DT News - India - World Health Assembly resolution on reducing oral disease burden

Amisha Parekh, Dental Tribune South Asia

Tue. 20 July 2021

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The increasing burden of untreated dental conditions and lack of oral health initiatives in global health agendas has been a cause of concern for ages recently brought to the limelight in the past few years. The World Health Assembly (WHA) passed a historic resolution on oral health in May 2021, initiating efforts in alleviating this burden. This article summarizes these challenges and the resolution passed by WHA.

Global burden of oral conditions [1,2]: The Lancet oral health series in 2019 reflected how oral health had been isolated from traditional health care and health policies. It has been estimated that oral diseases affect nearly 3.5 billion people. The Global Burden of Disease (GBD) study found that untreated dental conditions are a significant global health challenge with significant economic impacts and must be included in the global health agenda.

Challenges faced: A global health network for oral health must understand the challenges faced, influence global health policies, and drive health system reforms. Such global health networks face four strategic challenges:

Defining the problem and ways to address it - The ever-widening gap between high and low/ middle-income countries in terms of provision of dental services; dental services primarily being delivered privately leading to a business-oriented mindset and disjoint in terms of solutions such as upstream actions (taxation and fiscal policies) versus downstream actions (focused on dental health education and complex biomedical interventions) for addressing the oral health inequalities are some of the common challenges faced today.
Portray dental issues in ways that inspire external audiences to act. Traditional population dental metrics such as DMFT may have certain limitations. It may also fail to compare the burden of dental diseases against all maternal conditions combined like hypertensive heart disease, anxiety disorders, schizophrenia, cardiovascular and cerebral diseases, etc. There is a need to encourage the use of comparable metrics systems such as those used in the GDB study to address oral health problems in ways that resonate with external players whose resources are required.
Forge alliances with external actors (coalition building) - Dental organizations such as the International Association for Dental Research, World Dental Federation, and World Health Organization (WHO) global oral health unit that operate in isolation need to instead work towards coalition-building with especially those outside the healthcare sector and work on ways to inculcate oral health into the Political Declarations of the High-Level Meetings on the prevention and control of non-communicable diseases and universal health coverage (UHC; i.e., access to essential quality health services without financial hardship).
Establish institutions to facilitate collective action (governance). A global network consisting of dental and non-dental members representing all parts of society, including those influencing health priorities and resource allocation, is needed to get oral health recognized as a population health priority worldwide.

Fundamental gaps challenging the development of a global health network for oral health. The research priorities needed in order to overcome the three fundamental gaps in knowledge are as follows:

Global oral epidemiology and health information systems – For a global health network to function efficiently, there is a need to improve certain aspects like community oral health surveys and surveillance, reporting of data and develop a database repository, develop an analytic framework that leverages the interconnectedness of oral conditions, degree to which incomplete data can generate actionable estimates of oral health burden worldwide, following a systematic and comprehensive approach to data management and developing an appropriate global health information system to serve evidence-based planning and monitoring.
Collection, harmonization, and rigorous assessment of evidence for equity in prevention and treatment - There is a need to evaluate the relative importance of environmental, socioeconomic, commercial, and behavioral risk factors on the burden of oral conditions, identify health policies and interventions that can reduce inequalities in health and oral health simultaneously and evaluate the impact of existing (or about to be implemented) health policies on oral health by using quasi-experimental designs.
Strategies to deliver essential quality oral health care without financial hardship: Research priorities include revisiting dental curricula and educational methods, building inter-professional and inter-sectoral teams to develop competency frameworks that help policymakers tackle the social and commercial determinants of health at all levels, identifying strategies to incorporate social policies into health systems, and evaluating the impacts of these changes on population oral health.

World Health Assembly's resolution: The World Health Assembly (WHA) is the forum through which the World Health Organization (WHO) is governed by its 194 member states. WHA in May 2021 approved a historic resolution on oral health that indicates to inculcate oral health within the non-communicable disease agenda and that oral healthcare interventions should be included in universal health coverage programs. It urges the member states to address the key risk factors (high intake of free sugars, tobacco use, and harmful use of alcohol) shared between oral diseases and other non-communicable diseases and enhance oral health professionals' capacities. It also recommends shifting from the traditional curative approach towards a preventive approach that helps promote oral health.

Conclusion: If our objective is to reduce the global burden of untreated oral conditions, dental care needs to be integrated into primary health care focusing on prevention and interception of the disease at an early stage. Also, global health networks for oral health need to be established for achieving this goal. Dental professionals can play a significant role by addressing the high prevalence of untreated dental conditions, the challenges faced in distribution and access to dental care, and preparing for the future threats that align with the goals of global health. Lastly, the inclusion of dental treatment in universal health coverage packages shall play a significant role in making oral health affordable to all.

References:

The Lancet oral health series. https://www.thelancet.com/series/oral-health
Hugo FN, Kassebaum NJ, Marcenes W, Bernabé E. Role of Dentistry in Global Health: Challenges and Research Priorities. J Dent Res. 2021;100(7):681-685. doi:10.1177/0022034521992011
World Health Assembly Resolution paves the way for better oral health care. https://www.who.int/news/item/27-05-2021-world-health-assembly-resolution-paves-the-way-for-better-oral-health-care

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