Suchergebnisse

In July 1983, the Assistant Secretary for Health reviewed progress toward achievement of a dozen national objectives in fluoridation and dental health. These 12 objectives, classified under the categories of improved oral health status, reduced risk factors, increased public and professional awareness, improved services and protection, and improved surveillance-evaluation systems, hold promise for improved oral health in this country. It is noteworthy that the objective that 40 percent of 9-year-old children be caries-free in their permanent dentition has been accomplished (51 percent of 9-year-olds were caries-free according to a 1979-80 National Institute of Dental Research study). Still, dental caries is highly prevalent among teenaged children, and gingival and periodontal conditions are highly prevalent among children and adults. A number of highly effective methods are available for preventing dental decay in children as well as adults; they include community or school water fluoridation, the use of multiple forms of supplemental fluorides, avoidance of frequent consumption of foods that are high in sugar content, and the use of adhesive pit and fissure sealants. Personal use and professional provision of these methods in appropriate combinations can contribute significantly to future improvements in oral health. Meticulous personal oral hygiene practices combined with periodic professional care are the currently available means of protecting periodontal health. Through increased collaboration among various governmental, academic, and corporate entities, as well as active participation by individuals, the achievement of a number of these objectives becomes feasible to the benefit of national productivity, health care financing, and the quality of life for Americans.

The Cooperative Medical System (CMS) and its barefoot doctors have been in decline in rural China for nearly a decade. In order to explore the reasons for this, in 1987 we carried out a survey of villagers, barefoot doctors, and local administrators in Fengxian, Shanggoa, and Loaan counties, where incomes are good, fair, and low, respectively. The state of the CMS in these counties was contrasted and the situations which prevailed in 1978, 1982, and 1985, when the system was, respectively, at its peak, had begun to decline, and had declined markedly, were compared. A random sample of villages was selected and all the barefoot doctors and administrators as well as a random sample of households were surveyed. The results indicate that health status (as measured by infant mortality, immunization coverage, and rate of infectious diseases) has decreased in areas where the CMS has declined, while per capita incomes increased. Concomitantly, villager's expenditures on health care have increased. Barefoot doctors and their patients were, however, reasonably happy with the system, and in its absence the doctors are no longer able to obtain ongoing training. The CMS was fiscally sound, and did not decline to the same extent in all areas--it continues to thrive in Fengxian, which is relatively affluent. It is concluded that the system probably declined because many local administrators perceived that it no longer enjoyed the backing of the central government.