DEPARTMENT OF PREVENTIVE

DENTISTRY
UNIVERSITY OF BENIN TEACHING
HOSPITAL
BENIN CITY

LIST THE VARIOUS FRAMEWORK OF

HEALTH PROMOTION DISCUSS ORAL
HEALTH PROMOTION USING THE OTTAWA
CHARTER

BY

DR. AMAECHI UCHE ANDERS

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FEBRUARY, 2014
CERTIFICATION
I hereby certify that the department seminar presentation on THE
VARIOUS FRAMEWORK OF HEALTH PROMOTION DISCUSS
ORAL HEALTH PROMOTION USING THE OTTAWA CHARTER
was presented by DR. AMAECHI UCHE ANDERS in the month of
February 2014 and was accordingly approved

..
DR AGHIMIEN AO

...
DR. IZE-

IYAMU
Chief Resident

Head of Department

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OUTLINE
Introduction
Rationale for Health Promotion
Historic perspectives
Frameworks of health Promotion
Ottawa charter
Health Promotion Action in Ottawa charter
Oral health promotion
Rationale for oral health promotion

Oral

Health

Promotion

action

using

Ottawa

charter

framework
Conclusion
Reference

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INTRODUCTION
Health is the extent to which an individual or group is able on the
one hand to realize aspirations and satisfy needs and on the other
hand to change or cope with the environment.
Health is a basic human right and is essential for social and
economic development. Health promotion is the process of
enabling people to increase control over, and to improve, their
health.(WHO,

1986)

combination

of

Health

educational,

promotion
political,

is

any

planned

regulatory,

and

organizational supports for actions and conditions conducive to

the health of individuals, groups, or communities.(Harris,2004)
Rationale for Health Promotion
In the past, healthy behavioral change was considered likely
to occur by health education.

Practiced as a one way process with the health professional

transmitting information and advice produced from readymade

packages

of

ideas

and

plans

based

on

the

preconceived notions of the health staff.

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 This rather simplistic approach was not effective because it

failed to acknowledge the complexities of human behaviour
and the importance of the broader social, economic, and
environmental factors determining behaviour change.
Hence the emergence of the modern health promotion
movement which is based on
Prevention of disease at a primary level and the promotion of
health.
Application

of

the

above

concepts

to

developing

environments which promote healthier choices for people in

coping with their lives, in a manner that encourages those
choices to be the easiest choices
HISTORIC PERSPECTIVES
Growth of cities and poor health practices led to the
development of epidemic diseases.
Failure of the curative approach to reduce impact
Lalonde (1974) recognised that biomedical interventions not
primarily responsible for improvement in health

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 Primary Health Care adoption at Alma-Ata in 1978.

McKeown

(1979)

demonstrated

convincingly

that

improvements in health over about two centuries was the

result of rising standards of living.

INTERNATIONAL CONFERENCES ON HEALTH PROMOTION

i.

1st Global Conference on Health Promotion: Ottawa 1986

ii.

2nd Global Conference on Health Promotion: Adelaide 1988

iii.

3rd Global Conference on Health Promotion: Sundsvall 1991

iv.

4th Global Conference on Health Promotion: Jakarta 1997

v.

5th Global Conference on Health Promotion: Mexico 2000

vi.

6th Global Conference on Health Promotion: Bangkok 2005

vii.

7th Global Conference on Health Promotion: Nairobi 2009

viii.

8th Global Conference on Health Promotion will be held in

Helsinki, 10-14 June 2013
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FRAMEWORKS OF HEALTH PROMOTION

Base action upon a comprehensive needs assessment using both
normative and lay measures of need.Develop a range of clearly
stated and challenging goals
Preventive rather than curative approachespromote public
health measures to the public and public authorities.

Be based

upon contemporary theories of individual and organizational

change
A re-orientation from prescription to supportive health promotion
methodsredress the balance of influence and make healthier
choices easier.
Promote self-esteem and facilitate decision-making skills rather
than be prescriptive. Combat the influence of those interests
which produce and profit from ill health. This involves controls
on

industry

sponsored

educational

materials

in

schools,

advertising, and campaigns to reduce barriers to good health.

Public health rather than individually focussed programmes.

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Focus on the social causes of ill health rather than a victimblaming. Approachacknowledging the limited real choices
available to any individual.
Address the underlying determinants of health.
Tackle causes that are common to a number of chronic
diseases
Supportive rather than authoritarian styles of action.

commitment to distribute success equitably. Ensure actions are

evidence based.
Community participation rather than professionally dominated
activities.
Working in partnership with key groups and agencies.
OTTAWA CHARTER
The principles of social justice - equity, diversity and supportive
environments

are

an

essential

part

of

effective

health

promotion.

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 The Ottawa Charter promotes social justice as it is designed

to provide access to health opportunities for all members of
a community and aims to reduce the level of health
inequalities
Prerequisites for Health
i.

Peace

ii.

Shelter

iii.

Education

iv.

Food

v.

Income

vi.

Stable eco-system

vii.

Sustainable resources

viii.

Social justice and equity

The Ottawa Charter incorporates three basic health promotion

strategies:
i.

Advocate

ii.

Enable
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iii.

Mediate

ADVOCACY
At making political, economic, social, cultural, environmental,
behavioural and biological conditions favourable

ENABLE
All people to achieve their fullest health potential through
reducing inequity in health by;
- a supportive environment
-

access to information

Life skills and opportunities for making healthy choices.

MEDIATE
Professional and social groups and health personnel have a major
responsibility to mediate between differing interests in society for
the pursuit of health

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HEALTH PROMOTION ACTION/OTTAWA CHARTER

Promoting health through public policy
Creating a supportive environment
Strengthening community action
Developing personal skills

Reorienting health services

Oral health promotion

Any planned effort to
-

Build public policies

Create supportive environments

Strengthen community action

Develop personal skills

- Reorient health services in ways that will influence these

factors.

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Oral Health promotion activity has 3 elements which may

overlap. They are
i.

Oral disease Prevention

ii.

Oral Health Education

iii.

Oral Health Protection

Rationale for oral health promotion

The most common oral diseases/abnormalies of public health
interest because
i.

High prevalence

ii.

Preventable

iii.

Availability of means of prevention

iv.

Under utilization of these means of prevention

v.

Financial implication in management and quality of life

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Oral Health Promotion Action/Ottawa charter

Possible approaches for building healthy public policy

Laws to control non milk extrinsic sugars (NMES) in foods
produced in the country.
Subsidies in agriculture, low tax regimes to healthy food
industries
Stiff penalty for overspeeding, non-use of seat belts and
helmets, use of alcohol and other hard drugs during driving
Possible approaches for building healthy public policy

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 Inclusion of oral care services in children, pregnant women

and the aged health schemes policies
Supporting the creation of policies for smoke and pollution
free environments.
product labelling/ advertisement to expose risks with using
unwholesome products like tobacco

CREATING SUPPORTIVE ENVIRONMENTS

21Provides people with encouragement, opportunity, and rewards
for healthy oral lifestyles
This is addressed under
Physical

Social

Psychological

Economic

Political

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POSSIBLE APPROACHES
- Establishing community water flouridation systems
- Availability of non-propriety flouride toothpaste and cheap
toothbrush
- Easy accessibility of oral health-care centers
Provision of safe play areas, restriction of NMES snacks in
schools
Creation of smoke free areas
Campaigns to raise oral health awareness.
Strengthening community action
Enable concrete and effective community action in achieving
better oral health by

Setting priorities

Making decision

Planning strategies

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Implementation

Evalution and monitoring

Strengthening community action

This requires full and continuous access to information,
learning opportunities for oral health, as well as funding
support.
The key themes here are partnership, participation and
engagement.

POSSIBLE APPROACHES
Advocacy for oral health- care clubs and oral health in health
curriculum in schools
Joint funding for community water flouridation, school
flouride mouthrinses , tooth brushing or fissure sealing
programmes
Rewards for oral health promoting communities and schools

Inter- school competitions in oral health

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 Funding of community centers promoting health lifestyles

and offering counseling services
Developing personal skills
Supports personal and social development of the individual
through providing information, education and enhancing oral
health skills.
This can be facilitated in school, home, work and community
settings.
Developing personal skills
Compliments oral health public initiatives.
Success here depends on paying attention to the 3 Ps

patients characteristics

patient-oral health professional relationship

predictive characteristics

Information and education on

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 Drug , Alcohol and Tobacco use

Use

of

safety

equipment

(e.g.,

seat

belts,

helmets,

mouthguard, broad rimed caps)

Lifestyles (exercise, sexual behaviors)
Nutrition and oral hygiene

Oral health skills like;

I.

Toothbrushing

II.

Use interdental cleaning aids

III.

Pre-hospital care for orofacial, dental trauma

IV.

Reorient Health Service

V.

Responsibility of all groups

VI.

Focus on preventive and oral-outreach care service than

clinical and curative services.

VII.

Research, education and training of professionals

VIII.

Cooperation by the health and other sectors

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IX.

Design an effective oral health program that is cultural

sensitive and substainable with the community participation

X.

Developing

professionally

applied

fluoride/

sealant

programmes for high-need groups to be delivered by primary

health care professionals
XI.
XII.

Oral care outreach services to the underserved.

Collaboration with non-governmental organization, other
sectors (transport, entertainment, media, financial), political
groups, interested individuals to raise awareness and sustain
outreach programs

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CONCLUSION
Health promotion through the Ottawa charter framework has
proven to be effective because it acknowledges the challenges
posed by determinants of health .
.

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REFERENCES
Cappelli D, Mobley C: Prevention in clinical oral health care ;
(2008 ) Mosby, Inc., an affiliate of Elsevier Inc. Pg 183- 201,
223-249
Harris NO, Garcia-Godoy F:

Primary Preventive Dentistry -

6th Ed. (2004) Pearson Education, Inc., Pearson Prentice Hall,

Upper Saddle River, New Jersey 07458: pg 521-555
Mafeni JO. Challenges to manpower development

for

dentistry in Nigeria: NDA Conference, 2012

Murray JJ, Nunn JH, Steele JG: The Prevention of Oral Disease
4th Ed.(2003) Oxford University Press: pg 243-252
Nwoku AL. The role of general dental practitioner in oral
health. Niger Med J 2010;51:125-7
NyandindI U , Palin-Palokas T ,Miln A: The importance of
supportive environments for oral health promotion in schoolaged children in Tanzania: Health Promot. Int. (1994) 9 (1):
21-26.
Ogunbodede EO; The role of public health practitioners in
geriatric oral health care: NADPH Conference, 2013.
Ogunbodede EO, Sheiham A: Oral health promotion and
health education programmes for Nigeria--policy guidelines:
Afr Dent J. 1992;6:8-16.

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 Okeigbemen SA; Millenium development goals, the role of a

dental

surgeon:

keynote

lecture

OAU

Den

Sch

Conference,2011
Olusile AO. Improving low awareness and inadequate access
to oral health care in Nigeria: The role of dentists, the
government & non-governmental agencies. Niger Med J
2010;51:134-6
World Health Organization (1978). Alma-Ata 1978: Primary
Health Care. Report of the International Conference on
Primary Health Care, Alma-Ata, USSR, September 1978.World
Health Organization, Geneva.
World Health Organization : Global Conferences on Health
Promotion Report., 2010.
World Health Organization (1986). The Ottawa Charter for
Health Promotion. Health Promotion 1, pp. iiiv. World Health
Organization, Geneva.
Dr James 2014 best Endodontic of Lenview. Microscopic root
canal therapy.

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