Without doubt, this was a remarkable week for global oral health. During the 148th meeting of the WHO Executive Board, oral health was among the items discussed, initiated by a group of member states led by Sri Lanka and others. The last time the WHO governing bodies adopted a resolution regarding oral health was in 2007, which is ancient in a fast-paced global health context. Why should oral health be of interest at all for global health?
The question is easily answered – oral diseases are among the most common of mankind, with more than 3.5 billion people suffering from dental caries, severe periodontal disease, tooth loss and oral cancer. Inequalities in oral health are global, with people in low- and middle-income countries carrying the biggest share. Billions of people have no sustained and affordable access to even basic oral healthcare. Less than 20% of humanity (largely from high-income countries) benefit from almost 80% of direct oral healthcare expenditures, amounting to more than $350 billion USD (2015). The limitations of dental services or even loss of insurance coverage during the COVID-19 pandemic highlighted the daily challenges that millions are facing when seeking dental care in times without a pandemic.
Since the late 1990ies, oral health as a programmatic area barely survived changing WHO priorities and funding cuts. Reduced to a one-person unit and sidelined in the organizational structure, limited visibility and internal leverage led to rather faltering and half-hearted reactions to well-intended integration efforts with the nascent momentum for non-communicable diseases. The small global oral health community was unsuccessful in advocating for inclusion or alignment with the SDGs, thereby limiting traction in global health. Luckily, oral health was maintained within the organigram of WHO and has recently become part of the NCD department.
The UHC agenda provides a new opportunity for global oral health. The WHO Director-General’s report with the lengthy title “Achieving better oral health as part of the universal health coverage and noncommunicable disease agendas towards 2030” sets clear directions and does not shy away from listing massive challenges: lack of political priority, inadequate technical oral health capacity within governments, dominance of expensive curative treatment models despite largely preventable diseases, or data limitations for planning equitable services. Additional barriers include the dominating private, dentist-centred delivery mode of oral healthcare, and an oftentimes lackadaisical engagement to tackle the sugar industry and commercial determinants of oral health.
WHO and Member States have now been tasked to develop a long-overdue global strategy, action plan and monitoring framework for oral health, aligned with UHC and NCD agendas. The entire global (oral) health community should promote strong stakeholder engagement and ensure adequate financial resources from governments and development partners. An ideal long-term policy outcome would be the inclusion of oral health as a sixth major disease area of the NCD family and full integration in UHC programming.
Other initiatives, such as the Lancet Commission on Oral Health established last year, will hopefully muster the courage for candid problem analysis and provide tangible recommendations for innovative policy and action; inspired by a recent Lancet paper that called for “ending the neglect of global oral health – time for radical action”. The FDI World Dental Federation’s timely release of its Vision 2030 – Delivering Optimal Oral Health for All report is a step in the right direction of profound reform. Later this year, the U.S. Surgeon-General will publish a new report on oral health in America and the WHO is preparing a Global Oral Health Report – 2021 promises to be the year when oral health returns to the global health arena. After all, there is no global health without oral health.