Case Studies On Health Promotion Initiatives From The Nordic Countries

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Contents
	Introduction
1	Promoting healthy school meals for Norwegian children
2	From control policy to comprehensive family planning: success stories from Finland
3	Everybody is needed - Södra Skaraborg, Sweden
4	The promotion of oral health among Danes
5	Interventions for smoke-free schools. From information deficit to social influence
6	The prevention of night blindness in Bangladesh
7	Health policy development in Costa Rica

Case study #3: The Promotion of Oral Health among Danes

Name of the person reporting:	Erik Friis-Hasché, Dr.odont., Research Director, Associate Professor
Address:	Department of Paediatric Dentistry Faculty of Health Sciences University of Copenhagen 20 Nørre Allé DK-2200 Copenhagen N Denmark
Telephone:	+ 45 - 35 32 67 55
Fax No	+ 45 - 35 32 65 05
E-mail:	Erik.Friis-Hasche@odont.ku.dk

Rationale for initiative

The basic principles and main features of Danish health policies are equal and free access for all to most health care measures. However, in 1972 only 50 per cent of the schoolchildren received a regular, free oral health care service, and only 1 per cent of Danish children were caries free.

Objectives of initiative

In more than 70 years there had been initiatives aiming at the establishment of an oral health care service for all children. During the years the following initiatives had been taken:

1886: The first school dental clinic was established (private, local initiative)

1909: First municipal school dental clinic (public, local initiative)

1910: First society for oral health care (private, dental association)

1959: First commission for child oral health care (political, parliament)

1963: First department for child oral health care (professional, school of dentistry)

However, there were big gaps in prevention and treatment of oral health between children living in the big cities and children living in the countryside. Any further development did not occur until the Danish parliament's advent in 1972 of the Child Oral Health Care Act.

Description of inititative

The act required municipalities to establish child oral health care clinics for the treatment of all children under the age of 16. It is important to note that the oral health care must include:

General preventive measures including provision of information.
Individual preventive measures including counselling of each child and his/her parents, and instruction in oral health care for every child.
Regular examination of the dental development and oral health of each child.
Treatment of oral diseases and malocclusions to the extent necessary for maintaining the oral system in a healthy and functional condition.

In its section on preventive activities, the act directly requires establishment of staffs within the public health sector to actively perform public health promotion and preventive tasks. This is the first time in the Danish public health policy that this has been decreed by law.

The oral health services were to be provided for each child annually, starting with the first grade and ending with the ninth grade. A revision of the act in 1977 introduced a gradual year-by-year inclusion of preschool children, so that by 1987 the system included all children in Denmark. It has to be noted that the services were not targeting high risk groups in particular, but intended to cover all children in the relevant age groups.

Each individual municipal oral health clinic is free to define its own goals for the oral health of the local population. In 1985, however, the National Board of Health set operational goals for oral health in Denmark by the year 2000. These goals took into account an extrapolation of trends observed during the 13 years of monitoring caries statistics from the records kept on child oral health care. The goal for the 12 year old children states that at least 60 per cent should be caries free.

The municipal oral health care service in Denmark is, to a large extent, administered according to democratic principles of local autonomy. The National Board of Health supervises this administration.

Evidence of success

The World Health Organization's goals for oral health for children by the year 2000 was attained by the Danish child oral health care service in:

1985 for children aged 5-6, in

1986 for 12-year old children, and in

1988 for the 18-years old.

In 1996 71 per cent of the 12 year old children were caries free.

The number of dentists employed by the municipalities increased by 50 per cent from 1972 to 1995 (from 750 to 1075). The number of children treated pr. dentist increased by 160 per cent, from 479 in 1974 to 1250 in 1995.

Over a 10-year period (1977-1987) oral health care expenditures per child rose by 41 per cent from 695 DKK (Danish kroner) to 978 DKK. In the same period the cost-of-living index rose by 95 per cent (from 133 to 259). The expenditure on child health care has remained at a lower level than price increases in general. Presently the total population of children aged 0-17 amounts to 1,095,000, and the proportion of children registered as treated is 97 per cent.

Evaluation

When the systematic child oral health care service started in 1972, it was decided that the National Board of Health should annually register the dental health of all schoolchildren from 1st grade to 9th grade. A standard system for recording oral health status had been developed, and the forms were designed for Optical Character Recognition and are fed directly into a computer, which scans and analyses the data. The annual output consists of standard tables describing the dental health of all children in Denmark according to age, municipal dental service/clinic, for each county and for the entire country. Each of the municipal dental services receives a statistical overview of the local situation annually. Each year the National Board of Public Health publishes a report on the development of child oral health care in the country. The report covers three topics: epidemiology, resources (financial as well as manpower), and organization.

Due to the decreasing number of children and due to the greatly improved state of oral health, in 1989 The Parliament passed a new law that extended the municipalities' oral health services to offer free dental care to groups of frail citizens, dependent elderly people in particular. In the legislation there is also a clause that provides for the establishment of new (pilot) arrangements and for changes in the oral health care service organization.

Reflections

According to the Child Oral Health Care Act of 1972, it is the obligation of oral health care teams to provide information, motivation and instruction. Not only the individual child, but also the key figures taking care of its health during upbringing are involved in the preventive activities of the oral health care team. The aim has been to generate continuous, stable and adequate preventive attitudes and behaviour, not only in childhood and adolescence, but also later in life, when the health care system is no longer responsible.

To attain this goal, prevention has been planned as a continuing educational activity for all school grades. The educational program is designed with respect to the emotional, cognitive and social development of the child. One of the essential prerequisites for the successes of the program has been that the oral health care team comprehend educational and psychological concepts in the context of education, and have the necessary skills to implement and organize the programs.

To ensure a dynamic development, the preventive oral health care programs and their results have each year been under constant evaluation.

The municipal oral health care services presently respond to a number of challenges that might appear unexpected, but are the logical result of progress. An example is the integrated and coordinated preventive health care programs aimed at the local population, covering nutrition, tobacco, alcohol, physical exercise, contraception and oral care.

Dissemination

In the period 1972-91, 386 publications have documented, evaluated and discussed the development of child oral health care. Forty percent of the publications were in international journals (English language).

Lessons learned

In the development of health promotion and disease prevention, the professionals and the associations are skilful in presenting arguments, but decisions in the political arena are necessary in order to influence action and ensure progress. Since the society and the context continuously change, producing new financial conditions and new disease and health challenges, the health promotion effort, with its approaches and methods, have to change and develop continuously. Prompt decisions and immediate action are required. In this context, the Danish solutions to the child oral health care challenges may serve as an example of success.

References

Friis-Hasché, E. (1994). Child oral health care in Denmark. A great success in health promotion. Copenhagen: Copenhagen University Press.

Go back to: Case Studies On Health Promotion Initiatives From The Nordic Countries

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