Oral Health Matters! The Lancet FIRST ever commission on Oral Health

In July 2019, The Lancet published a path-breaking two-part Oral Health Series that highlighted the global public health burden of oral diseases affecting 34% of the population across the globe and the need for a radical reform of dental care systems, whose treat-over-prevent model has failed to combat the global challenge of combating oral diseases.

In recognition of the global public health importance, woeful neglect of oral diseases and commitment to include global oral health within medicine and global health agenda, The Lancet in early 2020 established a Commission on Oral Health.

This is the latest announcement by The Lancet on Twitter on 25th June 2020

Last year @TheLancet Series aimed to get #GlobalOralHealth on global health agendas

Today, we announce that 27 experts across research, policy, advocacy & clinical dentistry from 16 countries will continue this work via a Lancet Commission on Oral Health https://t.co/kIRCUsE1au pic.twitter.com/mAjagyWAQ4

— The Lancet (@TheLancet) June 25, 2020

What is the Lancet Commission?

A Lancet Commission is a scientific review, inquiry and response to an urgent and often neglected or understudied health predicament.

Importance of the Lancet Commission

Lancet Commissions are international, science-led, multi-disciplinary collaborations that aim to achieve transformational change with a particular focus on policy or political action.

Composition of Lancet Commission on Oral Health (LCOH):

27 experts across clinical dentistry, academic research, policymaking, health and human rights advocacy from 16 countries across the world have been appointed as Commissioners on the first-ever LCOH. LCOH will be co-chaired by Colombian public health dentist Dr Carol Guarnizo-Herreno and UK’s Prof. of public health dentistry Dr Richard Watt, who also is the Director of WHO’s Collaborating Centre on Oral Health Inequalities.

Sr.No.	Nationality	Name	Education	Current Organisation
1	India	Dr Manu Mathur	PhD (Epidemiology)	Public Health Foundation of India (PHFI)
2	India	Mirai Chatterjee	MPH (John Hopkins)	SEWA RURAL, Gujarat
3	Thailand	Dr Supreda A	DDS	Thai Promotion Health Foundation
4	Thailand	Dr Viroj T	MD, PhD	Ministry of Public Health
5	USA	Dr Habib Benzian	DDS, MScDPH, PhD	New York University
6	USA	Dr Cristin Kearns	DDS, MBA	Univ. of California, San Francisco (UCSF)
7	USA	Dr Robert Weyant	DMD, DrPH	Pittsburgh Univ. School of Dental Med
8	Canada	Dr Paul Allison	OMFS, DrPH, PhD	Canadian Academy of Health Sciences
9	Canada	Dr Mary McCallum	DMD	Private Dental Practice
10	UK	Dr Blanaid Daly	MSc DPH, PhD	Dublin Dental University, Ireland
11	UK	Dr LD Macpherson	Dentist + MPH+ PhD	University of Glasgow, UK
12	UK	Katie Dain	MA (SOAS), London	CEO, NCD Alliance, London
13	Brazil	Dr Roger Celeste	PhD (Epidemiology)	UFRGS
14	Brazil	Dr Marco Peres	PhD (Epidemiology)	Griffith Univ., Queensland, Australia
15	Brazil	Dr Aluisio J Barros	MD, PhD	University Federal de Pelotas (UFPel)
16	South Africa	Dr Lekan Ayo Yusuf	PhD (Health Educn)	Deputy VC, SM Health Science Uni
17	South Africa	Dr Usuf Chikte	Msc DPH + PhD	Stellenbosch University, South Africa
18	France	Dr Benoit Varenne	PhD (Epidemiology)	NCD Department, WHO
19	Netherlands	Dentist Stephan Listl	PhD (Economics)	Radboud University, Netherlands
20	Hong Kong	Dr Judith Mackay	Medical Dr.	Hong Kong University (HKU)
21	Kenya	Dr MW Muriithi	BDS +MPH	Ministry of Health, Kenya
22	Australia	Dr Sharon Friel	MSc, PhD	Australian National University (ANU)
23	Japan	Dr Manabu Sumi	Medical + PhD	Ministry of Foreign Affairs, Japan
24	Fiji	Dr Leenu M	MDS (Orthodontics)	Private Group Dental Practice
25	Colombia	Dr Gina Watson	MBBS + MPH	Country rep of WHO/PAHO in Ecuador

Key Priorities of Lancet’s Commission on Oral Health:

1. Governance and Advocacy for Global Oral Health

Explore best practices to raise the political and policy profile of oral health and integrate oral health within the wider health policy and development frameworks.

2. Equity, Social Justice and Oral Health

Develop improved evidence-based monitoring systems to assess oral health equity, review evidence of the effectiveness of interventions to reduce oral health inequalities and inform policy development to promote oral health equity.

3. Health System Reform, Governance and Transformation

Provide evidence to support policymakers to develop robust and resilient oral healthcare systems across the globe including human resources, payment systems, integrated delivery models, relevant technology and minimising environmental impact.

4. Commercial Determinants

Highlight and expose the influence of industry and profit motives on all aspects of oral health including education, research, service delivery and policy and develop appropriate means of minimising this influence and improving the transparency of industry relationships with oral health stakeholders.

Background of Lancet Oral Health Series:

Lancet’s series published on 18th July 2019 on Oral health argued that it has been isolated from traditional healthcare and health policy for too long. It called for greater prominence of oral health on the global health agenda campaigning for Non-Communicable diseases (NCD’s) and Universal Health Coverage (UHC).

Key Messages:

1. Despite being largely preventable, oral diseases are a major global public health problem. Most prevalent oral diseases globally are untreated dental caries in deciduous as well as permanent teeth, severe periodontal disease, complete tooth loss and cancers of the lip and oral cavity.

2. Most prevalent Oral Diseases worldwide (2010)

1. Untreated caries in permanent teeth: Ranks 1st, affecting 35% OR 2.4 billion people
2. Severe Periodontitis: 6th, affecting 10.8% OR 743 million people
3. Untreated caries in deciduous teeth: 10th, affecting 9% of the global child population
4. Complete tooth loss affects 2.3% OR 158 million people
5. Lip and oral cavity cancers: Top 15 most common cancers in 2018 (IARC)

3. Oral diseases impose a substantial economic burden on individuals, families and societies.
In 2015, oral diseases accounted for the US $ 357 billion in direct costs (treatment expenditures) and the US $ 188 billion in indirect costs (productivity losses due to absence from work and school)

4. Personal consequences of chronic untreated oral diseases are severe and include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life and decreased work productivity

5. Oral diseases share common risk factors with other NCD’s which include tobacco use, harmful alcohol consumption and free sugar consumption. Of particular concern is the effect of free sugar consumption on the prevalence of caries, obesity and diabetes. Integrated public health policies needed to tackle shared common risks

6. 21st-century dentistry continues to adopt a treatment dominated, interventionist, increasingly high-tech and specialised approach to dental care. Such an approach has failed to tackle the global burden of oral diseases. Radical reform of dental care systems urgently needed

7. A preventive approach focusing on population-wide impact needed as the current individualistic clinical paradigm has failed to achieve sustained improvements in population oral healthy.

8. Provider payment systems should put more emphasis on incentivising prevention instead of rewarding restorative and interventionist dental care

9. A range of highly developed corporate marketing strategies is used by the global sugar industry to increase their sales and profits.

For e.g. By 2020,

Coca- Cola set aside the US $ 12 billion on marketing across Africa

PepsiCo set aside the US $ 12 billion for marketing its products in India

WHO’s total budget of 2017 was the US $ 4.4 billion

Tighter regulation and legislation by governments required

10. Pressing need to develop a clear and transparent conflict of interest policies and procedures to limit the influence of the sugar industry on dental research and oral health policy.

Click here to read more: https://www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/dental-public-health/lancet-commission-oral-health

Author:
Dr Divyesh B Mundra is an analytical healthcare management professional.
Masters in Health Administration (MHA) from the most reputed Tata Institute of Social Sciences (TISS), Mumbai.
Since then, he is working for one of India's most innovative healthcare organisations (private hospital chain) based out of Bangalore, Karnataka. He is an avid reader and tweets daily on the Indian healthcare system.
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