By Sara Roda, Senior Policy Officer, Council of European Dentists.

Health is a cornerstone of human development, at all times and in all places. Investing in health enhances economic, social and educational development, increases productivity, active participation and general well-being, and reduces costs for treatment and healthcare.

Health is a fundamental human right and its importance is recognised in the Millennium Development Goals (MDGs), which set concrete targets for international development efforts for 2015: reduce child mortality (Goal 4), improve maternal health (Goal 5), combat HIV/AIDS, malaria and other diseases (Goal 6), and others include health-related targets, such as eradicate extreme poverty and hunger (Goal 1) and ensure environmental sustainability (Goal 7).

Furthermore, the policy framework of WHO Health 2020, which identifies evidence-based strategies addressed to policy-makers, recognises that governments can achieve real improvements in health if they work together and with civil society. Health development is a key component of Health 2020 as “Health is a resource that enables every person to realise his or her potential and to contribute to the overall development of society. (…) [It] is crucial as a means to achieve other goals in life. Poor health wastes potential, causes despair and drains resources across all sectors of society. ⁱ

Smart and Inclusive Growth

Health policy is also relevant to Europe 2020’s objectives for smart and inclusive growth. This strategic document strengthens the link between European health policies and supports reforms in Member States health systems. Investing in health would help the EU face present challenges: an ageing population, an increase of chronic diseases, a greater demand for healthcare and the high cost of technological progress. Europe 2020 recognises that:

1. keeping people healthy and active for longer has a positive impact on productivity and competitiveness.
2. innovation can render the healthcare sector more sustainable and help discover new medicines;
3. the healthcare sector has an important role to play in improving skills and creating jobs as it employs 1 in 10 of the most qualified workers in the EU; and
4. with a projected 45% increase in the number of people aged 65 and over in the next 20 years, financing rising healthcare costs and access to a dignified and independent life for the aging population will be central to the political debate.

All these fundamental policy documents are however silent with regards oral health policies. Oral health is often seen by policy-makers as a superfluous branch of medicine, a luxury not quite relevant to our everyday life. Yet oral health remains a challenge, like any other health issue that can, in its way, help tackle other broader challenges. A lot needs and can be done to change the way oral health is currently thought about. Perhaps a concrete example from the terrible days of slave trade can show that even historically good teeth were considered a key indicator of health. In those days, between the XVI and XIX centuries, one of the indicators used to see if a person was healthy and able to endure hard labour was the state of their teeth. Slaves with bad teeth were usually rejected by slave traders and they could even be put to death – a stark example on how good teeth could deeply affect and save someone’s life.

Health as an indicator of human development

Even in this tragic and horrid period of mankind, oral health was used as an indicator of general health. Oral health is an integral part of general health and well-being.ⁱⁱ Good oral health is essential for individuals to communicate effectively, to eat a variety of foods, and is important in overall quality of life, self-esteem and social confidence.ⁱⁱⁱ

Several oral diseases (including dental caries, periodontal diseases, oral pathology and cancers, dento-facial trauma and dental erosion) affect a significant proportion of the EU population, constituting a heavy burden on individual quality of life and on costs to health care systems. The major risk factors for oral diseases are the same as for major chronic non-communicable diseases such as obesity, heart disease, stroke, cancers, diabetes and mental illness. The presence of an untreated oral disease in a patient also increases the risk of the patient developing one or more of other major chronic diseases.

Rather than attempting to tackle each chronic disease, either oral or general, in isolation, a more effective approach is needed. Directing prevention and promotion activities at the common-risk factors – e.g. diet, smoking, alcohol and stress – is an effective and efficient way of reducing the burden of chronic diseases. This common-risk approach implies a greater integration of oral health into general health promotion and a broader concept of the role of oral health professionals, including early diagnosis of diseases.

Health is a shared responsibility and a shared challenge

Oral health is the responsibility of society as a whole and we need to come together to set national public health objectives on oral health prevention and promotion programmes in order to achieve better and more equitable oral healthcare. We urge national governments to properly invest in oral health and develop a joint approach allying public health departments, insurances, national dental associations, healthcare professionals and patients’ organisations, etc. when implementing such programmes. We feel however more encouraged now that health promotion is one of the priorities of the current European Commissioner for Health.

The pace of improvement of oral health in each country depends of course on the level of existing disease, particularly in disadvantaged communities, but mainly on the investment of national governments in supporting health promotion. We are confident that together we can contribute to better oral health and through this help foster greater societal involvement in other crucial challenges!

Footnotes:

i) The WHO Health 2020 aims at improving health for all by reducing health inequalities, increasing leadership and participatory governance in health.

ii) CED Resolution ‘For Better Oral Health of All EU Citizens: Mutual Integration of Oral and General Health!’, adopted in May 2011.

iii) Some anedoctal evidence of the links between oral and general health:

• A study in the U.S., where it is estimated that 80 percent of adults have some degree of gum or periodontal disease, showed that those with severe periodontal disease were twice as likely to die, of any cause, before the age of 64;
• Patients with Type I or Type II diabetes have a 2.5 to 3.5 greater risk of developing periodontal disease. On the other hand, presence of inflammation in the mouth exacerbates the diabetic condition and makes its treatment less effective;
• In another study, patients suffering from periodontal diseases were twice as likely to have a stroke;
• Higher numbers of premature babies were found to be born to women with periodontal disease and in one study premature births were reduced by 84% in women who received appropriate dental treatment before 35 weeks of pregnancy; and

People with severe mental illnesses like schizophrenia or bipolar disorder are over three times more likely to lose their teeth because of poor oral health than the general population.

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