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Dental Caries; Why we must gear the oral heath workforce towards taking action on the social determinants of health

Why we must gear the oral heath workforce towards taking action on the social determinants of health

The United Nations Declaration on Prevention and Control of Noncommunicable diseases (NCDs) recognized oral diseases, which includes dental caries, 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[1].

Building on this commitment, World Health Organization (WHO) produced a Global Action Plan for the Prevention and Control of NCDs 2013-2020[2], which included oral diseases.

The global action plan stated that most premature deaths from NCDs are linked to common risk factors, namely tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. FDI World Dental Federation in its policy statement on NCDs[3] recognised that “NCDs are largely caused by a cluster of risk factors: tobacco, unhealthy diet, particularly sugars[4], physical inactivity and harmful use of alcohol. Those risk factors also cause oral diseases[5],[6].”

WHO Global Action Plan noted that NCDs and their risk factors also have strategic links to health systems and universal health coverage, environmental, occupational and social determinants of health, communicable diseases, maternal, child and adolescent health, reproductive health and ageing. It stressed that the unequal distribution of noncommunicable diseases is ultimately due to the inequitable distribution of social determinants of health, and that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies.

The social determinants of health[7],[8] (SDH) “are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”

WHO Global Action Plan places great emphasis on SDH, which are specifically referenced in 2 of its objectives;

Objective 3. To reduce modifiable risk factors for noncommunicable diseases and underlying social determinants through creation of health-promoting environments

Objective 4. To strengthen and orient health systems to address the prevention and control of noncommunicable diseases and the underlying social determinants through people-centred primary health care and universal health coverage. Health systems also need to collaborate with other sectors and work in partnership to ensure social determinants are considered in service planning and provision within communities.

Strategies to address noncommunicable diseases need to deal with health inequities which arise from the societal conditions in which people are born, grow, live and work and to mitigate barriers to childhood development, education, economic status, employment, housing and environment.

Upstream policy and multisectoral action to address these social determinants of health will be critical for achieving sustained progress in prevention and control of noncommunicable diseases.

Action on SDH is embedded in efforts to reorient health services, the health workforce, and health workforce education.

  • WHO framework for Integrated people centred health services[9] means “putting the comprehensive needs of people and communities, not only diseases, at the centre of health systems, and empowering people to have a more active role in their own health.”
  • United Nations High-Level Commission on Health Employment and Economic Growth[10] calls for the health workforce to be “geared towards the social determinants of health, health promotion, disease prevention, primary care and people-centred, community-based services.”
  • WHO eBook on integrating a Social Determinants of Health Approach into Health Workforce Education and Training[11], provides a framework that articulates and demonstrates the relevance of the social determinants of health approach to transformative health workforce education and training.

 

How we can respond ?

The World Economic Forum (WEF) poses the question “The Fourth Industrial Revolution: what it means, how to respond[12]”. WEF says that we stand on the brink of a technological revolution that will fundamentally alter the way we live, work, and relate to one another.

WEF acknowledges that we do not yet know just how it will unfold, but one thing is clear: the response to it must be integrated and comprehensive, involving all stakeholders of the global polity, from the public and private sectors to academia and civil society.

Big data, technology and social media are helping to drive innovation in addressing the challenges of NCDs, which will allow us to address and manage dental caries in an integrated and comprehensive manner.   

Dental record systems are playing an increasingly important role in extending and expanding approaches to managing dental caries at individual, community and population levels, across the lifecourse, as well as helping to strengthen health and education systems[13].


[1] Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, Para 19, http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf

[2] World Health Organization Global Action Plan for the Prevention and Control of NCDs 2013-2020 http://www.who.int/nmh/events/ncd_action_plan/en/

 

[4] WHO Sugars intake for adults and children Guideline

 http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/

[5] FDI World Dental Federation toolkits http://www.fdiworlddental.org/resources/toolkits

[6] FDI World Dental Federation Oral health and the United Nations Political Declaration on NCDs. A guide to advocacy, http://www.fdiworlddental.org/sites/default/files/media/images/oral_health_and_un_political_dec_on_ncds.pdf

[7] Commission on Social Determinants of Health, 2005-2008, http://www.who.int/social_determinants/thecommission/en/

[9] WHO framework for Integrated people centred health services http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/

[10] United Nations High-Level Commission on Health Employment and Economic Growth http://www.who.int/hrh/com-heeg/en/

[11] WHO eBook on integrating a Social Determinants of Health Approach into Health Workforce Education and Training  http://www.who.int/hrh/resources/ebook_integrating_social_determinants/en/

[13] Lancer Commission report ‘Health professionals for a new century: transforming education to strengthen health systems in an interdependent world’ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61854-5/abstract

 

 

 

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