1、口腔健康促进与健康教育,Oral Health Promotion & Health Education北京大学口腔医学院 预防口腔医学教研室,The concept of health（1）,健康（health）： 健康不仅仅是没有疾病或衰弱，而是身心健康、社会幸福的完美状态。 Health is a state of complete physical， mental， and social well-being and not merely the absence of disease or infirmity。 World Health Organization (1946) Basi
2、c Documents， 5th ed. P. 1.,Understand the concept of health（2）,根据人类系统结构定义健康， 引入行为科学的方法研究健康问题。强调健康不仅与个体有关，还与社会，生态和经济方面的因素有关。What this definition recognizes relevant to health care is that the terms “physical，mental，and social ” ，conceptualize health according to human-system framework which invites a
3、 behavioural science-oriented approach to the study of health. Furthermore，it emphasizes the idea that health goes beyond the individual to include social，ecological and economic facets of health.,The dimensions of health,个体健康（inner circle） 6 个方面社会健康（middle circle）环境健康（out circle）,The concept of ora
4、l health（1）,口腔健康(oral health): 牙齿清洁、无龋洞、无疼痛感、牙龈颜色正常、无出血现象。 Teeth clean no caries cavities, no pains, gingiva with normal colure and no sign of bleeding. WHO 1981,The concept of oral health（2）,口腔健康（Oral Health）：口腔健康是牙、牙周组织、口腔临近部位及颌面部均无组织结构与功能性异常。 Dental health is concerned with the functional efficie
5、ncy not only of the teeth and supporting structures but also the surrounding parts of the oral cavity and or the various structures related to mastication and the maxilla-facial complex。 WHO 1965,The concept of oral health（3）,口腔健康不再仅仅关系到对口腔疾病的治疗，而是与可预防的一系列口腔疾病危险因素有关，特别是社会心理、经济和文化因素。,Oral Health Educ
6、ation,口腔健康教育,健康教育定义 Definition of Health Education：,Any planned combination of learning experiences designed to predispose，enable，and reinforce voluntary behaviour conducive to health，in individuals, groups, or communities. （Frazier，1992）,健康教育定义 Definition of Health Education：,健康教育（health education）
7、：任何学习机会和教学活动的结合，其内容是为了促进人们自觉接受有益于健康的行为。 Any combination of learning opportunities and teaching activities designed to facilitate voluntary adaptations of behaviour that are conducive to health。 Green，L.W. National policy in the promotion of health, 1979,口腔健康教育的最终目的 The objective of dental health edu
8、cation,口腔健康教育的最终目的是使人认识到并能终生保持口腔健康。 The ultimate objective of all planned dental health education activities is to obtain and maintain optimum dental and oral health status for all individuals throughout life. （WHO 1970）,口腔健康教育的基本概念 （1） Basic Concepts of Oral Health Education,口腔健康教育（Oral health educ
9、ation）：以教育的手段促使人们主动采取利于口腔健康的行为，以达到建立口腔健康行为的目的。 健康教育的一部分。口腔健康目标的实现要求运用健康教育有效的原则和程序。Dental health education is an integral part of general health education，the achievement of dental health goals will require the application of principles and processes that are effective in other aspects of health educ
10、ation。 （WHO，1970）,口腔健康教育的基本概念 （2） Basic Concepts of Oral Health Education,是通过行为改变来促进健康的科学：包括个人、集体和整个社会的改变。,口腔健康教育的基本概念（3） Basic Concepts of Oral Health Education,健康教育不能代替预防服务措施，它是预防服务措施的教育部分，为了使人们了解和接受这些措施的价值。 Health education is not a substitute for a preventive serviceit is the educational compone
11、nt of such a service designed to develop understanding and acceptance of its value. （WHO 1984）,口腔健康教育的基本概念 （4） Basic Concepts of Oral Health Education,“人民有权利和义务参加讨论制定健康计划以及如何贯彻等问题” “针对人群中流行的疾病进行健康教育，并教给人们确定、预防和控制这些疾病的方法”，是初级卫生保健八项任务的首位任务， 健康教育和促进在实现个人和社区的口腔健康中是必不可少的，两者不可分割，无论何时都应该成为所有保健项目策划、执行和评价的一部
12、分。 1978年阿拉木图宣言第四条款,口腔健康教育的基本概念 Basic Concepts of Oral Health Education,“the people have the right and duty to participate individually and collectively in the planning and implementation of their health care”, “Education concerning prevailing health problems and the methods of identifying, preventin
13、g and controlling them” as the first of the eight recommended activities making up primary health care. WHO。 Primary health care. Alma-Ata 1978.,口腔健康教育的基本概念 （5） Basic Concepts of Oral Health Education,传递正确的信息 educating with correct information： 例：刷牙不是预防龋齿的有效方法，只有使用含氟牙膏才能有效预防龋齿。因此针对龋病的预防，口腔健康教育应着重强调使
14、用含氟牙膏（每天至少一次）而不是强调机械刷牙。但是，刷牙对预防牙周疾病是重要的。,口腔健康教育的基本概念 （5） Basic Concepts of Oral Health Education,健康教育采用多种教育方法，要与项目直接或间接相关，保证向人们传达的知识的准确性，并使人们正确理解，保持人们对项目的兴趣和积极参加。 Educational efforts using many different educational methods should be directed towards those associated with the programme, directly or
15、indirectly, to ensure accurate knowledge and understanding，and to maintain interest and participation。（WHO，1984）, 口腔健康教育的原则 Health education principles,口腔健康教育纳入综合健康教育计划中。 Oral health education should be built into general health education programmes. (WHO, 1984)国家或地方综合性的保健规划中都应明确规定口腔保健目, 口腔健康教育的原则 H
16、ealth education principles,每项口腔预防措的实施都包括健康教育的内容。Every available preventive oral health procedure includes educational components. (WHO, 1984), 口腔健康教育的原则 Health education principles,对各类保健计划制定的相关人群都要进行健康教育： 政策制定者、食品加工业人员、保健服务人员、家长、教师、参加预防措施的人员和学生。Education of a variety of different target groups：polic
17、y-makers，food manufacturing industry，all health care providers，parents，school personnel，primary health care workers，programme participants， and school students. (WHO, 1984), 口腔健康教育的原则 Health education principles,健康教育教材的设计要内容准确，及时更新知识，形式要有趣并有艺术性。Educational materials should be designed to gain or foc
18、us attention, to provide new knowledge, to facilitate interpersonal and group discussion, and to reinforce or clarify prior knowledge and behaviour. Materials such as leaflets, news releases, posters, films, and slides series are appropriate educational aids. (WHO, 1984), 口腔健康教育的原则 Health education
19、principles,因地制宜，符合当地文化、教育和社会情况和目标。In all community and school-based settings, oral health instruction should be consistent and compatible with scientific knowledge as well as with the local culture, the educational system, and social goals.(WHO, 1984),社区健康教育方法 the methods used in community health du
20、cation,社区健康教育方法可分为四大类 divided into the following four broad categories： 1. 个别交流（one-to-one communication）。 2. 以组为单位报告、讨论、决定有关健康信息（group presentations of information and group discussion and decision-making）,社区健康教育方法 the methods used in community health education,3.借助传播媒介（disseminating information th
21、rough mass communication channels, including the use of pamphlets, posters, newspaters, newsletters, rediao and television.） 4.组织社区活动（community organizational strategies）项目实施的不同阶段，单个或联合应用。,Oral Health Promotion,口腔健康教育计划,口腔健康教育计划的目标 Objective of the oral health education programmes,目标在调查研究基础上，计划预定时间内
22、可以实现的，也可以衡量的指标。 口腔健康教育目标应包括的四类内容： 改进口腔健康状况的目标； 减少危险因素的目标； 改进服务与防护的目标； 提高公众与专业人员认识的目标；,口腔健康具体目标 Oral health goal,口腔健康具体目标四要素： 特定人群； 具体指向； 可被测量的尺度； 目标预期实现的时间；,口腔健康教育计划的设计,六个步骤： 确定有待解决的问题； 确定目标； 评估本目标实施的条件； 确定内容与选择方法； 充分估计执行中的困难； 评估效果；,口腔健康教育的评价 Evaluation,对口腔健康项目的评价： 是否完成了项目所提出的目标 项目的设计与执行是否合理有效 项目的投入
23、效益 （社会效益与经济效益）,口腔健康教育的评价 Evaluation,对口腔健康知、信、行评价的内容： 口腔健康意识的变化 口腔健康知识的变化 对口腔健康问题所持态度的变化 口腔健康行为的变化 社会环境的变化：口腔卫生方针、政策,口腔健康教育与促进的评价 Evaluation,评价的目的保证资源的充分利用。 评价的时间在项目进行之前，计划阶段就要确定评价的方法。 直接评价通常采用标准指数，直接评价健康状况改善的程度，如DMFT，CPITN。 间接评价同时也需要调查和衡量某些行动，以便鉴定项目某些方面是否合适或需修订或取消。,口腔健康教育与促进的评价 Evaluation,取得评价用的资料有困
24、难或经费上的问题但不容忽略，行政长官往往忽略这一步骤，应予以关注方法：在进行整个人群效果评价之前，可在一个局部地区进行不同方面的评价；同时，在方便的时候，定期进行评价。,口腔健康促进,Oral Health Promotion,健康促进的起源 The origins and development of health promotion (1),Invest highly - After the 2nd World War Ensuring access to health services facilities (hospital & primary care) for those in n
25、eed The National Health Service (UK, 1948) Universal publicly managed health insurance schemes (Canada, 60s-70s) Legislation - health-related resources (USA) Medicaid and Medicare - readily available to the old and poor (Green & Kreuter, 1990),健康促进的起源 The origins and development of health promotion
26、(2),Resource development - After the 2nd World War The original assumption: Better access to high-quality health service inevitably led to better health. ? The challenging assumption: Spending more money on health services will have limited impact on the health of the population.,健康促进的起源 The origins
27、 and development of health promotion (3),The facts: 免费医疗保健没有消除贫富人群的健康差异 the provision of free health care did not in and of itself eliminate the health gap between the wealthy and the poor. 死亡率和发病率与社会经济状态成反比 The mortality & morbidity vs socioeconomic status - inversely,健康促进的起源 The origins and develo
28、pment of health promotion (4),The consequence: 医疗费用限制政策出台 Cost containment policy 推出健康教育措施以促进自我保健，减少就医 The role of health education in promoting self-care and reducing utilization of services,健康促进的起源 The origins and development of health promotion (5),新型保健机构诞生（健康维护机构） New forms of medical practice (
29、health maintenance organizations) 医疗专业人员提供疾病预防服务可以收费 Professionals were paid for prevention,健康促进的起源 The origins and development of health promotion (6),疾病普改变：The major health problems of modern populations, particularly the poor, were and continue to be chronic degenerative diseases Expensive to man
30、age but could not be cured Could be prevented by changes in personal behaviours in social and physical environments,健康促进的起源 The origins and development of health promotion (7),The historical research of McKeown improvements in health of over the past 200 years were the product of rising standards of
31、 living, improvements in the social and physical environment in sanitation and water supplies.(1979),健康促进的起源 The origins and development of health promotion (8),Tuberculosis The mortality from tuberculosis declined by 90% before chemotherapy and BCG vaccination became available. host resistance The
32、improved environment decreased exposure to infectious diseases and increased host resistance to microorganisms.,健康促进的起源 The origins and development of health promotion (9),New approach to population health health promotion Rejects much of the philosophy on which health service provision has been bas
33、ed. Involves the prevention of diseases and behviour change through health education And goes far beyond them,新公共卫生 New Public Health,阿拉木图初级卫生保健宣言1978 渥太华健康促进宪章1986 阿德雷德健康的公共政策建议1988 对健康的支持环境1991,健康促进的定义 Defining health promotion, 运用行政或组织手段，广泛动员和协调社会各相关部门以及社区、家庭和个人，使其履行各自对健康的责任，共同维护和促进健康的一种社会行为和社会战略
34、。,口腔健康促进的发展 The development of oral health promotion,1990s- The discipline of oral health promotion has therefore emerged as a means of improving oral health based upon the principles of the New Public Health movement。,口腔健康促进的发展 The development of oral health promotion,A core element of oral health
35、promotionthe recognition of The importance of the determinants of oral healththe need to reduce oral health inequalities,口腔健康促进的发展 The development of oral health promotion,Contemporary oral health promotion seeks to promote oral health by improving both： The ways people live 生活方式 The condition of li
36、ving that are relevant to oral health 生活条件,健康的决定因素 the determinants of health,环境因素： 环境因素包括自然环境与社会环境两个方面 行为与生活方式： 行为与生活方式是指因自身行为所产生的影响健康的因素 卫生保健服务因素： 卫生保健服务因素是社会因素中直接与健康有关的一个重要方面，包括预防服务，医疗与康复服务 生物遗传因素： 已知人类的遗传性缺陷和遗传性疾病近三千种，约占人类各种疾病的15,口腔健康促进危险因素策略 Risk Factor Approach,WHO 2003,健康促进的功能五个工作领域,促进制定有利于健康
37、的政策 building healthy public policy 促进建设和保护物质环境和自然环境 creating supportive environments 促进提高个人和群体保健知识和技能 developing personal skills 促进调整卫生服务方向 reorienting health services 促进发展社区能力 strengthening community actionOttawa Charter for Health Promotion（WHO 1986）, 健康促进的原则 Principles of Health promotion（1）,1、全社
38、会参与，结合日常生活，不仅仅关注处于危险因素中的患病人群 Health promotion involves the population as a whole in the context of their everyday lives rather than focusing on people who are sick or at risk for specific diseases., 健康促进的原则 Principles of Health promotion（2）,2、针对健康决定因素，社会多部门协同行动 It is directed towards action on the d
39、eterminants of health and requires close cooperation between many different sectors of society. 3、采取多种联合措施，进行必要的组织机构调整，通过社区建设和地区行动确定并铲除健康危险因素 It combines many different approaches and requires organizational change, community development and local activities to identify and remove health hazards., 健
40、康促进的原则 Principles of Health promotion（3）,4、以切实有效的公众参与为目标，使个人和社区获得发现健康问题并正确抉择的生存技能Health promotion aims at effective and concrete public participation and requires that problem-defining and decision-making life skills be developed further in individuals and communities., 健康促进的原则 Principles of Health
41、promotion（4）,5、尽管不是医疗服务，但这是卫生和社会范畴的活动，卫生专业人员可以在教育和鼓动中发挥特殊作用 While it is an activity in the health and social fields, it is not a medical service; health professionals have a special contribution to make in the areas of education and advocacy. WHO 1984, 口腔健康促进的策略与方法,群体策略 Community strategies 专业人力策略 P
42、rofessional strategies 个体策略 Individual strategiesWHO 2003,群体策略方法 Community strategies（1）,Community-wide health promotion interventions Community water fluoridation, salt fluoridation School-based fluoride mouthrinse,群体策略方法 Community strategies （2）,fluoride tablet programmes School-based or school-li
43、nked dental sealant programmes, oral hygiene programmes, screening and referral,专业人力策略方法 Professional strategies,Patient education and counselling on risk factors Professional plaque control Topical application of fluorides Provision of dental sealants Individualized recall schedule,个体策略方法 Individual strategies,Self-care practices Oral hygiene measures Toothbrushing, flossing, traditional cleaning, dentifrice Self-applied fluoride use Self-initiated use of dental services,泰国一个小村庄 口腔健康促进实例,思考题,健康促进与健康教育的目的有什么不同? 如何评价健康教育的效果？ 健康促进的途径有哪些？,
