Community Dental Health (2023) 40, 68 © BASCD 2023

doi:10.1922/CDH_Jun23Editorial02

Editorial

The WHO Global Oral Health Action Plan 2023-2030

Oral health is finally on the global agenda. The World The plan includes 11 core indicators to monitor progress
Health Organisation Global Oral Health Action Plan with 40 additional indicators including essential care
(OHAP) 2023-2030 (WHO, 2022a) has been completed and some clinical and public health measures such as
following a public consultation which took place during implementing a sugar tax.
August and September 2022. As oral diseases are the most A second publication, the WHO Global Oral Health
prevalent non-communicable diseases; it is good to see Status Report, Executive Summary and Country Profiles
that the OHAP will co-exist alongside the Global Action (WHO 2022b) was released in November 2022. It details
Plan for the Prevention and Control of Non-communicable the current situation with regard to: Oral Disease Burden,
Diseases 2013–2030. This editorial summarises the OHAP Risk Factors for Oral Diseases, Economic Impact and
and highlights the opportunities and challenges discussed National Health System Response and as such should
during the September 2022 EADPH congress, held co- provide a baseline against which to assess what the Oral
jointly with the Council of the European Chief Dental Health Action Plan has achieved by 2030. Additionally,
Officers (CECDO). the European Observatory on Health Systems and policies
The OHAP has six strategic objectives: has published a report on Oral health care in Europe:
• Governance: to improve political and resource com- Financing, Access and Provision.
mitment to oral health, strengthen leadership and So, what challenges are to be overcome if the OHAP
create win-win partnerships within and outside the is to succeed?
health sector. The first is to ensure that the social determinants of
• Oral Health Promotion and Prevention: to enable all health are tackled in line with the WHO’s Global Action
people to achieve the best possible oral health and Plan on the Prevention and Control of NCDs and that
address the social and commercial determinants and oral health is integrated within national policies. Raising
risk factors of oral diseases and conditions. the profile of oral health is a priority for all countries,
• Health workforce: to develop innovative workforce considering the overwhelming burden of oral diseases and
models and revise and expand competency-based conditions across the life-course. The implementation of
education to respond to population oral health needs. the OHAP into policy is complicated by different organ-
• Oral health care: to integrate essential oral health isational structures and systems and identifying the right
care and ensure related financial protection and es- people to influence, who may have insight and power
sential supplies in PHC to bring policy into action. It is important to recognise
• Information systems: to enhance surveillance and the role of Chief Dental Officers in respective countries,
health information systems to provide timely and alongside other sectors outside health systems. Thus, it
relevant feedback on oral health to decision-makers will be vital to identify and explore key stakeholders
for evidence-based policy-making. who may have the power to dictate public health policy.
• Research: to create and continuously update context The second challenge is to implement the action plan
and needs-specific research that is focused on the and achieve the target of UHC within our respective
public health aspects of oral health. (WHO 2022a) countries with varying political structures and systems of
The Action Plan proposes 94 specific actions to help healthcare funding and public health. Funding of general
member states achieve the objectives and two overarching healthcare is universally managed by governments via
and ambitious global targets, which are that by 2030: taxation or social health insurance in Europe. However,
• 80 % of the global population will be covered by for oral health care, one third of spending is funded by
essential oral health care to ensure progress towards public sources and the remainder is paid by voluntary
Universal Health Coverage (UHC) for oral health. health insurance or out of packet payments (European
• The global prevalence of the main oral diseases and Health Observatory, 2022). Therefore, statutory cover-
conditions, over the life course, will show a relative age is limited to some countries whereas others relying
reduction of 10%. heavily on private healthcare; the most vulnerable and

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those on low income are likely to bear the burden of oral Another working group recognised the relationship
diseases exacerbating oral health inequalities. This has between oral and general health. Integration between
implications for integrating oral health care into Universal the two is essential to improve population oral health.
Health Coverage (UHC) and tackling NCDs, as there is This also applies to education and research. Education
an unlevel playing field between and within countries. A should be inter-disciplinary in line with WHO’s vision
recent Lancet editorial emphasised this point ‘There is no of inter-professional practice, with aligned curricula for
health without oral health and there is no UHC without health, allied health and oral health professionals. Public
oral health care.’ (Winkleman et al., 2022). Furthermore, health needs to be embedded into the curriculum for
public health funding is inconsistent locally and regionally. all oral health professionals to help them understand its
How do we as professionals advocate for future funding importance rather than just focusing on clinical practice.
and increase capacity of the workforce to achieve UHC? Similarly, an oral public health should be embedded in
There are significant inequalities in oral health and medical and allied health professional curricula. Quality
expenditure. Typically, high-income countries spend 800 research is fundamental to achieving the objectives in the
times more than low-income countries. Put another way, OHAP. Research will also need to be multi-disciplinary,
80% of global oral health expenditure only benefits 20% with a focus on public health and recognising patient
of the world’s population. In addition, workforce and and public involvement, including vulnerable groups.
capacity to provide oral healthcare is skewed towards Consideration should be given to social determinants
high income countries. and oral health inequalities. Interdisciplinary partnership
The third challenge is defining what constitutes es- between oral and general health professionals is key to
sential oral health care. One definition sees essential oral maximising improvements in oral and general health. Sir
health care as maintaining a functional, pain-free dentition Richard Horton, editor of Lancet put all of this in a very
and which enables people to eat, speak and be compe- succinct statement at the launch of The Lancet series in
tent to take care of their dental health and their general London, 2019 ‘Everyone who cares about global health
health. Policy makers will need to take several factors should advocate to end the neglect of oral health.’
into consideration, including cost, workforce availability The WHO Oral Health Action Plan puts oral health
and capacity and education of the oral health workforce. on the global health agenda giving us momentum to
They will also need to include sustainability and envi- improve oral health for our populations. Political influ-
ronmental protection in oral health care. Re-orientation ence and advocacy will be key with local, regional and
of health services to focus on prevention is essential for global public health associations having a clear and
improvements in oral health and yet the emphasis seems consistent approach to tackling oral health inequalities.
to remain on delivery of dental treatment. Collaboration with the wider public health agenda and
The fourth challenge is the inconsistent information inter-sectoral working will be instrumental in achieving
systems and data on oral health status and systems. The OHAP and its targets.
European region the Organisation for Economic Coopera-
tion and Development and Eurostat databases alongside References
country-based reporting could be helpful. However, they
include few, if any oral health data. Existing data cannot European Health Observatory on Health Systems and Policies
be compared between countries, as some were collected (2022): Oral health care in Europe. Financing access and
over 20 years ago, from nationally unrepresentative sam- provision. Health Systems in Transition 24, No. 2.
Patel, R.N., Eaton, K.A., Pitts, N.B., Schulte, A., Pieper, K. and
ples (Patel et al., 2016). The 2022 European Association of
White, S. (2016): Variation in methods used to determine
Dental Public Health pre-congress workshop (Transcript national mean DMFT scores for 12-year-old children in
available at the CDH website) suggested that innovative European countries. Community Dental Health 34, 286-291.
methods could be adopted to estimate the burden of oral Riordain R.N., Glick M., Mashhadani S.S.A.A., Aravamudhan
diseases, recognising the limitations in the quality of K., Barrow J., Cole D., Crall J.J., Gallagher J.E., Gibson
the data. Having an action plan is one thing but if you J., Hegde S., Kaberry R., Kalenderian E., Karki A., Celeste
cannot measure how you perform, it is almost useless. R.K., Listl S., Myers S.N., Niederman R., Severin T., Smith
Undoubtedly, the oral health indicators will pose M.W., Murray Thomson W., Tsakos G., Vujicic M., Watt
implementation challenges to at a national level consid- R.G., Whittaker S. and Williams D.M. (2021): Developing
a Standard Set of Patient-centred Outcomes for Adult Oral
ering the difficulties they have already with other non-
Health – An International, Cross-disciplinary Consensus,
communicable diseases. Nevertheless, it is important to International Dental Journal 71, 40-52.
integrate oral and general health and use these indicators Winkelmann, J., Listl, S., van Ginneken, E., Vassallo, P. and
to highlight oral health inequalities. Benzian, H. (2022): Universal health coverage cannot be
Subjective indicators are as important as clinical universal without oral health. The Lancet Public Health 8,
indicators in advocating for oral health. Therefore, the E8-E11. World Health Organisation (2022a): WHO Global
indicators could be expanded to incorporate a functional Oral Health Action Plan 2023-2030 Available at: https://
dentition, oral health-related quality of life and social and cdn.who.int/media/docs/default-source/ncds/mnd/eb152-
economic impacts. Additionally, process indicators could be draft-global-oral-health-action-plan.pdf.
World Health Organisation (2022b): WHO Global oral health
included, such as the availability of oral health initiatives.
status report, executive summary and country profiles.
Additionally, it would be beneficial to consider FDI’s and Available at: https://www.who.int/team/noncommunicable-
the International Consortium for Health Outcomes Mea- diseases/global-status-report-on-oral-health-2022. Geneva:
surement (ICHOM) Minimum Adult Oral Health Standard World Health Organisation.
Set (AOHSS) (O’Rioridan et al., 2020). Such a long list
of indicators is aspirational and countries will need to use
a variety of indicators, depending on population needs.
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