Global Oral Health in a Flattening World
Eli Schwarz, KOD, DDS, MPH, PhD
What does a “flat world” look like in regard to dentistry and oral health? The “flattening world” was a concept introduced by the bestselling author Thomas L. Friedman in 2005.1 Friedman’s discussion focused mostly on globalization trends in trade and finance, such as outsourcing, off-shoring, global supply chains, and other so-called flatteners in the 21st century. However, a considerable portion of his argument related to the emerging gaps in education and ambition between America and up-and-coming countries, such as China, India, and South Korea. Do any of these big-picture global developments have anything to do with dentistry or oral health, or is dentistry, as a predominantly personal service industry, outside these trends? This question was addressed in The Future of Dentistry.2 The decade-old report had looked at globalization trends in dental research, organizational partnerships, and education. It emphasized that the future of dentistry and oral health demands the dental profession think broadly and act globally. It stated: “To date, recognition and acceptance of a leadership role in international health have not been priorities among dental professionals in the United States. The future of dentistry will favor a philosophy that joins dentistry in the United States with the global dental community. Success in preventing and controlling oral disease in the United States is increasingly dependent on an ability to share knowledge and expertise with others around the world.” It is interesting to visit a few of the report’s points and assess them based on recent and future developments.
In a way, dentists used to think of dental research as a global enterprise. William Gies’ foresight in the 1920s in organizing the International Association for Dental Research and establishing the Journal of Dental Research was amazing. It is difficult to imagine a world without these global interactions. Traditionally, dentistry and the education of its manpower have been much more parochial and national/local. Recently, I have returned from Australia, where I spent the last 5½ years as the Dean of Dentistry at the University of Sydney. During this period, the value of Australia’s education exports grew 21%, replacing tourism as the top services export, and became Australia’s third largest export overall. Education was worth more than all other Australian export industries in 2007 except coal ($20.8 billion) and iron ore ($16 billion).3 Dentistry is a small part of this development through the dental schools, most of which admit varying proportions of international dental students. At the University of Sydney, North Americans constitute the predominant group, adding wonderful international and multicultural perspectives. This is a component of globalization that is rarely mentioned. The students complete dentistry side by side with their Australian peers and obtain a degree that ensures them immediate licensure in Australia and New Zealand. Many stay and work as dentists or continue to postgraduate studies. During the last 5 years, discussions have transpired about facilitating a recognition system whereby Australian and American or Canadian dental degrees would be mutually accepted as equal. Although The Future of Dentistry report predicted that the accreditation of a non-US dental school by the State of California might open an easier access to foreign dental graduates, very little has happened. However, it is very likely that an Australian-Canadian agreement will be forthcoming, which will facilitate the movement of dentists between those two countries through a mutual degree recognition system. This would make it possible to graduate from the University of Sydney and begin working in Toronto directly after passing the national board examinations, and vice versa. During the 1980s, such discussions occurred in the European Commonwealth and laid the foundation for the present European Union’s system comprising 27 independent countries and affecting approximately 500 million people. A dentist who is a graduate from any of the European schools can move to the other countries and become licensed without taking further examinations. It is a strange thought that in our flattening world, it is easier for a dental graduate from Copenhagen, Denmark to work in Athens, Greece or Manchester, England than it is for a dentist who is a graduate from Boston University to work in Las Vegas.
The global educational perspective was very much at the fore in the development of the American oral health therapist training program. As documented by Nash et al,4the integration of these professionals into dental care delivery systems throughout the world is a means to reduce inequalities in oral health and improve access to care. Aside from the controversy in this country, it was an interesting advance in global dental education collaboration when the first batch of Alaskan therapy students were sent to New Zealand to train because no education program was available in this country.5 Such an innovative step has led to relevant domestic programs being defined and supportive federal legislation to fund further demonstration trials (in the US) of this new category of healthcare worker.
In other instances, the dental profession has more easily been able to adopt practices that are more in line with traditional globalization mechanisms. There has been a sharply increasing trend for dentists in the US and Europe to use dental technicians in, for instance, Mexico, China, and the Philippines, to produce high-quality dental crowns, bridges, and dentures as a natural part of treatment. This is an inherent acceptance of the increasing level of educational and technical proficiencies in those countries in order for them to be able to match the standards and expectations of Western dentists. The problems confronted by dentists in terms of quality assurance, purity of metals used, and other issues are exact parallels to the experiences of Wal-Mart, Nike, and other global enterprises, which have been trailblazers and able to solve most of their issues. The flattening world is a global village without barriers. We are not there yet in all instances, but clearly, dentistry and global oral health will have a home in that village.
Professor Eli Schwarz is associated with both the dental faculties of the University of Sydney in Australia and the University of Nevada in Las Vegas. Previously, he served as Dean of the Faculty of Dentistry at the University of Sydney, the Executive Director of both the American Association of Dental Research and International Association of Dental Research, Dean of Dentistry at the University of Hong Kong, and the Chief Dental Officer of the National Board of Health of Denmark. In 1987 he was conferred the Royal Order, Knight of the Order of Dannebrog, by her Majesty Queen Margrethe II of Denmark.
1. Friedman TL. The World Is Flat: A Brief History of the Twenty-First Century. 1st ed. New York, NY: Farar, Straus and Giroux; 2005.
2. American Dental Association. Future of Dentistry. Chicago, IL: American Dental Association, Health Policy Resource Center; 2001.
3. Education replaces tourism as Australia’s no. 1 services export. IDP Education Pty Ltd Web site. Accessed April 5, 2010.
4. Nash DA, Friedman JW, Kardos TB, et al. Dental therapists: a global perspective. Int Dent J. 2008;58(2):61-70
5. Innovation Profile. Dental health aide program improves access to oral health care for rural Alaska native people. Agency for Healthcare Quality and Research Web site. http://www.innovations.ahrq.gov/content.aspx?id=1840&tab=1. Accessed April 6, 2010
About the Author
Eli Schwarz, KOD, DDS, MPH, PhD
Founder and President
Global Alliance for Oral Health
Las Vegas, Nevada