Perspectives on the New Public Healthand challenges in health assessment
Statements from the 10th Colloquium of FIHS
6th August 2011, TokyoFukai Institute ofHealth SciencePerspectives on the New Public Healthand challenges in oral health assessment
Kakuhiro Fukai, D.D.S., Ph.D.
Director, Fukai Institute of Health Science

Introduction
Public health has made an important contribution to the improvement ofhuman health since the 18th century. In modern times, comprehensive health caresystems have been developed in order to ensure that public health promotes individual
health care as well as disease prevention and health promotion at the community level.
This new concept of linking community and individual health is ever more important inorder to meet the current health needs of the 21st century. Under these conditions, itwill be essential to carry out health assessment based on measurements of both
personal and community health.

History and Definition of Public HealthIn the earliest stages of the history of public health, empirical quarantines
were begun in the middle ages, when it was thought that epidemics were caused bymiasma. In the 19th century, Koch R (1843-1910) et al. found that epidemics werecaused by microorganism. Prior to this, Snou J (1813-1853) examined cholera (1853)
and dealt with it. Meanwhile, from viewpoint of a public health system, Frank P(1745-1821) started the idea of medical police, suggesting that health problems needed
to prevent at the social level rather than blamed on individuals. Then, from the 18 th to19th century, the Industrial Revolution brought rapid movement of people into urban
areas. Gathering people in limited areas caused the vicious cycle of “unsanitary –disease – poverty” and made people’s health worse. In response to this situation inEngland, the Public Health Law drafted by Chadwick E (1800-1890) was enacted in
1848. Then, Rumsey H (1809-1876), and Simon J (1816-1904) et al. continued this work
after the establishment of the law in England1).
The most widely-accepted definition of Public Health (1920), originallyformulated by Winslow CEA (1877-1957), can be stated as follows: “the science and artof disease prevention, prolonging life, and promoting health and well-being throughorganized community effort for the sanitation of the environment, the control of1

community infections, the education of the individual in principles of personal hygiene,
the organization of medical and nursing service for the early diagnosis and preventive
treatment of disease, and the development social machinery which will ensure to every
individual in the community a standard of living adequate for the maintenance ofhealth2） ”.. According to the Acheson Report, in England public health is currently
defined simply as: “the science and art of preventing disease, prolonging life andpromoting health through the organized efforts of society” 3）.

“New Public Health”: A Paradigm which Encompasses Community andIndividuality
In the past, public health activities have resulted in the reduction of infectious
diseases and an increase in the average life span. The 20th century was characterized asa period of dramatic progress in medicine and medical care. At the same time, it was an
era during which societies developed a better understanding of individual and social
health promotion within the context of various social, economic, and cultural
backgrounds, as represented by the Alma Ata Declaration (1978) and Ottawa Charter(1986) 4）. Considering the perspective of social determinants for health (Marmaot M,1999) 5）, it was time to develop the theoretical basis for a new way of thinking aboutpublic health.
In the 21st century, however, we face phenomena such as an aging population,
an increase in chronic diseases, new types of infections, and skyrocketing medical
expenses in both industrially advanced nations and developing countries. As a result, a
new concept of public health has developed, which is based on the “organizedcommunity”. Specifically, personal health problems should be addressed with medicalcare, while community health is dealt with through public health and health education.
Under this system, medical care should be seen as one part of a larger concept of publichealth the two should be closely connected. This is a new paradigm for public health,and it would entail providing comprehensive coverage of individual healthcare. Set
against this background, the concept of “New Public Health” has been proposed as an
attempt to rebuild a comprehensive concept of the arts and sciences which encompasses
disease prevention, prolonging of life, and health promotion6-7）. This would involve areconfirmation of the personal health education proposed by Winslow, in a way thatanswers the needs of modern society.

2Oral Health Assessment
Health professionals need to improve health assessment8-9） and begin
measuring health in a way that is consistent with this new concept of public health, acomprehensive notion which includes and integrates both individual and community
health. Personal cognition and living environment influences one’s activities of dailyliving as well as impairment which is triggered by weakness of individual physicalfunction. Indeed, from the perspective of improvement of daily living and healthbehavior, cognition of personal health values is an essential consideration. A common
indicator of health assessment will be an indispensable tool for supporting andencouraging individual behavior change, community health, and improvement ofdisease control measures. This will require changes in medical systems as well.
Considering the elderly, for example, assessment indicators covering disease anddisability have been proposed in Japan, such as the Comprehensive Geriatric
Assessment (CGA)10）. From the viewpoint of lifestyle health, however, there is stillinsufficient research concerning the subjective individual assessment of disease andhealth, objective assessment by health professionals, and comprehensive indicators
covering both community and individual health, all of which are important when
considering the health of young children and adults.
Oral health is strongly related to lifelong health and survival as well as
personal quality of life (QOL). According to previous studies, oral health-related qualityof life is comprised of four factors: (1) functional, (2) psychological, (3) social, and (4)discomfort symptoms such as pain8）. Further studies are needed to examine how oral
health impacts physical, psychological, and social health. What is urgently needed is for
medical health professionals to come to an agreement on the elements which compose
oral health.
I propose six elements which comprise the concept of oral health: (1) oral healthcondition, (2) oral function, (3) QOL, (4) health behavior, (5) supportive environment,and (6) age characteristics. It has been emphasized that these indicators need to beshared with health professionals as well as residents and patients themselves 11-12）.
Further studies are needed in order to accumulate more evidence, as is furtherdiscussion as to whether this classification is best and how to improve the indicators inorder to assess personal elements.

3References
1.

Minowa M: The history of public health, Monthly seminar of dental epidemiology,
Fukai Institute of Health Science, 31 March 2011.

2.

Winslow CEA: The Untilled Fields of Public Health, Science, n.s. 1920: 51, 23.

3.

Department of Health, Public Health in England: Report of the Committee ofInquiry into the Future Development of the Public Health Function. London:
Department of Health, 1988.

4.

Kickbusch I: The contribution of the world health organization to a new publichealth and health promotion, American Journal of Public Health 2003: 93, 383-388.

5.

Marmot M and Wilkinson GW edited: Social determinant of health, Oxford
University Press, London, 1999.

6.

Tulchinsky T and Varavikova EA: The New Public Health, 2nd ed. Elsevier Inc.
London, 2009.

7.

Kihara M: Public health with scientific analysis of society and health (1). A major
topic for the 21 Century and new public health, Nihon Koshu Eisei Zasshi 57(12),1094-1097, 2010.

8.

World Health Organization: Measuring health and disability Manual for WHO
Disability Assessment Schedule (WHODAS 2.0), 2010.

9.

McDowell I: Measuring health a guide to rating scales and questionnaires, 3rd ed.
Oxford University Press, London, 2006.

10. Toba K.: The guideline for comprehensive geriatric assessment, Nihon Ronen
Igakkai Zasshi. 42(2), 177-180, 2005.
11. Fukai K: The concept of a new oral health indicator and the approach of healthpromotion and improving oral health, Health Science and Health Care 7(1), 1-3,
2007.
12. Fukai K: Subjective health assessment in oral health, Health Science and HealthCare 9(2), 43-44, 2009.

4

深井保健科学研究所第10回コロキウム「新しい公衆衛生」と健康度評価の課題
Perspectives on the New Public Health andchallenges in health assessment■開催趣旨
公衆衛生は、18世紀以降、人々の健康課題の解決に貢献してきた。しかしながら21世紀になって、この公衆衛生に、集団の疾病予防・健康増進にとどまらず、個人を対象とした医療・介護・健康づくりを包括したシステムが求められるようになってきた。このような個人と集団を結ぶ新しい枠組みは、現在のヘルスニーズに応えていくためのものであり、そのなかで、個人と地域の健康度測定の課題は大きい。今回のコロキウムでは、公衆衛生をめぐるこれまでの歴史的な経緯を踏まえ、これからの公衆衛生と健康度評価の展開について議論を深めたい。

■日程：2011年8月6日（土）12時受付■会場：日仏会館（東京・恵比寿）１階ホール〒150-0013 東京都渋谷区恵比寿3-9-25■主催：深井保健科学研究所■プログラム
12：00 受付開始
12：30－14：00 基調講演
深井穫博(深井保健科学研究所）「新しい公衆衛生における口腔保健の課題」【交通機関】
JR山手線：恵比神原正樹（大阪歯科大学）「DMFTから見えてくる口腔保健」寿駅東口下車，恵比寿ガーデン
花田信弘（鶴見大学）「健康は測れるか？（仮）」プレイス方面へ
14：00－14：30 ディスカッション
徒歩10分「新しい公衆衛生」と健康度評価
東京メトロ日比谷線：恵比寿駅
14：30－17：30 健康をめぐる諸課題（予定）１番出口アト
瀧口 徹（新潟医療福祉大学），岡本悦司（国立保健医療科学院）
レ・JR恵比寿駅
東口を経由 徒中村修一（九州歯科大学），安藤雄一（国立保健医療科学院）
歩12分
簔輪眞澄（元国立保健医療科学院），俣木志朗（東京医科歯科大学）
鶴本明久（鶴見大学），佐々木健（北海道庁）ほか
17：30－19:30 懇親会（レスパス日仏会館1F）■参加費（予定）
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