A Decay and Caries Prevention Program for Primary Schools - Term Paper Example

Proposal paper on health policy Author name Institution Date A DECAY AND CARIES PREVENTION PROGRAM FOR PRIMARY SCHOOLS 1.0 Introduction The research is based on students from St. Michael's School Palm Island in the state of Queensland. The research shall focus on oral health for indigenous children belonging to the Aborigines. The reason for choosing the topic 'A Decay and Caries' for primary school is based on previous researches which have been conducted on the same area. Statistics based on research clearly show that children born of indigenous Australians have more incidents of tooth decay and dental caries as compared to their counterparts born of non indigenous Australian parents. Oral diseases pose a very serious challenge to the population. Oral diseases bear a lot of similarities with other conditions such as cardiovascular diseases and diabetes which are known to be 'multifactorial.' The conditions which are known as multifactorial carry that tag since they arise from genetic causes, behavioural risk and the environment in which one lives. Most of the diseases which affect the oral cavity and the gum result from the diet that one consumes. Scientists refer to dental caries as infectious diseases which depend on sugar while periodontal disease comes up due to deficiencies in certain nutrients in the body. 1.1 Background Before 1980s, children belonging to the indigenous Australians, Aborigines and Torres Strait had better oral health as compared to their counterparts belonging to non native Australians (Marthaler, 2004). This was the case despite the fact that the two indigenous groups did not fare as well economically as their counterparts. Scientists have realized that children from Aborigines and Torres Strait Islanders have about twice the incidents of dental caries when compared to other Australian children (Jamieson, Armfield & Roberts-Thomson, 2007). Some shocking figures indicate that in some communities, Aboriginal and Torres Strait Islander children have incidents of dental caries which are given times when compared to non indigenous children. A surprising finding was from a community which had more than nine out of every ten children having teeth which were filled, missing or decayed. Those children in the remote community who had teeth problems had little access to medical treatment since statistics indicated that only about ten per cent of the children had their teeth treated through filling of the decayed surfaces (Jamieson, Armfield & Roberts-Thomson, 2007). The research shall focus on St. Michael's school which is based on Palm Island. It is a school which was established by sisters belonging to the order of Our Lad Help of Christians. The school's management later changed with another order of sisters known as Franciscan Missionaries of Mary Sisters taking over the running of the school. The new administrators remained as such up to the year 2011 with their mission being 'Witnessing the power of truth by love.' The school is unique due to the fact that its establishment was primarily to benefit only students coming from the aboriginal and Torres Strait Islanders. The school seeks to fulfil the desires of the parents which is to see their children attain a good education so as to enhance their opportunities for growth and ensure that they are able to communicate in Australian English without any hitches (National Advisory Committee on Oral Health, 2004). 2.0 Current Policy: Strengths and Limitations 2.1 Individual funding dental services In Australia, individuals are the ones who mostly fund dental service. People then have to get the necessary services out of their own pockets and they do not enjoy the services of private dental insurance. The Commonwealth plays a central role in ensuring that dental services are provided and financed (Kelaher et al, 2006). However, it is the states which bear the responsibility of ensuring that major public programs for adults who are disadvantaged and children. The services provided by the states cannot meet the demand of concession card holder. This scenario leads to a situation where people have to wait for an average of five years and in other instances for longer even though the monies allocated for the purposes has been increased significantly (Petersen, 2003). There is a severe shortage of national providers of dental services which curtails the public and private sectors' ability to offer comprehensive dental services. 2.2 disjointed development of oral health services. In Australia, oral health services have been developed in a disjointed manner. The services have not grown at the same pace with the general health services and financing is largely private. There is thus a mix of dental services provided by public and private institutions. Public dental services are to be found in schools. The public services therefore, cater for children and aid adults who are economically disadvantaged. The fact that dental services provided by private institutions outnumber those provided by the state paint an erroneous picture that oral health services should not be given high priority and also to be accessed only as a matter of choice (Kruger, Dyson & Tennant, 2005). 2.3 State and Territory Oral Health Services: What do we know? After the First World War, the government of Australia began limited oral health services for children. In the 1960s, the services for children saw an expansion due to the introduction of dental care based in schools in some of the states (Marthaler, 2004). A great majority of the treatment was conducted by dental therapists. In the year 1973, school dental scheme in Australia funded by the Commonwealth became available to every Australian child. After a while, the Commonwealth got out of its direct involvement in the oral health program. After this withdrawal, some of the Australian states introduced a system whereby children were to foot part of the expense for their oral health services. Most states have endeavoured to improve their dental services at school with some states covering secondary school students. The number of children who receive oral health care is quite low in the state of Queensland (Endean & Roberts-Thomson, 2004). Whenever services are in short supply or people have to foot part of the bill, it goes without saying that those who suffer most are the most vulnerable members of the society, the poor. This is perfectly seen in the case of poor oral health state of children belonging to indigenous Australians as compared to their non indigenous counterparts who are generally well off economically and hence able to appreciate and pay for their dental check ups and treatment (Endean & Roberts-Thomson, 2004). General oral health services for disadvantaged adults: Various states in Australia, including Queensland, have confine dental care funded by the public for adults who have Centrelink's concession cards. Many jurisdictions have introduced a system where the same adult have to cater for a part of their bill for oral health services. Different jurisdictions provide different amounts of funding for oral health to those adults who are eligible. The Commonwealth Dental Health Program was established following a research conducted under the National Health Strategy (Locker, 1992). The research brought into the fore the challenges that people with low incomes face in their quest for dental care. Failure by adults to afford the services of dental care means that they cannot also afford or give priority to their own children's dental health. Private Dental Care: The private sector provides the largest amount of funding for oral health services in Australia. This occurs either with the contribution of private dental insurance or in the absence of such insurance. There is a serious issue with regard to people who are at a disadvantage and are not eligible for dental services meant for the public. These people, where most of the indigenous Australians lie, do not have it easy either when it comes to access of private health services. The cost of private dental treatment is very high being about $300 per house (Locker, 1992). From the year 1997, the Commonwealth government introduced subsidies to people who possessed private health insurance. The government later extended the program to all people who was in possession of private health insurance. The subsidy provided by the Australian government amounts to about 30 percent of the total cost (Endean & Roberts-Thomson, 2004). People who have higher incomes also tend to have bigger numbers in the insurance circles. It then follows that those who can afford to pay for private insurance get more benefits from the government than the ordinary people whose income is quite low. General Health: Children of the Aborigines and Torres Strait Islander children have a higher risk of suffering from diseases, injuries and are at risk of dying much earlier than other children in Australia. Indigenous children are also more prone to be admitted in hospitals for many conditions and diseases. The mortality rate for the indigenous children is at least twice that of the non indigenous children. The problems experienced by the indigenous children can be explained from a number of perspectives. One reason for the sorry state that indigenous children find themselves in is that their parents are at the bottom of the ladder in terms of socioeconomic conditions. These conditions obviously have a bearing on the health outcomes of the children due to poor income and condition of housing. The indigenous communities are more prone to engage in activities such as drinking, smoking and hence more likely to be obese (Endean & Roberts-Thomson, 2004). Children born of indigenous people have a higher probability of low birth weight. This translates to vulnerability to a host of diseases which punctuate the lives of many of these innocent children. Remoteness has also been seen as a reason for children of the Aborigines and Torres Strait Islander children to have ill health (Kruger, Dyson & Tennant, 2005). Many children in the remote areas do not meet the measures of an average Australian child. Indigenous children are more likely to have more incidents of anaemia and also suffer from conditions resulting from deficiencies in mothers who are expectant. These communities thus failed to have proper diet which translates in poor health. Even for those indigenous communities who live in areas which have abundance of resources do not escape from the problem of ill health due to poor diet since there are needs which have to be satisfied by the family meaning that proper diet is not given a priority. Oral Microflora: There are aetiological factors which cause dental caries. These factors include microorganisms and, fermentable carbohydrates (Low, Tan, & Schwartz, 1999). The third requirement is a tooth surface which is susceptible to diseases. Young children get colonisation of bacteria very early and are exposed to sucrose. This encourages the environment which makes it possible for microorganisms' growth in the dental plaque. Studies have shown that mutans streptococci affect children while they are about one year old when they get their incisor teeth. If a child gets affected by mutans streptococci by the time they are two years of age, then such a child is about four times likely to have caries than a child who is not affected by them (Kelaher et al, 2006). 3.0 Oral Health of Aborigines and Torres Islanders, What is the position to date? The proportion of indigenous people in the population rises relative to geographic remoteness. About half of indigenous children reside in remote areas. There is cause to believe that children of the indigenous people in Australia living in remote experience worse oral health when compared to their fellow indigenous children residing in urban areas. These allegations are usually made without empirical data to prove their veracity, but based merely on anecdotal evidence (Spencer, 2003). Children in some remote regions in Australia were found to have twice as much the incidents of dental caries when compared to the average child in Australia. The research was conducted following the signing of a memorandum of understanding with health service providers and indigenous communities in the remote regions. The data was collected for a period of about three years. The professionals who collected the data were also involved in providing services to the community. The data collected took into consideration factors such as sociodemographic information and self care habits. The researchers also sought to find out about their respondents' experience with dental caries and gingivitis. The researchers defined risk status in terms of the likelihood that a person would develop further complications in oral health in the near future and this was based on opinions supplied by dentists who examined the subjects in the study. Other data collected included cases of hypoplasia and dental fluororis (Spencer, 2003). 3.1 Proposed Program The recommendation based is acceptable by the culture and they are aimed at promoting the right oral health and introduce initiatives for education. The recommendations also focus on provision of providing dental services which are improved. They also focus on access to fluoride in different forms. There should be a focus on research initiatives which focus on two indigenous Australian communities, the Aborigines and the Torres Strait Islanders with respect to oral health of their children. Issues of diet and its effect on oral health need to be addressed. 3.2 Oral Health Promotion and Education There is shortage in promotion of effective oral health and tools for educating indigenous groups on matters pertaining to oral health. Queensland health department has made some progress in this issue but there is still more that needs to be done (Kelaher et al, 2006). Indigenous health promotion groups in conjunction with policy planners on issues of dental health, the government and other parties that would feel the need of coming on board to adopt measures which are proactive so as to develop messages of promoting health which target the indigenous communities. The measures adopted could include having members of the indigenous communities featuring on television commercial which are aimed at promoting dental health behaviours which are sound. Currently, advertisement seems alien to a majority of those from the indigenous communities. It would also be instructive to use media which the indigenous communities can identify with. There should be initiatives which encourage Aboriginal and Torres Strait Islander children in programs which aim to promote good oral health in members of their communities (Kelaher et al, 2006). There should be more members of staff involved in promotion of good oral health and another way would be to have the department of dental services being more inclined to embrace the culture and practices of the indigenous communities. This strategy could be implemented by ensuring that when children from indigenous communities attend dental care there are members drawn from their communities who welcome such children. These people would be charged with welcoming and talking to the children and talking to the children in a way in which they are used to and this makes the children to feel more at ease. Dental personnel should be given sufficient time to ensure that they conduct thorough examinations on oral health on Aboriginal and Torres and Strait Islander children (Kruger, Dyson & Tennant, 2005). 3.3 Water Oral health personnel should work hand in hand with other health care workers who provide primary health care. It would be good to have workers dealing with the issue of nutrition. It is also advisable to have the indigenous communities encouraged to drink water and there should be access to water which potable and cool for communities which reside in remote areas. The reason that the three aspects cannot be divorced is due to the fact that research is clear on the fact that dental health is affected by diet and also the kind of water that is taken (Endean & Roberts-Thomson, 2004). 3.4 General/Oral health services and training There should be a focus on having more indigenous people being trained as professionals in dental health. One way of achieving this would be by having schemes which provide incentives whereby such people could have a fee waiver and have lower entry grades to institutions dealing with dental health (Petersen & Yamamoto, 2005). Indigenous culture and customs should be emphasised during the training. As part of the qualifying process, oral health workers should have a placement in areas occupied by indigenous communities. There are many challenges in getting dental workers in remote areas and it would be advisable that the mandate of health workers is expanded to include oral health care during their training (Kelaher et al, 2006). This would enable such workers to have awareness as to the cause and solutions to problems of dental health. 3.5 Water fluoridation This is an effective and cheap way of ensuring that dental decay is reduced among members of the indigenous communities. This should be addressed since there are incidents where the teeth of indigenous communities get affected due to their lack of an important mineral, fluoride. Fluoridation of water is not only convenient but does not upset the lifestyles of the people in a given community (Kruger, Dyson & Tennant, 2005). People are thus avoided the trouble of having to seek dental services which might be out of reach due to high costs and the distances involved. 5.0 Need for continued research There is need for continued research with regard to oral health of the Aborigines and Torres Strait Islanders children oral is very vital due to various reasons. Such research would help to establish the trends that these problems follow. Such consistent research would help to determine the unique oral health requirements for the Aborigines and Torres Strait Islanders. This would allow oral health service providers to ensure that their resources are used in a better ways. The research should have a close relationship with evaluation of strategies being employed to promote oral health. The findings from investigations which are well designed would come in handy in ensuring the visibility of the plight of the Torres Strait Islander and Aboriginal children. The oral health of the children of the two indigenous communities is dependent upon a multiplicity of factors. These factors include environmental, social, cultural and personal factors. A great majority of the factors are not in the purview of an individual health provider. The factors lie squarely in the court of health professionals involved in preventive interventions. 5.1 Oral Self care practices Findings by a study of the Aboriginal and Torres Strait Islander Child Oral Health in Remote Communities showed that not more than 20 percent of the children polled brushed their teeth (Kruger, Dyson & Tennant, 2005). The research findings may have been as a result of lack of oral care services and if at all they did exist, then such services were not consistent. Children tend to adopt the habits for the people that they interact with on a regular basis. Those charged with the responsibility of caring for the children ought to lead by example and this has been proved to be the most effective way of instilling discipline in children. Indigenous communities don not have storage areas which are fit fro storing items such as toothbrushes, there is also the challenge of getting clean water and the lifestyle of the communities not being sedentary. There is a major shift in the type of food that Aboriginal and Torres Strait Islander children consume. The problem has been coupled by a sedentary lifestyle has meant that other health conditions like diabetes and obesity are also afflicting the children from the indigenous communities. Diabetes is an important determinant in oral health with regard to periodontal diseases. Diabetes has been known to play a role in the early stages of prepubertal periodontitis (National Advisory Committee on Oral Health, 2004). 6.0 Proposed Program A decay and caries prevention program for primary schools The program has been set up upon a realization that the oral health of the indigenous communities has been deteriorating when compared to members of the non indigenous communities. A pilot program has been designed which brings together different view points about the undesirable position of the indigenous communities. St. Michael's School, Palm Island was chosen as the setting for the program because it is a school primarily for children by indigenous communities. The two communities, the Aborigines and Torres Strait Islanders have a poor record when it comes to oral health. The overarching objective is to ensure the communities are educated on the need for oral health and government intervention in the oral health of indigenous communities. There is little research about oral health practices by the indigenous students in primary school. The program is designed to solve the lacuna that exist and bring the indigenous communities at par with the rest of the communities in Australia. 6.1 Objectives The aim of this program will be achieved by fulfilling the following objectives with regard to the Aborigines and Torres Strait Islanders. i. Increase research on the special needs on the oral health of the indigenous communities and allocate more resource in aid of the marginalized communities who have been sidelined in matters pertaining to oral health. ii. Increase to about 65% the number of primary school students who have access to information on oral health and practice basic oral hygiene. iii. Ensure that the indigenous communities have access to the relevant information on oral health and access to water and proper nutrition. iv. Increase the number of members of the indigenous communities who are trained in oral health and health generally by about 1000% in the next five years. v. Increase the number of indigenous communities participating in promotions for oral health. Strategies An assessment was carried on the needs of the community before the program development. The aim of this was to obtain data about the practices that exist and oral health practices within the school. The school community participated in developing strategies which will ensure the objectives are met. Consent of parents was sought before their children participated. Those children opposed to participate in the program did not take part but did benefit from the activities of the program. The program as a matter of necessity included authorization from the school administration and the State Authorities since this is a matter that affects issues of public concern and hence it is only right that the administrators should be aware. The participants were: Various types of health workers including oral health workers and nutritionists. Students and staff members of St. Michael’s School, Palm Island. Companies Involved in oral health research and manufacture of products for oral health care. Local Media Objective 1 Strategy 1.1 Use of focus groups and forums, including parents, students, and staff to develop and implement a comprehensive policy on oral health. Focus groups will be for the start to be held with students, parents and staff to identify any issues particular to St. Michael's School that may be in contrast to evidence found. 1.1.1 Facilitator-Project Coordinators Objective 2 Strategy 2.1 Engage school staff, local sporting identities and peer educators to act as role model to promote oral health care. This strategy will be implemented by: -Having health workers from the indigenous communities take part in advising the students on the needs of maintaining oral health. -Some of the students are to be recruited and take part in roles such as peer educators and this would aid in ensuring their colleagues take oral health seriously. -The facilitators shall employ plays to drive their message home. -The facilitators shall endeavour to create a friendly environment as possible so that students find it as fun and feel relaxed. 2.1.1 Facilitator- Project Coordinators Objective 3 Strategy 3.1 Enlist corporate sponsorship to access free oral health products from major companies involved in the sector. Companies which produce oral health products shall take part in the program. The participating companies shall be required to provide the products necessary to ensure the success of the program. The inclusion of the companies shall serve the purpose of ensuring that they become alive to the issues affecting the Aborigines and Torres Strait Islanders. Students, staff members and parents shall have to give their opinions and ask questions on the products which the companies produce. The companies should be challenged to come up with products which recognize the uniqueness of the two communities from the rest. It would be instructive to have customized health care products. 3.1.1 Facilitator: Project Coordinators Objective 4 Strategy 4.1 Engage students in learning the importance of studying to be health workers. Students shall have time to interact with different workers in the oral health and nutrition. Students shall have information about the necessity of such courses and have some form of mentors who are going to guide them making their career choices. The students shall be engaged in discussion and have an opportunity to ask questions and air their views on the mode of delivery for the course content as provided by the facilitators. The facilitators shall use different modes of instruction such as used PowerPoint presentations. Other modes of instructions which are to be adopted will entail use of videos and Television commercials which feature members of the two communities with the aim of ensuring the students can identify with the commercials because some members of their community are involved in their production. 4.1.1 Facilitator-Students in conjunction with volunteer health workers. Objective 5 5.1 Provide comprehensive in class education program Adequate knowledge on oral health is lacking among the children. There is going to be time allocated each week to educate children about oral health, hygiene, nutrition and the importance of all the three. The classes shall be conducted in a way which is interesting to ensure that students find fun and at the same time get to learn. The teaching on the need for oral health shall be conducted by the health workers. These workers shall be a combination which means that a good number of the health workers teaching the children shall be from the Aborigine and Torres Strait Island extraction. The students shall be provided with some sample products and told how they are to be used. 5.1.1 Facilitator- Project Coordinators Evaluation Plan Since this is a pilot program, there will be no intervention groups. The primary shall be comparing the changes in oral health practices in the target group before and after the intervention. During the phase concerning community needs assessment pre testing was done among the students to reduce chances of compromising the outcome of the program as a result of prior knowledge. In developing objectives and the strategies, qualitative research methods were used. This involved use of focus groups. The program was conducted in conjunction with students and staff of St. Michael's School Palm Island, the Queensland Health Promotion Officer and Oral Health Promotion Officer. Focus groups are a relatively cheap way of getting views which are either shared or divergent. Focus groups also allows for participants to interact in an atmosphere which is relaxed and informal. The trial shall be with the students of St. Michael's school, a school primarily meant for children from the indigenous communities. The primary focus shall be establishing whether the proposed programs would be successfully applied to the wider community of the so called indigenous Australians. There shall be a pre testing phase which shall be done among students to ensure that they comprehensively understand the aim of the project so as to ensure that the results obtained are objective. Strategies shall be realigned after applying qualitative methods of research such as focus groups. Members of staff would be invaluable to the success of the project and hence they shall be involved in every step to ensure that students are more comfortable with the process as a whole. There shall also be outcome evaluation which would measure how effective the program is going to in achieving the set goals. Cultural changes and change in policy by the government cannot be expected to take place in a day and it must be a continuous process. Budget Overview See Appendix A for budget overview Timeline Overview See Appendix B for timeline overview 7.0 Conclusion It is a sad fact to realize that a great majority of non Indigenous students do not have to be concerned with the problems associated with lack of access to oral health facilities. However, a different picture emergences when you look at the children of the Aborigines and the Torres Strait Islanders. Children from these two groups get to have their deciduous teeth destroyed extensively. This is not a good picture since a great majority of the population in Australia does not have to grapple with such problems. The indigenous communities are faced with different challenges. In the first instance, these people do not have adequate access to oral health care. The second problem is that the water consumed by the same groups do not have sufficient quantities of fluoride to protect their teeth. There is limited oral health education which takes into account the cultures of the indigenous communities. The other concern is that the dental profession in the country does not embrace the philosophies of the indigenous communities. The indigenous communities have very few oral health professionals in their ranks. Matters are not made any better due to the large quantities of cariogenic food and drinks which have negative effects on consumers' health. With all these conditions in place, the needs of the indigenous communities in terms of oral health are bound to increase. References Endean, C. & Roberts-Thomson, K. (2004). Anangu oral health: the status of the Indigenous population of the Anangu Pitjantjatjara lands. Australian Journal of Rural Health, 4(12): 99-103. Jamieson, L., Armfield, J. & Roberts-Thomson, K. (2007). Oral health of Aboriginal and Torres Strait Islander children: Dental statistics and research series, number 35. Sydney: Australian Institute of Health and Welfare. Kelaher, M. et al (2006). Improving access to medicines among clients of remote area Aboriginal and Torres Strait Islander Health Services. Australian and New Zealand Journal of Public Health, 7(30): 177-183. Kruger, E., Dyson K. & Tennant, M. (2005). Pre-school child oral health in rural Western Australia. Australian Dental Journal, 50: (4):258-262. Locker, D. (1992). The burden of oral disorders in a population of older adults. Community Dental Health Journal, 9(2):109-24. Low, W., Tan, S., & Schwartz, S. (1999). The effect of severe caries on the quality of life in young children. Pediatric Dentistry, 21(6):325–6. Marthaler, M. (2004). Changes in dental caries 1953–2003. Caries Research, 38(3):173–81. National Advisory Committee on Oral Health (2004). Healthy mouths healthy lives: Australia's national oral health plan 2004-2013. Adelaide, SA: Government of South Australia. Petersen, P. & Yamamoto, T. (2005). Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, 33(2): 81-92. Petersen, P. (2003). The World Oral Health Report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Spencer, A. (2003). An evidence-based approach to the prevention of oral diseases. Medical Principles and Practice, 12(1):3-11. Appendix A: BUDGET Budget Estimates Detailed budget for items required Estimated Amount ($) (a) Personnel   (Full time staff in one and a half years) 50,000     (b)Equipment   Printing paper for survey 3,000.00 Calling expenses 2,000.00 Mail 3,000.00 Laptops 10,000.00 Sub Total 18,000.00     (c ) Maintenance   Travel expenses 5,000.00 Overheads 4,500.00 Office items 3,500.00 Sub Totals 13,000.00 TOTALS 81,000 Appendix B: Timeline               Initial training at the school by Oral health workers   Compilation of the report based on feedback received           Jan-May 2012 June-Sept 2012 Oct- December 2012 Jan-March 2013 April-June 2013           Preparing the course content         Conducting other preliminary requirements Seeking the necessary authorizations and conducting background checks   Engaging celebrities and other personalities in training and getting suggestions from the school community.   Read More