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1、口腔健康促进与健康教育口腔健康促进与健康教育wOral Health Promotion&Health Education 北京大学口腔医学院北京大学口腔医学院 预防口腔医学教研室预防口腔医学教研室 The concept of health（1）w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 O

2、rganization(1946)Basic 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 whi

3、ch invites a 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（个体健康（inner circle）6 个方面个方面社会健康（社会健康（middle circle）环境健康（环境健康（out

4、circle）The concept of oral health（1）w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 1981The concept of oral health（2）w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

5、functional efficiency 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。w

6、Oral Health Education口腔健康教育口腔健康教育健康教育定义健康教育定义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）健康教育定义健康教育定义Definition of Health Educatio

7、n：健康教育（health education）：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口腔健康教育的最终目的 The

8、objective of dental health educationw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口腔健康教育的基本概念（1）Basic Concepts of Oral Heal

9、th Educationw口腔健康教育（Oral health education）：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。w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 effec

10、tive in other aspects of health education。（WHO，1970）口腔健康教育的基本概念口腔健康教育的基本概念（2）Basic Concepts of Oral Health Educationw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。个体个体或或群体群体行为改变行为改变知识知识态度态度价值观价值观干预干预技能技能环境环境健康教育工作原理健康教育工作原理口腔健康教育的基本概念（口腔健康教育的基本概念（3）Basic Concepts of Oral Health Educationw健康教育不能代替预防服务措施，它是预防服务措施的教

11、育部分，为了使人们了解和接受这些措施的价值。wHealth education is not a substitute for a preventive serviceit is the educational component 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口腔健康教育的基本概念（4）Basic Concepts of Oral Health Educationw“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”

12、w“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，w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、执行和评价的一部分。1978年阿拉木图宣言第四条款口腔健康教育的基本概念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

13、implementation of their health care”,“Education concerning prevailing health problems and the methods of identifying,preventing 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口腔健康教育的基本概念（5）Basic Con

14、cepts of Oral Health Educationw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口腔健康教育的基本概念（5）Basic Concepts of Oral Health Educationw健康教育采用多种教育方法，要与项目直接或间接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

15、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。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 indirectly,to ensure accurate knowledge and understanding，and to maintain interest and participation

16、。（WHO，1984）口腔健康教育的原则口腔健康教育的原则 Health education principles1.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口腔健康教育的原则 Health education principles2.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 p

17、rocedure includes educational components.(WHO,1984)口腔健康教育的原则口腔健康教育的原则 Health education principles3.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：policy-makers，food manufacturing industry，all health care providers，parents，school perso

18、nnel，primary health care workers，programme participants，and school students.(WHO,1984)口腔健康教育的原则口腔健康教育的原则 Health education principles4.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 focus attention,to provide new knowledge,to facilitate interpersonal and group di

19、scussion,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口腔健康教育的原则 Health education principles5.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,ora

20、l 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)社区健康教育方法社区健康教育方法the methods used in community health ducationw社区健康教育方法可分为四大类 divided into the following four broad categories：w1.个别交流

21、（个别交流（one-to-one communication）。）。w2.以组为单位报告、讨论、决定有关健康信息以组为单位报告、讨论、决定有关健康信息（group presentations of information and group discussion and decision-making）社区健康教育方法社区健康教育方法the methods used in community health educationw3.借助传播媒介（disseminating information through mass communication channels,including the

22、use of pamphlets,posters,newspaters,newsletters,rediao and television.）w4.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。wOral Health Promotion口腔健康教育计划口腔健康教育计划口腔健康教育计划的目标口腔健康教育计划的目标 Objective of the oral health education programmesw目标在调查研究基础上，计划预定时间内可以实现的，也可以衡量的指标。w口腔健康教育目标应包括的四类内容：改进口

23、腔健康状况口腔健康状况的目标；减少危险因素危险因素的目标；改进服务与防护服务与防护的目标；提高公众与专业人员认识认识的目标；口腔健康具体目标口腔健康具体目标 Oral health goalw口腔健康具体目标四要素：w 特定人群；特定人群；w 具体指向；具体指向；w 可被测量的尺度；可被测量的尺度；w 目标预期实现的时间；目标预期实现的时间；口腔健康教育计划的设计口腔健康教育计划的设计w六个步骤：1.确定有待解决的问题；2.确定目标；3.评估本目标实施的条件；4.确定内容与选择方法；5.充分估计执行中的困难；6.评估效果；口腔健康教育的评价口腔健康教育的评价 Evaluationw对口腔健康项

24、目的评价：1.是否完成了项目所提出的目标 2.项目的设计与执行是否合理有效 3.项目的投入效益（社会效益与经济效益）口腔健康教育的评价口腔健康教育的评价 Evaluationw对口腔健康知、信、行评价的内容：1.口腔健康意识的变化 2.口腔健康知识的变化 3.对口腔健康问题所持态度的变化 4.口腔健康行为的变化 5.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口腔健康教育与促进的评价 Evaluationw评价的目的保证资源的充分利用。w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。w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。w间接评

25、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口腔健康教育与促进的评价 Evaluation1.取得评价用的资料有困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1.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。口腔健康促进口腔健康促进wOral Health Promotion健康促进的起源健康促进的起源 The origins and development of health promotion(1)wInvest highly-After the 2nd W

26、orld WarEnsuring access to health services facilities(hospital&primary care)for those in needwThe National Health Service(UK,1948)wUniversal publicly managed health insurance schemes(Canada,60s-70s)wLegislation-health-related resources(USA)wMedicaid and Medicare-readily available to the old and poor

27、(Green&Kreuter,1990)健康促进的起源健康促进的起源 The origins and development of health promotion(2)wResource development-After the 2nd World WarThe original assumption:wBetter access to high-quality health service inevitably led to better health.?The challenging assumption:wSpending more money on health services

28、will have limited impact on the health of the population.健康促进的起源健康促进的起源 The origins and development of health promotion(3)wThe facts:免费医疗保健没有消除贫富人群的健康差异免费医疗保健没有消除贫富人群的健康差异wthe 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

29、济状态成反比死亡率和发病率与社会经济状态成反比wThe mortality&morbidity vs socioeconomic status-inversely健康促进的起源健康促进的起源 The origins and development of health promotion(4)wThe consequence:医疗费用限制政策出台wCost containment policy推出健康教育措施以促进自我保健，减少就医wThe role of health education in promoting self-care and reducing utilization of se

30、rvices健康促进的起源健康促进的起源 The origins and development of health promotion(5)新型保健机构诞生（健康维护机构）wNew forms of medical practice(health maintenance organizations)医疗专业人员提供疾病预防服务可以收费wProfessionals were paid for prevention健康促进的起源健康促进的起源 The origins and development of health promotion(6)疾病普改变：The major health prob

31、lems of modern populations,particularly the poor,were and continue to be chronic degenerative diseasesExpensive to manage but could not be cured Could be prevented by changeswin personal behaviours win social and physical environments健康促进的起源健康促进的起源 The origins and development of health promotion(7)w

32、The historical research of McKeown improvements in health of over the past 200 years were the product of rising standards of living,improvements in the social and physical environment in sanitation and water supplies.(1979)健康促进的起源健康促进的起源 The origins and development of health promotion(8)Tuberculosis

33、wThe mortality from tuberculosis declined by 90%before chemotherapy and BCG vaccination became available.host resistancewThe improved environment decreased exposure to infectious diseases and increased host resistance to microorganisms.健康促进的起源健康促进的起源 The origins and development of health promotion(9

34、)New approach to population health health promotionwRejects much of the philosophy on which health service provision has been based.wInvolves the prevention of diseases and behviour change through health educationwAnd goes far beyond them新公共卫生新公共卫生 New Public Healthw阿拉木图初级卫生保健宣言1978 w渥太华健康促进宪章1986w阿

35、德雷德健康的公共政策建议1988w对健康的支持环境1991健康促进的定义健康促进的定义Defining health promotionw 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。口腔健康促进的发展口腔健康促进的发展 The development of oral health promotionw1990s-The discipline of oral health promotion has therefore emerged as a means of improving oral hea

36、lth based upon the principles of the New Public Health movement。口腔健康促进的发展口腔健康促进的发展 The development of oral health promotionA core element of oral health promotionthe recognition ofwThe importance of the determinants of oral healthwthe need to reduce oral health inequalities口腔健康促进的发展口腔健康促进的发展 The dev

37、elopment of oral health promotionContemporary oral health promotion seeks to promote oral health by improving both：wThe ways people live 生活方式生活方式wThe condition of living that are relevant to oral health 生活条件生活条件健康的决定因素 the determinants of health w环境因素：环境因素包括自然环境与社会环境两个方面 w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

38、响健康的因素 w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 w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 口腔健康促进口腔健康促进危险因素策略危险因素策略 Risk Factor ApproachSocio-cultural risk factorsHealth system and oral health servicesEnvironmental risk factorsUse of oral health servicesOutcome:Oral health statusImpairmen

39、tQuality of lifeGeneral healthRisk behavior:Oral hygieneDietTobaccoAlcoholWHO 2003健康促进的功能健康促进的功能五个工作领域五个工作领域1.促进制定有利于健康的政策 building healthy public policy2.促进建设和保护物质环境和自然环境 creating supportive environments3.促进提高个人和群体保健知识和技能 developing personal skills4.促进调整卫生服务方向 reorienting health services5.促进发展社区能力

40、strengthening community action Ottawa Charter for Health Promotion（WHO 1986）健康促进的原则健康促进的原则Principles of Health promotion（1）1、全社会参与，结合日常生活，不仅仅关注处于全社会参与，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

41、people who are sick or at risk for specific diseases.健康促进的原则健康促进的原则Principles of Health promotion（2）2、针对健康决定因素，社会多部门协同行动针对健康决定因素，社会多部门协同行动wIt is directed towards action on the determinants 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，采取多种联

42、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通过社区建设和地区行动确定并铲除健康危险因素素It combines many different approaches and requires organizational change,community development and local activities to identify and remove health hazards.健康促进的原则健康促进的原则Principles of Health promotion（3）4、以切实有效的公众参与为目标，使个人和社区以切实有效的公众参与为目标，使个人

43、和社区获得发现健康问题并正确抉择的生存技能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.健康促进的原则健康促进的原则Principles of Health promotion（4）5、尽管不是医疗服务，但这是卫生和社会范畴的尽管不是

44、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活动，卫生专业人员可以在教育和鼓动中发挥特殊作用殊作用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口腔健康促进的策略与方法w群体策略 Community strateg

45、ies w专业人力策略 Professional strategiesw个体策略 Individual strategiesWHO 2003群体策略方法群体策略方法Community strategies（1）wCommunity-wide health promotion interventions wCommunity water fluoridation,salt fluoridationwSchool-based fluoride mouthrinse,群体策略方法群体策略方法Community strategies（2）wfluoride tablet programmeswScho

46、ol-based or school-linked dental sealantwprogrammes,oral hygiene programmes,screening and referral 专业人力策略方法专业人力策略方法 Professional strategieswPatient education and counselling on risk factorswProfessional plaque controlwTopical application of fluorideswProvision of dental sealantswIndividualized recall schedule个体策略方法 Individual strategieswSelf-care practiceswOral hygiene measuresToothbrushing,flossing,traditional cleaning,dentifricewSelf-applied fluoride usewSelf-initiated use of dental services泰国一个小村庄泰国一个小村庄口腔健康促进实例口腔健康促进实例思考题w健康促进与健康教育的目的有什么不同?w如何评价健康教育的效果？w健康促进的途径有哪些？