UN Summit: Stepping Up Efforts to Address Oral Diseases
Recognizing that non-communicable diseases (NCDs) are the leading cause of death and morbidity globally—killing more people than all other causes—Heads of State met last September at the United Nations in New York City to discuss this growing burden of ill health and its impact. It was only the second time in the UN’s history that health was discussed by the Member States; the first time was in 2001, when the topic was HIV/AIDS. On this most recent occasion, four major NCDs were targeted—cardiovascular diseases, cancers, diabetes, and chronic lung diseases—including their key risk factors, such as tobacco and alcohol use, unhealthy diets (high in sugars, salt, and trans fats), and insufficient physical activity.
While the greatest burden of NCDs falls on the countries least equipped to deal with these challenges—low- and middle-income countries and the poorest people within all countries—it is clear that NCDs are driving a downward push towards worsening poverty everywhere. An abundantly central issue at this key gathering of the world’s premier leadership was the essential link between healthy populations and their ability to work and be productive contributors to local and national economies.
At the end of the conference, 193 Member States signed the Political Declaration on Prevention and Control of NCDs, which included Article 19 stating “that renal, oral and eye diseases pose a major health burden for many countries and that these diseases share common risk factors and can benefit from common responses to non-communicable diseases.” The World Health Organization (WHO) is now in the process of developing a comprehensive global monitoring framework with voluntary global targets and indicators for NCDs.
Putting Teeth into NCDs
The President of Tanzania, H.E. Jakaya Kikwete, highlighted the importance of oral health in the context of the four main NCDs by hosting a side event at the high-level UN meeting, called “Putting Teeth into NCDs.” At the meeting, held September 19, 2011, at New York University’s College of Dentistry, President Kikwete urged other Heads of State, Ministers of Health, and health experts to increase efforts to strengthen prevention and control of oral diseases, which are often neglected despite their tremendous impact in most countries. The symposium, which was moderated by Ali Velshi, CNN anchor and chief business correspondent, not only featured leaders in health sciences and education, but also a number of other international dignitaries, including Helen Clark, Administrator of the UN Development Programme and former Prime Minister of New Zealand; Karin Johansson, State Secretary of the Ministry of Health and Social Affairs of Sweden; and Nicola Roxon, Minister of Health and Ageing of Australia. All made persuasive cases for the inclusion of oral health in the decisions of the UN Heads of State regarding national strategies to address the NCD burdens. Former Secretary of the Department of Health and Human Services, Louis Sullivan made a similar argument for the US.
Oral Diseases Worldwide
Ray C. Williams, Dean of the Stony Brook University School of Dental Medicine, described the importance of oral health for global health and its relationship to NCDs. Dental caries is the most common chronic disease on earth, affecting more than 90% of the world’s population. All other diseases—including oral cancer, periodontal disease, craniofacial trauma and disorders, and Noma (a deadly disfiguring disease of children in sub-Saharan Africa)—have significant impacts on general health, well-being, and productivity throughout life. Safe and affordable oral care is often not available for large parts of populations in low- and middle-income countries. In addition, there are also high-income societies where millions live without access to oral healthcare, as pointed out by Habib Benzian, project lead and co-author of the Oral Health Atlas, a unique publication of the FDI World Dental Federation mapping the neglected state of oral health worldwide.
NCDs and oral diseases share common risk factors and are linked in reciprocal ways. The mouth can be a mirror for systemic diseases that manifest there; similarly, oral diseases can impact systemic conditions. Policies that address the risk factors for oral maladies—such as the intake of sugars, tobacco, and alcohol—address the very same risk factors associated with cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Other factors, namely, lack of clean water and sanitation, poor education, low socio-economic status, and poor housing, are determinants of general health and oral health alike.
Dentistry’s Response and Responsibilities
Stakeholders both in the public and the private sectors of the oral health community have begun to take action based on the recommendations of the Political Declaration. Furthermore, key international stakeholders have been diligent in trying to integrate suggested metrics for oral health into the broader discussions led by WHO to develop a global NCD monitoring framework.
For example, the WHO Regional Office for Africa convened 17 francophone chief dental officers in Ouidah, Benin, in November 2011 and produced a consensus statement conveying the importance of integrating oral health into NCD programs addressing tobacco control, healthy diet, and fluoride. Oral health staff at the Pan American Health Organization, the WHO regional body responsible for the Americas, is working to integrate language and metrics into the regional targets and indicators as the global monitoring framework evolves. The FDI World Dental Federation, representing the dental profession worldwide, has released support material that will assist national dental associations in their advocacy with national governments to incorporate oral health into their national NCD strategies.
The inclusion of oral health in the Political Declaration issued by the UN Heads of State was a collaborative effort of many players and organizations. Many of the same and other participants will support national planning, implementation, and evaluation of integrated NCD strategies. These efforts involve clinicians and their representatives, dental educators, researchers, public sector administrators, policy-makers, and industrial leaders, as well as non-governmental organizations (NGOs) working with disadvantaged populations nationally and globally.
There are also challenges for individual oral health professionals working directly with patients; their role is undoubtedly most critical in terms of having a direct impact on health. Every dentist can communicate effectively in the context of personalized healthcare. The messaging related to tobacco and alcohol use; appropriate intake of sugars; appropriate fluoride exposure; and the importance of diabetes control, blood pressure control, and oral hygiene are all essential for any public policy to work and have meaning for the individual. There are also larger responsibilities of health professionals to promote healthy environments in the communities they serve, whether at the workplace, in schools, or in their neighborhoods, where they might, for example, work to foster healthy school meals and snacks, support smoking bans in public places, or engage in fluoride promotion with local communities.
Global health, after all, is local, too. Many communities often represent people from all over the world, who bring with them the risk factors for diseases to their new borders. They bring lifestyle choices, cultural practices, and patterns of use of health services stemming from their countries of origin. Globalization of commerce and trade of goods and services all influence what people eat and use—all of which, in turn, impact people’s health and well-being. Separating what might be global from local is an artificial device, as everyone now lives in a new globalized world.
Recognizing that, the authors are reminded of the words of President Kikwete: “I implore my fellow Heads of State and governments to include oral health among the NCDs and for health ministers to become more engaged. We must share a sense of moral duty to make proper oral health a priority.” If President Kikwete feels this moral sense of responsibility, no less should oral health professionals feel it as well. This is our duty.
Videocast of the UN Summit side event, press release, and photographs: dentalaegis.com/go/cced103
World Health Organization oral health publications: dentalaegis.com/go/cced104
United Nations: High-level Meeting on Non-communicable Diseases: dentalaegis.com/go/cced105
The Political Declaration text: dentalaegis.com/go/cced106
The Oral Health Atlas: Mapping a Neglected Global Health Issue. Myriad Editions & FDI World Dental Federation, Brighton & Geneva; 2009. dentalaegis.com/go/cced107
World Health Organization. Global Status Report on Noncommunicable Diseases 2010. Geneva, Switzerland: 2011. dentalaegis.com/go/cced108
Genco RJ, Williams RC, eds. Periodontal Disease and Overall Health: A Clinician’s Guide.
Yardley, PA: Professional Audience Communications, Inc. for Colgate-Palmolive Co., 2010. dentalaegis.com/go/cced109
Oral health and the United Nations Political Declaration on NCDs: A guide to advocacy. Geneva, Switzerland: FDI World Dental Federation; 2012. dentalaegis.com/go/cced139
About the Authors
Lois K. Cohen, PhD
Paul G. Rogers Ambassador for Global Health Research
Habib Benzian, DDS, MScDPH
The Health Bureau Ltd
Marion Bergman, MD, MPA
Director of Healthcare Projects
Miracle Corners of the World