A Collaborative Model for Global Health Research: Investing in Oral Health for All
At a time when domestic budgets are constrained, the question arises about why a nation needs to invest in global health or even research on global health when its own population's health is in any given nation's first interest. The major challenge for any public health professional is to tackle this broad range of risk factors in concert with change leaders and agents in sectors of society within and external to the health sector. Investigators continue to focus on the populations where they, the researchers, live and work. Save the expense involved, the principle of international collaborative research partnerships, characterized by multiple country sites where there is ownership of data by all partners, is a governing tenet to consider going forward. the over-arching issue is how can oral health researchers contribute substantially and purposefully to reducing not only oral health inequalities, general health inequalities but reduce poverty and access to full social and economic participation in society.
Major changes in strategies are needed to promote oral health worldwide.
Dentistry is facing very serious challenges and threats and should be embracing major changes in strategies. The challenges relate mainly to controlling the unabating increase in dental caries, evidenced by the fact that most caries occur in adults, not in children (1). The current strategies, using fluoride and dental health education, are obviously not dealing with the increase in dental caries as people age. Even in fluoridated areas, there are unacceptably high levels of caries in adults in all industrialized countries. A typical example is in the United States, where in 2004, the Decayed Missing and Filled Surfaces (DMFS) was 5 in 16-19-year-olds, but 30 in 35-49-year-olds and 50 in 50-64-year-olds (2). The relentless increase in caries with age shows that dental policies are not controlling the only direct cause of caries: sugars. The challenge is to introduce robust strategies to reduce levels of sugar consumption. Otherwise, dentistry will continue to be preoccupied by issues of access to dental care and be excluded from major changes in policies on controlling noncommunicable diseases (NCD). Such important UN and WHO policies are a major threat to dentistry. Another major threat is the legal binding imperative to phase down the use of amalgam (3,4). The High-level Meeting of the UN General Assembly on Prevention and Control of NCDs and the adoption of the Political Declaration (United Nations General Assembly resolution 66/2) represented a breakthrough in the global approach to control NCDs (5). For the first time, all Member States of the UN agreed that NCDs such as cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and oral diseases constituted a major challenge to socioeconomic development, environmental sustainability, and poverty alleviation. The series of multisectoral policies formulated by the UN High-level Meeting, the Moscow Declaration on Healthy Lifestyles and Noncommunicable Disease Control, the Rio Declaration on Social Determinants of Health, and the WHO require governments to introduce policies to reduce the risk factors common to most NCDs and to their determinants. So dentists must integrate their activities with those who are actively promoting policies to reduce sugar and smoking, otherwise dentistry will be left on the sidelines. As yet, although there are discussions on the subject, there are no significant changes in national oral health policies that harmonize with the recommendations of the UN, the WHO, and groups such as the NCD Alliance (6-8). Dental policy makers have not formulated significant evidence based policies on health promotion and disease prevention, apart from water fluoridation. They remain in the dental silo. The editorial by Benzian et al. (9) on the significance for oral health worldwide of the UN High-level Meeting on NCDs said “Now is the time that scientific evidence, social demand, and political [action] should be brought together to create conditions for comprehensive prevention and control of NCDs with oral diseases as an integral component.” That call should be viewed as an imperative because the UN Environment Programme Intergovernmental Negotiating Committee (3,4) will make phasing down the use of dental amalgam legally binding on governments. The main way the Intergovernmental Committee says that should be done is “Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration” (3). As mentioned earlier, fluoridating the mouth has reduced, but not prevented the increases in caries. The reductions over a lifetime are about 10% (10). Therefore, to meet the requirements of the UN resolution, major initiatives are needed to reduce the consumption of dietary sugars as no other measure will markedly reduce caries. An obvious way to do that is to coordinate actions by making alliances with groups concerned with reducing other NCDs and risk factors common to them. Those risk factors includes sugars – the cause of caries and obesity (11). A new model for oral health care is needed. The World Dental Federation (FDI) Vision 2020 (12) states that “the time is now right for developing a new model for oral health care. . . . We believe that, by shifting the focus of our model from (1) a traditionally curative, mostly pathogenic model to a more salutogenic approach which concentrates on prevention and promotion of good oral health and (2) from a rather exclusive to a more inclusive approach.” Such a new model involves allocating much more resources to populationbased oral health promotion directed at the social determinants of risk factors common to NCDs and building bridges with those working on NCDs. Dentistry should address political factors related to controlling those common risk factors, particularly the “causes of the causes” of sugars, smoking and behaviors related to traumatic injuries. The WHO Commission on the Social Determinants of Health concluded that social determinants of health are much more important than access to quality healthcare (13). Unless those determinants of NCDs are addressed, improving access to Journal of Public Health Dentistry 73 (2013) 87–88
The 7th WHO Global Conference on Health Promotion - Towards Integration of Oral Health, Nairobi, Kenya, 26-30 October 2009.
Since the first World Health Organization (WHO) Global Conference on Health Promotion (GCHP) that produced the Ottawa Charter for Health Promotion, subsequent GCHPs were held in different continents. It was Africa's turn to host the 7 th GCHP in Nairobi in October 2009, organised by WHO and Kenya Ministry of Health. The theme of the meeting was Promoting Health and Development: Closing the Implementation gap. It was the first time in the GCHP history that oral health received such a high profile and featured in one of the 12 special sub-plenary sessions. This report summarises the proceedings of the sub-plenary session on social determinants of oral health. Strategies for tackling social determinants of oral health and closing the implementation gap were considered, together with specific examples from developed and developing countries from different WHO regions. Oral health promotion implications were discussed based on public health experience and operational research. At the end of the session, input on oral health related issues was prepared for the Nairobi Call to Action adopted by the conference. In follow-up, the WHO Global Oral Health Programme contributes to the newly established WHO initiative Mainstreaming Health Promotion, which particularly seeks to build capacity in health promotion in low- and middle income countries. This work is carried out in support of the World Health Assembly Resolution (WHA60.17) on oral health.