Dental Public Health

[Type the document subtitle]

Table of ContentsIntroduction.................................................................................................................................................4

Role of FDI World Dental Federation.........................................................................................................5

Strategies & Management of Oral Diseases................................................................................................6

National Dental Associations (NDAs): Area of Action...............................................................................7

Indicators for Oral Health............................................................................................................................8

The UN Political Declaration......................................................................................................................9

Government Commitments & National Actions........................................................................................13

Conclusion.................................................................................................................................................15

References.................................................................................................................................................17

IntroductionOn 19-20th September 2011, a high level meeting on non-communicable diseases was held by the

United Nations General Assembly that presented the international community with a unique

opportunity to take measures against epidemics and augment developmental initiatives as a

means of saving millions of lives. This United Nations meeting served the purpose of raising

awareness regarding the recent increase of non-communicable diseases in the developing and

developed worlds, at an international level. The meeting was prepared for by stakeholders such

as professional organisations, non-governmental organisations, private sector, academia and

organisations of the civil society (United Nations, 2011).

Among the non-communicable diseases recognised by the World Health Organization, the four

major non-communicable diseases are cardiovascular diseases, cancer, chronic lung diseases and

diabetes (Fig. 1); these are seen as major threats to the world development (Ministry of health,

2003). During the meeting, the socio-economic impact of non-communicable diseases and their

increasing burden on the community was identified; several commitments were made towards

taking severe actions on both national and global level so as to treat and prevent non-

communicable diseases. Fig. 1: (Ministry of health, 2003)

The FDI World Dental Federation that is in line with the World Health Organisation recognises

oral diseases as a significant part of the non-communicable disease group and used this

opportunity i.e. the high level UN meeting, to elevate their profile and promote the requirement

of improved oral health at both national and global level (United Nations, 2011).. It is necessary

to understand that non-communicable diseases are often caused by factors including tobacco &

sugar intake, unhealthy diet, access alcohol consumption and reduced physical activity levels.

These factors are similar to those involved in causing oral diseases. Hence, during the meeting,

the UN Political Declaration identified the common risk factors shared by oral diseases with non-

communicable diseases and established that these may benefit from the responses to non-

communicable diseases.

The rising burden of non communicable diseases is majorly hindering global development along

with accomplishment of several goals; it is necessary to understand that non-communicable

diseases to a great extent contribute to hunger & poverty and play a significant role in the

unequal distribution of heath across countries (United Nations, 2011).. Additionally, the global

burden exerted by oral diseases continues to grow every minute; their impact is noticeable in

Major Non Communicable

Diseases

Cardiovascular Diseases

Cancer

Chronic Lung Diseases

Diabetes

terms of reduced life quality, impaired functioning, pain & suffering and treatment cost. Similar

to the inequalities of other non-communicable diseases, the unequal distribution of the outcomes

of oral health are now unacceptable. Thus, promotion of health equity became the major focus

during the meeting and several declarations were made towards the reduction of such

inequalities.

The following report discusses the concepts of the UN strategy for reduction of non-

communicable diseases and the policies that the dental professional should adopt so as to prevent

oral diseases and other non-communicable diseases. It is necessary to understand that several

concepts were underlined during the high level UN meeting and only some of them, specifically

those that discuss & elaborate the policies and methods for reduction and prevention of oral

diseases are discussed in the following report.

Determinants of Chronic Diseases:Sheiham & Watt (2000) describe some of the determinants of the chronic diseases. They say that

health factors are influenced by some key variables as well as the reasons why a person may

catch a disease. (Sheiham & Watt, 2000) The prompt reasons for the real dental sicknesses,

caries and periodontal illness are eating regimen, Normal danger element approach plaque and

smoking. Oral mucosal injuries, oral malignancy, temporomandibular joint brokenness and

torment are identified with tobacco, liquor and stress and injury to teeth and wounds (Fig. 2). As

these reasons are normal to various other endless infections, for example, coronary illness,

tumor, and strokes, it is normal to utilize a typical danger element approach

Fig. 2: (Sheiham & Watt, 2000)

Obesity

Diabetes

Diet Smoking

Role of FDI World Dental FederationThe FDI World Dental Federation plays an essential role when discussing reduction and

prevention of oral diseases on a global scale (WHO, 2011). A policy statement prepared by FDI

containing the oral health policies will serve the purpose of an advisory document for NDAs i.e.

National Dental Associations. The statement generated by FDI takes into account the UN

Political Declaration of non-communicable diseases and the outcomes of the Rio Summit

conducted on Social Determinants of Health; these are expected to directly affect the oral health

sector which in turn will help in the expansion of the scope of dentistry nationally and globally.

In other words, FDI aims on playing a crucial role and part in the current and future agendas for

global health.

FDI effectively recognizes that health along with the economic and psychosocial impact of oral

diseases across developed and developing countries have not been effectively integrated into the

global response that happens to be proportionate to the scale of their impacts. Thus, the FDI

should aim to:

1. Become a part of the initiatives for global health improvement and integrate oral health

onto the agenda of non-communicable diseases. This will allow for improvement of oral

Cancers

Cardiovascular Diseases

Respiratory Diseases

Mental Illness

Dental Carries

Skin Diseases

Periodontal Diseases

Trauma – Teeth & Bones

Control

Stress

Excercise

Alcohol

InjuriesHygiene

health and health on a global scale, especially in countries with insufficient knowledge

regarding dental personnel.

2. Continue to explore the establishment of Oral Health Alliance for the promotion of

improvement of oral health on a national and global scale with stakeholders; they should

continue to collaborate in the private sector along with NGOs. Similarly, it will be

beneficial for them to continue to actively collaborate with NCD Alliance and WHPA.

3. Explore and discuss with IADR and World Health Organisation the possibilities of

constructing guidelines for the development of goals of oral health where these goals

may include any sociodental goals in terms of oral health. Any need of manpower in

terms of determining the social determinants of health should be mentioned.

Strategies & Management of Oral Diseases Earlier on, a 2007 World Health Organisation had been working on integrating oral health into

the list of prevention programmes for chronic diseases. The approaches used for the purpose of

prevention and control of oral diseases had turned out to be ineffective. Though, there are several

existing approaches and methods that can be used in prevention of large proportion of oral

diseases. Considering these, the FDI aims to encourage;

1. Reduction of the “knowledge-implementation gap.” This can be achieved by

recommending guidelines that health promotion activities based on evidence.

2. Following the principles outlined and mentioned in the Ottawa Charter for Promotion of

Health care; these principles recommend the need of shifting from vertical to horizontal

approaches and encourages involvement and integration with those who are actively and

currently combating non-communicable diseases.

As previously mentioned, the UN Political Declaration identified the common risk factors shared

by oral diseases with non-communicable diseases and established that these may benefit from the

responses to non-communicable diseases (WHO, 2011). It is evidence that several oral diseases

share common risk factors with other non-communicable diseases such as diabetes, cancer,

cardiovascular diseases etc. For this reason, the prevention of oral diseases needs to be integrated

with prevention of other non-communicable diseases and should be outline in the Common Risk

Factor Approach (CRFA) which is known to address the risk factors that are common to other

chronic conditions. Additionally, any evidence based strategies should be comprehensible,

participatory and multidisciplinary in nature; they should address the social determinants

involved in improvement of oral health. Also, there should be a focus on encouraging

interventions that are worldwide and factors that allow promotion of health along with the

interventions that result in reduction of burdens caused by diseases, on a global level.

National Dental Associations (NDAs): Area of ActionFrom research, it is evident that there is a strong relationship between oral diseases and the rest

of the non-communicable diseases such as cancer, diabetes, respiratory and cardiovascular

diseases. For instance, diabetes mellitus has been recognised for influencing the developing of

periodontal diseases; apart from the expected results, the treatment of periodontal diseases has

proved beneficial in controlling blood glucose levels (United Nations, 2011).. It is necessary to

understand that periodontal diseases are also well connection to cardiovascular diseases. When

discussing cancer, oral cancer is enlisted among the most common cancers across the globe,

where intake of alcohol and use of tobacco are enlisted as the most common and major risk

factors. Similarly, respiratory or lung diseases may also be result of oral microflora.

Practical and manageable options for combating oral diseases are to be presented by FDI &

national dental associations in terms of social determinants of oral health and non-communicable

diseases. Within national dental associations, authorities must be informed of and possess

knowledge regarding the relationship between various oral diseases and other non-communicable

diseases along with their common risk factors (AOK Health Grant, 2003). The authorities should

be well aware of the considerable amount of suffering & pain caused by oral diseases, the day-

to-day life disruption and the economic burden they have on the society.

As the global movement of awareness regarding non-communicable diseases continues to gain

momentum, determinants of non-communicable diseases will be majorly impacted; some of

these include reduction of tobacco and sugar intake which may potentially reduce oral diseases

and in turn effect dental practices globally, the number of dental health practitioners and

manpower infrastructure involved. Hence, the worldwide consideration of non-communicable

diseases movement is necessary for the dentistry industry so as to effectively reduce the burden

of oral diseases; for this direct participation of the dental profession is crucial. In other words, it

is highly essential for national dental associations to remain pro-active in the current health

initiative taken at a global scale.

National dental associations and dentists play a crucial role in combating non-communicable

diseases and their primary principle role is of an advocate; this refers to their role of advocating

the integration and implementation of well-developed interventions that may be within or outside

the health sector (Ministry of health, 2003). They are required to consider ways that would allow

creation and enhancement of synergies among various sectors such as employment, education &

agriculture. Additionally, they are also required to inform & educate government, community

leaders and policy marks regarding the impact and necessity of oral health and its well being

(AOK Health Grant, 2003). For instance, they should be well informed regarding the influences

of sugar and tobacco control within their food and tobacco industries.

National Dental Associations should combating oral diseases, as a part of the current non-

communicable diseases agenda, by using the common risk factor approach and the available

evidence that will allow prevention, when discussing the determinants of oral health. This

approach will not benefit the improvement of oral health along with the evidence based oral

health care but will also result in reduction of rates of non-communicable diseases.

Indicators for Oral HealthWhen discussing the indicators and targets, three such global indicators and target in terms of

Oral Health may be discussed and should be considered (AOK Health Grant, 2003). They are as

following:

Indicators Target Note

1.The proportion of number

of children with caries.

This proportion of number

is reduced by…

According to

www.fdiworlddental.org/data-

mirror, the dental cares in

young adults aged between 6

and 19 years, is used as an

indicator.

2. The number of days lost in

school due to oral diseases

The number of days lost

in school due to oral

According to FDI’s oral

health Atlas, in 2008,

diseases can be reduced

by…

approximately 1900 hours of

school were lost per 1000

children, in Thailand due to

oral health problems.

3.

The number of national

health care facilities

available so as to provide

urgent and safe treatment to

those in need.

The number of health care

facilities available on a

national scale can be

increased by…

Research states that oral pain

is ranked high in the health

complaints made by patients

who intend to seek health at

such primary health care

facilities. For this reason, the

appointment of highly skilled

health workers who are

capable of using emergency

oral care, is essential. In

complicated cases, the

patients can be referred to

next level of health care by

such workers; this can be

used as a means to increase

safety and ensure affordable

oral care.

The UN Political DeclarationAs previously mentioned, UN Political Declaration identified the common risk factors shared by

oral diseases with non-communicable diseases and established that these may benefit from the

responses to non-communicable diseases (AOK Health Grant, 2003). It is important to

understand that the UN Political Declaration defined and identified a global response to non-

communicable diseases; the problems and the need to act further so as to combat these problems

were recognised. The declaration contains a series of commitments made that ensure action,

unlike the previous documents on non-communicable diseases that simply urge and advice

measures. One should understand that a declaration holds crucial importance since it is a

powerful tool used by the UN to ensure action and cooperation internationally.

The contents of the Declaration can be analysed under themes including national leadership &

ownership, diagnosis & treatment, prevention, improving health systems, research &

development, resources, global development agenda and NCDs, partnered NGOs, monitoring

and evaluation, plan of action.

Subject Commitments

National Leadership

& Ownership

Establishing and strengthening national non-communicable diseases

policies and plans by 2013

Integrate the non-communicable disease policies into the national

health planning programs and develop further agendas

Promotion of “whole-of-government” and “whole-of-society”

concepts across the private sectors.

Early diagnosis &

Treatment

Prioritizing the need of early detection, diagnosis, screening and

treatment of non-communicable diseases.

Increasing affordability, safety, effectiveness and quality of

medicines & technologies with the help of generics and patent

licensing.

Increasing accessibility to such medical health care.

Increasing maintenance and accessibility of equipment and

technologies

Promotion of patient empowerment

Prevention Promotion of health policies national and globally

Implementing and strengthening population wide and cost effective

interventions so as to reduce the risk factors associated with non-

communicable diseases

Promoting intake of healthy diets by implementing the

recommendations of the world health organisation onto food and

beverages manufactured for children. This can be further achieved by

eliminating trans fats; reducing salt, saturate fats & sugars;

encouragement of politics that support manufacturing and promotion

of healthy food products.

Increasing awareness regarding the need of physical activity for

children; physical activity should be prioritized in all educational

sectors. For instance, prioritizing physical education in schools.

Additionally, awareness regarding physical activity can be ensured in

areas such as urban planning, transportation, work-site healthy

lifestyle programmers, public parks and other recreational spaces.

Accelerate the implementation of control on tobacco use and control

by State parties and encourage countries who have not done so to

consider to agree.

Promotion and creation of implementation of healthy behaviours in

working environments such as among workers; one way would be

creating tobacco free workplaces.

Promotion of prevention of non-communicable diseases and

implementing control within the reproductive and sexual, maternal &

child health programmes such as breastfeeding for the first 6 months.

Improvement of

Health System

Strengthening health systems that support universal coverage, cost

effective services and healthcares that work towards preventing,

detecting, treating and caring for non-communicable diseases.

Promotion of training and retention of health care workers

Strengthening the information system used in planning and managing

health care support systems

Strengthening the infrastructure within healthcares which will further

allow feasible procurement, distribution and storage of medicines and

equipments.

Research &

Development

Strengthening the capacity for research and development on non-

communicable diseases on a national level and ensuring its

integration into the programmes designed by health care systems.

Resourcing Identifying, mobilizing, predicting & sustaining the financial

resources through regional, domestic, bilateral & multilateral

channels and other financing mechanisms.

Providing other countries with technical assistance and the capacity

building for the purpose of development and enhancing aid quality

along with fulfilling any commitments related to Official

Development Assistance (ODA).

Prioritizing the financial allocations for non-communicable diseases

on a national level and establishing taxation measure where needed

and appropriate.

Global Development

Agenda

Encouragement of inclusion of non-communicable diseases into the

cooperation development agenda and health care initiatives like the

millennium development goals.

Collaboration with

NGOs

Promote and encourage partnerships between governments and civil

societies

Ensuring the active and complete participation of civilians with non-

communicable diseases during national responses; encouraging the

community to take part in such activities so as to create awareness

Promotion of building of non-communicable disease related NGOs

regionally and nationally; will help creating awareness regarding non-

communicable diseases and provide civilians with education on the

matter.

Monitoring &

Evaluation

Strengthening the surveillance and monitoring systems of the country

Developing a global monitoring framework for non-communicable

diseases and setting up targets globally along with indicators

Considering and outlining the various national targets and indicators

Follow up Action The UN Secretary General is to present any recommendations for the

bilateral and multisectoral non-communicable disease partnership, in

2012.

The UN Secretary General is to present a progress report on the non-

communicable diseases and on the impact made developmental goals

that are agreed up internationally, in 2013.

The UN is to hold a meeting that will aim to review and assess the

progress of what was been achieved till date, in 2014.

Government Commitments & National ActionsThe timeframe outline for the action continues to evolve with the progress in the process i.e.

within the UN & WHO. As per research, the upcoming global action plan on non-communicable

diseases is expected to run from 2013-2020

(World Economic Forum, 2010-2030). The key messages offered by FDI for national dental

associations include:

1. The dental profession should commit to contribute to the prevention and potential early

diagnosis of non-communicable diseases. Due to the shared common risk factors, the

dental professionals are obligated to contribute to the mission.

2. The dental profession shall be considered a unique position in supporting the national

non-communicable disease policies and strategies. Due to their access to “healthy”

patients in their daily work life, they are obligated to raise awareness regarding the risk of

oral diseases and hence, increase prevention.

3. Dental professionals should understand the scarcity of resources and that they should be

willing to contribute effectively, with all their forces and combining with others during

establishment and implementation of prevention strategies. They should be highly

focused on the achieving the enlisted objective in the Millennium Development Goals.

4. Dental professionals should recognise the close link and relationship between oral health

and other non-communicable diseases and that oral disease are a non-communicable

disease risk facto itself.

Along with the above mentioned key messages, several national priorities were made (Ministry

of health, 2003). The Political Declaration emphasises the commitments that are to be advocated

at a national level, which include:

1. Adaptation of an integrated approach towards determinants of the non-communicable

diseases; this is of high priority since recommended by the World Health Organisation

Commission to the Social Determinants of Health.

2. Establishment of multisectoral policies and plans for improvement of oral health and non-

communicable diseases, which ensure the use of common risk factor approach. It is

necessary for oral diseases to have major determinants that are common with those of

other non-communicable diseases.

3. Tested and evidence based health promotion strategies should be devised and awareness

should be increased through campaigns that discuss prevention of oral diseases and non-

communicable diseases along with promoting health literacy and education.

4. It is essential for the national authorities to produce, train and retrain health workers in

order to work on prevention and treatment of oral diseases and other non-communicable

diseases.

5. The national authorities should provide predictable, sustainable and adequate resources

that will be required for the promotion of oral health and prevention of oral diseases and

other non-communicable diseases.

6. There should be a major focus on strengthening information systems that allow and

encourage health planning and management.

7. There should be a major focus on strengthening the national non-communicable disease

and oral health surveillance; efficient monitoring systems should be developed so as to

evaluate the existing policies.

8. Encouraging the involvement of communities and civilians while developing,

implementing and evaluating the non-communicable disease/oral health plans, policies

and programmes.

9. The national capacity for increased research and development in context of oral diseases

and other non-communicable diseases should be building and strengthened.

10. Use of gender-disaggregated data so as to promote gender based approaches to non-

communicable diseases. (Ministry of health, 2003).

Along with the above national priorities, several actions at regional level were planned for

(Ministry of health, 2003). These include:

1. Continue to follow up on the regional commitments made in the UN Political

Declaration.

2. Development of regional strategies by the FDI that monitor the implementation and

progress of the declaration.

3. Encouraging regional funding sources such as development banks to integrate oral health

and non-communicable diseases into their organisation’s health and development

programmes.

4. Using World Health Day as a means and opportunity to approach regional organisations

to consider the necessity of raising awareness regarding oral health and discuss the

policies their organisations have outline when implementing political declaration.

5. Ensuring that at least five of the regional organisations receive publications from the

operating national dental associations within the given region so as to increase their

knowledge and awareness regarding oral health and prevention of other non-

communicable diseases.

6. Ensuring continous inclusion of sessions such as meetings, conferences, at both regional

and sub regional level. For instance:

a. Periodical high level meetings of Health ministers and Head government officials

b. World Health Organisation Commission regional meetings

c. Meetings for regional banks to carry out strategic planning

d. Regular meetings between multilateral banks and NGOs to discuss country

strategies. (Ministry of health, 2003).

ConclusionThe rising burden of non communicable diseases is majorly hindering global development along

with accomplishment of several goals; it is necessary to understand that non-communicable

diseases to a great extent contribute to hunger & poverty and play a significant role in the

unequal distribution of heath across countries. Additionally, the global burden exerted by oral

diseases continues to grow every minute; their impact is noticeable in terms of reduced life

quality, impaired functioning, pain & suffering and treatment cost.

This United Nations meeting served the purpose of raising awareness regarding the recent

increase of non-communicable diseases in the developing and developed worlds, at an

international level. Among the non-communicable diseases recognised by the World Health

Organization, the four major non-communicable diseases are cardiovascular diseases, cancer,

chronic lung diseases and diabetes; these are seen as major threats to the world development.

During the meeting, the socio-economic impact of non-communicable diseases and their

increasing burden on the community was identified; several commitments were made towards

taking severe actions on both national and global level so as to treat and prevent non-

communicable diseases (United Nations, 2011).. It is important to understand that the UN

Political Declaration defined and identified a global response to non-communicable diseases; the

problems and the need to act further so as to combat these problems were recognised. The

declaration contains a series of commitments made that ensure action, unlike the previous

documents on non-communicable diseases that simply urge and advice measures

From research, it is evident that there is a strong relationship between oral diseases and the rest

of the non-communicable diseases such as cancer, diabetes, respiratory and cardiovascular

diseases (Hamburg Forum, 2005). As previously mentioned, the UN Political Declaration

identified the common risk factors shared by oral diseases with non-communicable diseases and

established that these may benefit from the responses to non-communicable diseases. It is

evidence that several oral diseases share common risk factors with other non-communicable

diseases such as diabetes, cancer, cardiovascular diseases etc. For this reason, the prevention of

oral diseases needs to be integrated with prevention of other non-communicable diseases and

should be outline in the Common Risk Factor Approach (CRFA) which is known to address the

risk factors that are common to other chronic conditions.

The FDI World Dental Federation plays an essential role when discussing reduction and

prevention of oral diseases on a global scale (United Nations, 2011).. A policy statement

prepared by FDI containing the oral health policies will serve the purpose of an advisory

document for NDAs i.e. National Dental Associations. National dental associations and dentists

play a crucial role in combating non-communicable diseases and their primary principle role is of

an advocate; this refers to their role of advocating the integration and implementation of well-

developed interventions that may be within or outside the health sector. National Dental

Associations should combating oral diseases, as a part of the current non-communicable diseases

agenda, by using the common risk factor approach and the available evidence that will allow

prevention, when discussing the determinants of oral health. This approach will not benefit the

improvement of oral health along with the evidence based oral health care but will also result in

reduction of rates of non-communicable diseases.

References

1. Rio Political Declaration on Social Determinants of Health. Signed by WHO Member

States in Rio de Janeiro, Brazil, on 21 October 2011.

2. The AOK Health Grant. The AOK-Health Grant 2003 Announcement.

3. The Hamburg Forum [homepage on the Internet]. Quality in Health Service. Available

from: http://www.quantforum.de/veranst/hh_forum_3/forum3_info.html (Accessed:

October 12, 2005).

4. The Jannsen-Cilag GmbH. Future Grant 2002. Broshure n.d

5. The Ministry for Health, Social Issues, Women and Family of the North Rhine-

Westphalia region. Healthy Region North Rhine-Westphalia. The Project Association

2002. Announcement and invitation to participate 2003. Bielefeld, 2003.

6. The Ministry for Health, Social Issues, Women and Family of the North Rhine-

Westphalia region. The QualityForum in Health Service. Quality in Health Service –

Patient-security and risk-management. Folder, 2003.

7. United Nations: Political Declaration of the High Level Meeting of the General Assembly

on the Prevention and Control of NCDs. Signed by 193 Member States at the 66th UN

General Assembly on the 19th September 2011.

8. WHO: Oral health: action plan for promotion and integrated disease prevention

9. WHO Global Status Report on NCDs 2010. Outlines the global burden of NCDs, their

risk factors and determinants.

10. WHO Scaling up Action on NCDs: How Much Will it Cost? A financial planning tool for

delivering cost-effective interventions in low- and middle-income countries.

11. World Economic Forum: Global Economic Burden of NCDs. Report detailing estimates

of the economic impact of NCDs from 2010-2030.