The five key strategies of the Ottawa charter are:
Build healthy public policy
Create supportive environments
Strengthen community action
Develop personal skills
Reorient health services
All five of these Ottawa charter strategies are essential to health promotion. However, in different situations they each play different roles with varying significance.
In my work as a clinical dental hygienist, one of the five strategies I act the most upon is developing personal skills, and the formation of healthy public policy. In my personal/professional experience, individuals don't always take control of their own oral health and mitigate environmental factors to make choices to improve and/or maintain their oral health. Personal skills, ownership, and accountability is something I work with patients every day to improve. The basis of health promotion is "the process of enabling people to increase control over, and to improve their health" (WHO, 2021). Which in the context of my daily dental hygiene practice, means giving people the tools, education, and goals to improve and maintain their own oral health.
For example, ECC (early childhood caries – dental decay in children under six) is a completely preventable disease but is the most common childhood disease worldwide. It accounts for 30% of all day surgeries in pediatric hospitals (Canadian dental association 2014). While ECC is completely preventable, there are varying levels of environmental impacts that can impact its prevalence and need to be mitigated by a family/individual. Income, education levels and dietary habits are some of the environmental factors that have an impact on ECC. In Nova Scotia we have a children’s oral care policy program to educate and provide preventative and restorative care to children from birth until they are fifteen, at no cost to their families (Nova Scotia Government, N.D). However, rates of ECC in Nova Scotia are still prevalent. There hasn’t been a significant amount of research evaluating the program (which is an issue with many policies). However, it is significant for the prevention of ECC for families to have access to affordable oral healthcare. This program helps families to develop strategies to use at home, as well as have access to early diagnostic and preventative services. Caregivers are quick to put the blame on their children disliking getting their teeth brushed, have ‘soft teeth’ (which is not a thing), or a multitude of other reasons. While caring for children's teeth is not an easy task (and I say all of this without having children lol), ECC is a completely preventable disease. Developing personal skills & taking ownership over one’s own oral health, as well as utilizing existing public policy such as the children’s dental care program in Nova Scotia greatly decreases the risk of ECC.
In other settings the five strategies are of differing importance in my mind. For example, ECC in Indigenous communities. There is a significant social injustice, socio-economic inequalities and systemic inequalities that prevent indigenous children from receiving proper care, and the ability to prevent ECC within indigenous communities. While indigenous children face many of the same challenges as all children, one of the biggest factors is access to care within their communities (Kyoon-Achan et al. 2021). Families have access to funding for preventative dental care, but may be hours away from a dentist. Living in a rural setting, their family members may also have not had the opportunity to visit a dentist for preventative & educational tools. They also may not have access to fluoridated water (in some places not safe water in general), healthy food options may be accessible & a multitude of other environmental factors that are extremely difficult to overcome. In this situation, the significant strategies would be reorienting health services and building public policy to provide care and education within rural indigenous communities.
Canadian Dental Association (2014). CDA Essentials: The Canadian Dental Association Magazine. 1(4). https://www.cda-adc.ca/en/services/essentials/2014/issue4/files/assets/common/downloads/publication.pdf
Kyoon-Achan, G., Schroth, R., DeMare, D., Sturym, M., Edwards, J., Sanguins, J., Campbell, R., Chartrand, F., Bertone, M., Moffatt, M. (2021). First Nations and Metis peoples’ access and equity challenges with early childhood oral health: a qualitative study. International Journal for Equity in Health. 20(1):134. https://doi.org/10.1186/s12939-021-01476-5
Nova Scotia Government. N.D. Children’s Oral Health Program. https://novascotia.ca/dhw/dental-programs/children-oral-health-program.asp
World Health Organization (2021). Health promotion glossary of terms 2021. Geneva: World Health Organization. https://apps.who.int/iris/rest/bitstreams/1398462/retrieve
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