AAPHD Policy Statements
AAPHD Policy Statement on National Health Reform The American Association of Public Health Dentistry (AAPHD) supports fundamental health system reform in the United States. The Year 2000 Objectives for the Nation, as stated in Healthy People 2000, cannot be achieved without such change. This change must address access, cost, and quality of health care.
FUNDAMENTAL PRINCIPLES TO GUIDE NATIONAL HEALTH REFORM The American Association of Public Health Dentistry supports and promotes 15 basic principles to guide national health reform, and for including oral health in any product of such reform. The principles are organized in five broad categories and include:
ACCESS AND AVAILABILITY 1. Coverage for all individuals.
SCOPE OF SERVICES 3. Comprehensive primary health care services.
ADMINISTRATION 9. Public accountability for cost, quality, and access, with ongoing planning and evaluation that includes provider and consumer participation.
HEALTH PERSONNEL 14. Adequate supply, appropriate distribution, and effective utilization of trained health personnel.
RESEARCH 15. Sound biomedical, sociobehavioral, and health services research to support the organization, financing, and delivery of services.
AAPHD Policy Statement on Primary Care The American Association of Public Health Dentistry (AAPHD) reaffirms that "oral health is an integral part of total health, and oral health care is an integral part of comprehensive health care, including primary care." Oral diseases are among the most common in the United States, affecting both children and adults. Oral diseases profoundly influence general health and quality of life, including speaking, eating, learning, working, and other functions. Primary oral health care services are directed toward promoting health and preventing and managing oral diseases and conditions. By addressing the vast majority of the oral health problems present in the community, oral health professionals provide the foundation for an effective and efficient oral health care system. Oral health care is an integral part of primary care because: 1. The mouth is part of the body, and oral pain, disease, and disability should be prevented and/or treated. Many people are at risk of oral diseases, and risk continues through a lifetime. The AAPHD believes that primary care clinicians should be identified by skills needed to address patient and community needs rather than by clinicians' credentials. Oral health professionals fulfill the expectation of primary health care by ensuring coordinated, appropriate, and comprehensive personal and community-based services with an understanding of the patient's living conditions, family dynamics, and cultural background. AAPHD Interim Policy Statement on IOM Report Background The Institute of Medicine (IOM), part of the National Academy of Sciences, established a Committee on the Future of Dental Education "to identify measures to strengthen dental education in the United States and stabilize its position within the university." The specific charge to the Committee was to: examine the current status of dental education and oral health in the United States and consider future scientific, demographic, economic, organizational, and other developments that may affect oral health status and the system for educating dentists and other dental personnel; develop a statement of how, over the next 25 years, oral health and oral health services should be improved in the United States, and identify the short-term and long-term implications of this statement for dental education and public policy; describe strategies that will help dental education, research, and practice improve oral health by responding effectively to current problems and future developments in both science and society; and consider ways in which each dental school can better relate to the mission of its university and to the community at large. Through site visits, personal interviews, mail and telephone surveys, and oral and written testimony from the dental, medical, and lay communities, the committee collected "information and perspectives of dental education in the context of the broader systems of health professionals education and health care delivery." Based on their findings, the committee issued a report, entitled Dental Education at the Crossroads: Challenges and Change, in January 1995. This report included 22 recommendations covering dental education, research, and dental care delivery. Supporting materials for the recommendations were contained in the report and in background papers published in the Journal of Dental Education. · WHEREAS, the American Association of Public Health Dentistry (AAPHD) seeks to improve the oral and general health of all Americans; and BE IT RESOLVED THAT THE AMERICAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY: · Endorses the Institute of Medicine's report Dental Education at the Crossroads: Challenges and Change; and AAPHD Code of Ethics and Standards of Professional Conduct I. Introduction The American Board of Dental Public Health defines the profession's role as follows: . . .science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with dental health education of the public, with applied dental research, and with the administration of group dental care programs, as well as the prevention and control of dental diseases on a community basis. Dental public health professionals represent many talents including those required for clinicians, scientists, educators, administrators, and policy makers. Primarily however, these represent individuals who combine skills in all such fields in varying proportions or different roles and responsibilities over time. The diversity in scope of the members' roles poses a particular challenge to dental public health professionals when charged with determining an ethical stand for issues they may encounter. A profession has the obligation to be self-regulating. Implicit to this concept of self-regulation is the notion that a profession will have a written code of ethics that provides guidance for appropriate conduct of members in their professional practice. The dilemma of choosing between an individual as a patient and that of a community requires the creation of a code that formalizes guidance for professionals forced to make those decisions. The purpose of developing these guidelines is to provide guidance to people engaged in dental public health activities, assist in the education of public health students who are new to the profession, and provide an institutional memory when faced with challenges. Codes of ethics identify the principles that underlie professional behavior. They guide individual professionals and serve as evidence that a professional discipline is worthy of the public's trust. Codes of ethics are beliefs. Standards of professional conduct represent behavior guided by such beliefs. Professional conduct describes actions that are good and right for the community and civilization, performed without regard to concerns for personal benefit. The American Association of Public Health Dentistry (AAPHD) includes members who voluntarily agree to uphold, abide by, and promote the AAPHD Code of Ethics and Standards of Professional Conduct This code of ethics is aspirational, and not a legal instrument. The AAPHD Code of Ethics describes principles and beliefs inherent to the practice of a professional dedicated to improving the health of a community, thereby expanding and clarifying issues not defined in a code where the scope of practice is treatment of an individual patient. II. Preamble The American Association of Public Health Dentistry, directly and through its individual members, is committed to improving the oral health and general well-being of the public based on principles of public health. Association goals, strategies, policies, and services are founded in its Code of Ethics and Standards of Practice. The association strives to ensure that members are dedicated to excellence in the science, art, and practice of dental public health. Principle 1: Autonomy ( "Self-governance") The dental public health professional has a duty to respect the rights of individuals and the organizations by which they collectively govern and express themselves. STANDARD OF PROFESSIONAL CONDUCT A. RIGHT TO KNOW: Dental public health professionals have the responsibility to inform individuals and community organizations about the adverse conditions or problems known, issues involved, options available for correcting oral health problems and inequities, recommended courses of action, and the rationale for and possible side-effects of the recommendations. Principle 2: Nonmaleficence ("Do No Harm") The dental public health professional has a duty to protect individuals from physical, mental, and social injury. STANDARD OF PROFESSIONAL CONDUCT A. COMPETENCE: The dental public health professional has a duty to engage in professional life-long learning and skills development. The professional has a responsibility to keep abreast of developments in the scientific literature and professional discourse on professional and scientific issues. The professional has a duty to promote the application of scientific knowledge in his or her practice.
B. REFERRAL: The dental public health professional has a duty to recognize the limits of his or her abilities, and to seek consultation and/or refer individuals and organizational representatives to more competent authority. When referral is indicated, the dental public health professional is responsible for ensuring follow-up.
C. SCOPE: Individual and community services must be provided in a socially responsible manner. The dental public health professional must respect the reputation of each individual, organization, and community.
D. RESOURCES: Dental public health professional services must be performed with respect for the value of the services received, and conservation of individual, private, and public resources.
E. PERSONAL IMPAIRMENT: It is unethical for a dental public health professional to practice when one's judgment or skill may be impaired for any reason.
Principle 3: Beneficence ("Do Good") The dental public health professional has a duty to understand and promote individual and community health and welfare. STANDARD OF PROFESSIONAL CONDUCT A. CLINICAL CARE: Clinicians are committed to helping patients who need or request health services. Resources are often a compromising factor, particularly in public programs. The dental public health professional must provide the best care possible, but with the constraint that care should be equitable-i.e., the best possible care that helps the largest number of people for the longest period of time.
B. COMMUNITY PRACTICE: The dental public health professional has a duty to promote policies that improve oral health service resources.
C. PRIMARY CARE: The dental public health professional must cultivate independent responsibility for oral health and general well-being by individuals and communities.
Principle 4: Justice ("Fairness") The dental public health professional has a duty to treat individuals and community organizations fairly. STANDARD OF PROFESSIONAL CONDUCT
A. DISCRIMINATION: The dental public health professional must not discriminate against any individual or group on the basis of race, creed, color, gender, national origin, sexual orientation, age, and other personal characteristics.
B. COMMUNITY PRACTICE: The dental public health professional has a duty to promote policies that ensure the equitable distribution of available resources.
C. COMMUNITY POLICY: The dental public health professional has a duty to ensure that spokespersons for the public or segments of the public under consideration are included in the public policy development process and, to the extent possible, in the administration of programs on behalf of such groups.
Principle 5: Veracity ("Truthfulness") The dental public health professional must be honest and not misleading in all communications. STANDARD OF PROFESSIONAL CONDUCT A. REFERENCES: The dental public health professional respects copyrights and responsibly attributes original ideas.
B. RELIABILITY: The dental public health professional abides by his or her written and verbal direct and implied agreements.
C. CONFLICT OF INTEREST: The dental public health professional does not engage in activity in which there is a conflict of interest or where there is a potential for, or appearance of, conflict of interest
E. DEGREES: The dental public health professional refrains from using unearned and nonprofessionally related degrees.
Principle 6: Professionalism ("Collegiality") The dental public health professional has a duty to ensure the development of the science, art, and practice of dental public health among colleagues; to recruit, educate, and train future dental public health professionals; and to promote dental public health understanding and practices by the public. STANDARD OF PROFESSIONAL CONDUCT A. ADVANCEMENT OF KNOWLEDGE: The dental public health professional should contribute to the scientific literature, participate in professional and community meetings, and to otherwise share his or her knowledge and skills with colleagues and the public.
B. MENTORING: The dental public health professional has a duty to promote the development of those who possess less experience and/or skills.
C. SERVICE: The dental public health professional has a duty to promote this code in all his or her social and community endeavors.
D. MISCONDUCT: The dental public health professional has an obligation to protect the public, to lead by example, and to advise colleagues who may not be abiding by this code.
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