
 Reorient health services 
The role of the health sector must move increasingly in
a health promotion direction, beyond its responsibility
for providing clinical and curative services.
Reorienting health services requires health research,
changes in professional education.
Moving into the future – caring, holism and ecology
are essential issues in developing strategies for health
promotion.
The population should become equal partners in each
phase of planning, implementation and evaluation of
health promotion activities.
Reorient Health Services
 Supporting the development of community-based oral health providers.
 Collaborating with charities (etc) and social services in planning oral
health services.
 Promoting linked enrolment between Health visitors and child oral
health services.
 Increasing the preventive and social context components of training for
oral health professionals.
 Developing training and use of early caries recognition programmes by
primary health care professionals, for example, Lift the Lip.
 Developing policies that support ongoing access to oral health care.
 Developing professionally applied fluoride programmes for high-need
groups to be delivered by primary health care professionals.
Upstream downstream
Describe what the upstream
approach to public health means, and
give an example
https://www.youtube.com/watch?
v=xYeAmafTGCA
Upstream downstream approach to
public health

https://www.youtube.com/watch?v=xYeAmafTGCA
 High risk v Whole Population

Whole Population
High Risk
Attempts to modify social
Identifies high risk
norms
individuals or groups
Does not focus only on
those with disease
Health Promotion The Risk
Approach
Examples of high risk versus whole
population
Universal Targeted

Free Toothpaste to all Toothbrushing

Free dental programmes for a defined
examinations group of children
Mass media campaigns Fluoride varnish
encouraging all to brush programme for children in
teeth an area of deprivation
Water fluoridation
Common risk approach
 Health Education

“ Any combination of learning opportunities

designed to facilitate voluntary adaptations of
behaviour that are conducive to health”

Green (1979) Int J Health Educ

 Health Education
People interpret health messages through
the filter of their own values and attitudes
Involvement of participants is vital
Mass media transmit messages but do not
cause behavioural change
Not all people share health professional’s
values about health
Dental Health Education

Programmes:
Can improve knowledge
Temporarily improve oral hygiene
No demonstrated effect on dental caries levels

See Kay and Locker 1996

http://www.ncbi.nlm.nih.gov/pubmed/887102
8
Policy areas to improve oral health

Food policy to reduce sugar consumption

Community approach to improve body and
oral hygiene
Smoking cessation
Reducing accidents
Water fluoridation
Access to preventive dental care

Sheiham 1995
 Social Determinants of
health

(slides adapted from a Sir

Michael Marmot
Presentation:
www.otago.ac.nz/wellingto
n/otago023859.ppt)
Objectives
Be able to define Social Determinants
Be able to list 4 of the key principles of “fair society,
healthy lives” as an example of how to improve the
social determinants
Thanks to the equal democracy in which
we live every child no matter where they
are born, or the circumstances in which
they are born has an equal chance of
succeeding to be what they want to be in
life….

Discuss
 Social determinants

The social determinants of health are the conditions in

which people are born, grow, live, work and age. These
circumstances are shaped by the distribution of money,
power and resources at global, national and local levels.
WHO | What are social determinants of health?
www.who.int/social_determinants/sdh_definition/en/
Social gradient
Inequality
Economic inequality is the difference found in various
measures of economic well-being among individuals in a
group, among groups in a population, or among
countries. Economic inequality sometimes refers to
income inequality, wealthinequality, or the wealth gap
Inequalities between countries Glasgow men(Lenzie) 82 *

Glasgow men (Calton) 54

National data WHO 2009, Glasgow data: Hanlon et al. 2006

Inequalities and environment
 Review of the
Social
Determinants
of Health and
the Health
Divide in the
WHO
European
Region
The CSDH – closing the The Marmot Review – Fair
gap in a generation Society Healthy Lives
•A Fair Society
Life expectancy and disability-free life expectancy at birth
by neighbourhood income deprivation, 1999-2003
Social determinants of health across the lifecourse
 Fair Society: Healthy Lives:
6 Policy Objectives
A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
 Marmot Review: 6 Policy Objectives

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Inequality in early cognitive development of children in the 1970 British
Cohort Study, ages 22 months to 10 years

Feinstein 2003
Links between socioeconomic status and factors
affecting child development, 2003-4

Source: Department for Children, Schools and Families

Socio-emotional difficulties at age 3
and 5:
Millennium Cohort Study
Age 3 Age 5

Fully adjusted = for parenting activities and psychosocial markers

Kelly et al, 2010
Per cent achieving ‘a good level of development’* by
deprivation decile: England

*in personal, social and emotional development

and communication, language and literacy at age 5 Source: Department for Education
Per cent 5 year olds achieving ‘good development score’,*
Birmingham LA, West Midlands & England
%

*in personal, social and emotional development

and communication, language and literacy
 Marmot Review: 6 Policy Objectives

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Percentage of pupils achieving 5+ A*–C grades inc English and Maths at
GCSE by income deprivation of area of residence, England, 2008/9
 Marmot Review: 6 Policy Objectives

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Seasonally adjusted trends in unemployment for young people in
the UK, 1993-2011
37.7%

16-17
18.3%

18-24
8%
16 and over

Source: Office for National Statistics, Labour Force Survey

 Fair Society: Healthy Lives:
6 Policy Objectives
A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Minimum Income Standard by family type as a
percentage of median income, April 2008
 Poor Prospects for living standards
12% addition to price level over next 4 years
Rise in import prices (commodities including foodstuffs, base
metals and cotton)
Rise in energy prices
Rise VAT

“in 2011 real wages are likely to be no higher than they were
in 2005. One has to go back to the 1920s to find a time
when real wages fell over a period of six years”

Source: Speech given by

Mervyn King, Governor of the Bank of England
At the Civic Centre, Newcastle
25 January 2011
Trinity College Dublin
Dignity & Respect Policy
Not Accepting Bullying or Harassment
https://www.youtube.com/watch?v=wAgg32weT80
Aims
 To raise awareness on the prevention of bullying and harassment

 To support good communications amongst colleagues, staff and

students and to set acceptable standards of behaviour

 To set out everyone’s individual responsibility

 To provide methods of resolution for staff and students in which

they have a number of opportunities, both formal and informal,
to resolve their individual situations.

 To promote an environment in which diversity is respected.

Where does this policy apply?
College campus, buildings/centres in all locations

The campus of any other university or other place

where staff or students are representing the College

At events such as social functions, conferences,

sporting events, field trips or work assignments which
are related to the College, to a person’s work /study, or
at which a person is representing College

In writing, on the telephone, by email or on the

internet in any College related activity.
Are you being bullied or harassed ?
Is the behaviour unwanted and unnecessary?

Is it offensive or intimidating ?

Does it make you feel vulnerable, stressed or isolated ?

Is it negatively affecting your study ?

 Examples of Bullying
Verbal: personal insults, demeaning remarks, humiliation
in front of others, nicknames, ridicule, persistent
identification of one person ‘as a joke’, threats
Non-verbal or indirect: exclusion, hostile attitude,
spreading malicious rumours
Abuse of power: excessive criticism, withholding
essential information
Physical: aggressive behaviour, physical intimidation,
unwelcome physical contact up to and including assault
Sexual Harassment
Verbal: unwelcome sexual advances, suggestive jokes
and innuendo, requests for sexual favours, threats
Non-verbal or indirect: sexually suggestive pictures
or written material, leering or gestures; spreading
rumours about a person’s sexual behaviour or
orientation
Electronic: sexually suggestive messages or images
transmitted by computer or other electronic means.
Physical: unwelcome physical contact, up to and
including assault
Racial Harassment
Verbal: offensive jokes or remarks about a person’s
race or ethnic origin (including membership of the
travelling community), ridicule or assumptions based
on racial stereotypes
Non-verbal or indirect: exclusion, hostile or
demeaning attitudes, spreading malicious rumours
Visual: production, display or circulation of materials
offensive to particular racial or ethnic groups, such as
cartoons or racial propaganda
Physical: physical assault, threats of physical assault
 Possible Concerns
Not being believed
Having witnesses
Making too much of a ‘trivial’ incident
Making the situation worse
Repercussions on your studies
Impact on others
Nevertheless
• You have the right to the protection of this policy.

• You do not have to put up with bullying or harassment

• It can be resolved

• It is not your fault

• We all have to contribute to stopping and preventing

bullying and harassment
Resolving Incidents of Bullying or
Harassment
Informal

Formal

Mediation
Informal Process
Handle matters yourself

Talk to the Contact Persons or

others

Seeking Intervention
 Handling Matters Yourself
 Talk to Student Counselling or to Student 2 Student (
www.pleasetalk.ie ).
 Self help leaflets available on the Student Counselling website
(http://www.tcd.ie/Student_Counselling/ )
 Keep a record of incidents as they occur: what happened, dates,
times, places, witnesses (if any), your response and the impact
on you.
 Make it clear to the harasser that the behaviour is unwelcome
and unacceptable and ask them to stop. If this is not possible or
you find it difficult to approach the harasser, then you should
approach one of the Contact Persons for help.
Talking to Others
Seek Support
Talk to the Contact Persons
Talk to CAA /College
Tutor/Director of T&L/Dean
Support is Available
Students’ Union: welfare@tcdsu.org, Tel: 6468437
College Tutors. (Senior Tutors Office Tel: 8962551)
Student Counselling Service (Tel: 8961407)
Equality Officer – equality@tcd.ie,
http://www.tcd.ie/equality/
College Chaplains, (Tel: 896 1901/1260/1402/1417)
Please Talk – www.pleasetalk.ie – and click on the
TCD link
S2S Student2Student http://student2student.tcd.ie/
Role of the Contact Person
 Listen, provide personal support on your side, help you to
solve the problem
 Advise and give information on other sources of help e.g.
 Student Counselling / Health Services
 Provide information on the College’s procedures
 Assist you with handling the matter yourself directly
 May intervene formally on your behalf with the alleged
harasser if you feel you cannot do so after discussing the
matter fully with the Contact Person
 They will only act with your agreement
 If you decide to make a formal complaint they will provide
personal support during this procedure.
 Procedures
INFORMAL FORMAL MEDIATION
1. Talk to Contact 1. Talk to Contact 1. Talk to Contact
Person Person Person
2. Decide whether to 2. Write up case and
handle yourself or present to Dean
seek intervention 2. If agreed Contact
3. Seek more support Person will organise
3. Follow procedure from Contact person
for the method of 3. Mediation set up
4. Investigator will set
choice up process to hear
4. Review if resolved both sides and make 4. If no resolution, then
a report both the informal
5. If unresolved, can
consider mediation 5. If unresolved and formal process
or formal complaint mediation can be can be used
used
Where can the policy be found?

http://www.tcd.ie/about/policies/respect.php

Remember that you do not have to put up with

unacceptable behaviour from anyone

This policy offers advice on where and how to get

help