Social Inclusion - Royal College of Surgeons lecture
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Social Inclusion - mapping global inequality lecture Royal College of Surgeons of England Research Symposium - Tuesday, 31 May 2011

Social Inclusion - mapping global inequality lecture Royal College of Surgeons of England Research Symposium - Tuesday, 31 May 2011

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  • Background in public health & behaviour change, 4 years @ FDI, policy, advocacy, communication & project management \nIllustrated with maps & images from The Oral Health Atlas -2009\nSocial Exclusion is what can happen when people or areas suffer from a combination of linked problems - unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown. It is characterised by the inter-relatedness of problems that are mutually reinforcing; combined they create a fast moving, complex and vicious cycle. - Inclusion Institute, University of Central Lancashire\n
  • Background in public health & behaviour change, 4 years @ FDI, policy, advocacy, communication & project management \nIllustrated with maps & images from The Oral Health Atlas -2009\nSocial Exclusion is what can happen when people or areas suffer from a combination of linked problems - unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown. It is characterised by the inter-relatedness of problems that are mutually reinforcing; combined they create a fast moving, complex and vicious cycle. - Inclusion Institute, University of Central Lancashire\n
  • Social inclusion / exclusion seen through 4 lenses: exposure to risk factors, burden of disease, access to services and costs.\n
  • Social inclusion / exclusion seen through 4 lenses: exposure to risk factors, burden of disease, access to services and costs.\n
  • Social inclusion / exclusion seen through 4 lenses: exposure to risk factors, burden of disease, access to services and costs.\n
  • Social inclusion / exclusion seen through 4 lenses: exposure to risk factors, burden of disease, access to services and costs.\n
  • Major risk factors, such as tobacco use, physical inactivity and a diet high in fat, salt and sugar, contribute to a range of chronic diseases, such as obesity, diabetes, cardiovascular diseases and oral diseases.\nPoverty and chronic disease are linked into a vicious cycle; chronic diseases can exacerbate poverty and the poor have greater exposure to risk and less access to health services.\n
  • The average person in the Democratic Republic of Congo consumes less than one teaspoon of sugar a day, while the average person in the USA consumes more than 19\n The average American consumes 336 liters of soft drinks a year; nearly a liter a day\nThere are also disparities within countries & risks alone do not determine health\n
  • The average person in the Democratic Republic of Congo consumes less than one teaspoon of sugar a day, while the average person in the USA consumes more than 19\n The average American consumes 336 liters of soft drinks a year; nearly a liter a day\nThere are also disparities within countries & risks alone do not determine health\n
  • Many risk factors are results of broader determining factors, such as lifestyle, socio-economic status, or living conditions.\nAlmost 80% of diabetes deaths occur in low- and middle-income countries\n
  • Caries is a middle-income problem\nAccess is care increases with income\nlinks between oral diseases and socio-economic status\nWHO Commission on Social Determinants on Health (2008) expressed so clearly: “In countries at all levels of income, health and illness follow a social gradient: the lower the socio-economic position, the worse the health.”\nMaori women are five times more likely than New Zealand Caucasian women to be toothless.\n
  • Caries is a middle-income problem\nAccess is care increases with income\nlinks between oral diseases and socio-economic status\nWHO Commission on Social Determinants on Health (2008) expressed so clearly: “In countries at all levels of income, health and illness follow a social gradient: the lower the socio-economic position, the worse the health.”\nMaori women are five times more likely than New Zealand Caucasian women to be toothless.\n
  • Caries is a middle-income problem\nAccess is care increases with income\nlinks between oral diseases and socio-economic status\nWHO Commission on Social Determinants on Health (2008) expressed so clearly: “In countries at all levels of income, health and illness follow a social gradient: the lower the socio-economic position, the worse the health.”\nMaori women are five times more likely than New Zealand Caucasian women to be toothless.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Not going to focus on perio, the data is incomplete\n Links to general disease: type II diabetes, cardiovascular, premature &-low birth weight, etc.\n
  • Tooth decay is a middle income disease but lack of treatment mostly affects the poor\nGenerally, caries rates are highest in middle-income countries where sugar consumption is high but access to prevention and care is low. \n Breakdown of treatment by income\n Yellow is untreated disease\n
  • Tooth decay is a middle income disease but lack of treatment mostly affects the poor\nGenerally, caries rates are highest in middle-income countries where sugar consumption is high but access to prevention and care is low. \n Breakdown of treatment by income\n Yellow is untreated disease\n
  • Tooth decay is a middle income disease but lack of treatment mostly affects the poor\nGenerally, caries rates are highest in middle-income countries where sugar consumption is high but access to prevention and care is low. \n Breakdown of treatment by income\n Yellow is untreated disease\n
  • 6% of Californians, or about 1.8 million people, miss work or school each year due to dental problems\n In the Philippines, 85% of 6-year-old children had signs of dental infection\nBetween 1997 and 2006 there has been a 66% increase in the number of children admitted into hospital for tooth extraction in the UK.\n
  • 6% of Californians, or about 1.8 million people, miss work or school each year due to dental problems\n In the Philippines, 85% of 6-year-old children had signs of dental infection\nBetween 1997 and 2006 there has been a 66% increase in the number of children admitted into hospital for tooth extraction in the UK.\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • Once case study from the Philippines\n
  • World average: 6.3, Highest: Papua New Guinea 40.9, Lowest: El Salvador 0.4 \nThe average 5-year survival rate of oral cancer among white high-income males in Mumbai is 30%, whereas i the USA it i 70%\n
  • World average: 6.3, Highest: Papua New Guinea 40.9, Lowest: El Salvador 0.4 \nThe average 5-year survival rate of oral cancer among white high-income males in Mumbai is 30%, whereas i the USA it i 70%\n
  • The problem is worst in South-East Asia; Paan use is a key factor\n Smoking is associated with about 75% of oral cancer cases.\n The risk for oral cancer is 15 times higher when the two main risk factors, tobacco use and alcohol, are combined.\n
  • The problem is worst in South-East Asia; Paan use is a key factor\n Smoking is associated with about 75% of oral cancer cases.\n The risk for oral cancer is 15 times higher when the two main risk factors, tobacco use and alcohol, are combined.\n
  • Noma is a good example of an oral disease with a low incidence rate but a high impact, fatal in about 80% of cases\n While there have been cases of noma around the world, it is currently a mainly African problem\n
  • Noma is a good example of an oral disease with a low incidence rate but a high impact, fatal in about 80% of cases\n While there have been cases of noma around the world, it is currently a mainly African problem\n
  • Noma is a good example of an oral disease with a low incidence rate but a high impact, fatal in about 80% of cases\n While there have been cases of noma around the world, it is currently a mainly African problem\n
  • risk 40% higher fro deprived ares of the UK\n Boys are almost twice as likely to experience dental trauma as girls.\n
  • risk 40% higher fro deprived ares of the UK\n Boys are almost twice as likely to experience dental trauma as girls.\n
  • risk 40% higher fro deprived ares of the UK\n Boys are almost twice as likely to experience dental trauma as girls.\n
  • The dentist-to population ratio is a rough indicator of service availability, but does not necessarily result in the improvement in oral health. \nIllegal practitioners often fill the gap, sometimes causing more harm than good\nRural neglect = dentists are concentrated in the urban areas\nThere are only 16 dentists in Eritrea, and 15 of them work in the capital.\nIn India, the dentist:population ratio in rural areas is 1:300,000 and 1:27,000 in urban areas.\n Migration = low-income to high-income = brain drain\nThere are more dentists from Benin in France than in Benin.\n22% of dentists practicing in the UK are foreign born.\n
  • The dentist-to population ratio is a rough indicator of service availability, but does not necessarily result in the improvement in oral health. \nIllegal practitioners often fill the gap, sometimes causing more harm than good\nRural neglect = dentists are concentrated in the urban areas\nThere are only 16 dentists in Eritrea, and 15 of them work in the capital.\nIn India, the dentist:population ratio in rural areas is 1:300,000 and 1:27,000 in urban areas.\n Migration = low-income to high-income = brain drain\nThere are more dentists from Benin in France than in Benin.\n22% of dentists practicing in the UK are foreign born.\n
  • The dentist-to population ratio is a rough indicator of service availability, but does not necessarily result in the improvement in oral health. \nIllegal practitioners often fill the gap, sometimes causing more harm than good\nRural neglect = dentists are concentrated in the urban areas\nThere are only 16 dentists in Eritrea, and 15 of them work in the capital.\nIn India, the dentist:population ratio in rural areas is 1:300,000 and 1:27,000 in urban areas.\n Migration = low-income to high-income = brain drain\nThere are more dentists from Benin in France than in Benin.\n22% of dentists practicing in the UK are foreign born.\n
  • The dentist-to population ratio is a rough indicator of service availability, but does not necessarily result in the improvement in oral health. \nIllegal practitioners often fill the gap, sometimes causing more harm than good\nRural neglect = dentists are concentrated in the urban areas\nThere are only 16 dentists in Eritrea, and 15 of them work in the capital.\nIn India, the dentist:population ratio in rural areas is 1:300,000 and 1:27,000 in urban areas.\n Migration = low-income to high-income = brain drain\nThere are more dentists from Benin in France than in Benin.\n22% of dentists practicing in the UK are foreign born.\n
  • The dentist-to population ratio is a rough indicator of service availability, but does not necessarily result in the improvement in oral health. \nIllegal practitioners often fill the gap, sometimes causing more harm than good\nRural neglect = dentists are concentrated in the urban areas\nThere are only 16 dentists in Eritrea, and 15 of them work in the capital.\nIn India, the dentist:population ratio in rural areas is 1:300,000 and 1:27,000 in urban areas.\n Migration = low-income to high-income = brain drain\nThere are more dentists from Benin in France than in Benin.\n22% of dentists practicing in the UK are foreign born.\n
  • 80% of all oral health care is concentrated in 20% of the population\n
  • 80% of all oral health care is concentrated in 20% of the population\n
  • Dental treatment accounted for only 3% of the reduction in tooth decay in 12-year-olds in industrialised countries during the last 40 years. The main\nfactors were fluoride toothpaste and general socio-economic development. \nautomatic fluoride helps the socially excluded most, however they have the least access to toothpaste\n For every US$1 spent on salt fluoridation, around US$250 are saved in treatment costs.\n
  • In India and Nepal tax accounts for 25% of the retail price of toothpaste; in Burkina Faso this is up to 50%\n In the Netherlands an average 300g of toothpaste are used per person per year; in Myanmar 35g\nZambia it can take over 30 days to pay for toothpaste\n
  • In India and Nepal tax accounts for 25% of the retail price of toothpaste; in Burkina Faso this is up to 50%\n In the Netherlands an average 300g of toothpaste are used per person per year; in Myanmar 35g\nZambia it can take over 30 days to pay for toothpaste\n
  • In 2004, only 44% of US citizens went to see a dentist. The average treatment took 2.1 sessions and the average cost was US$560.\n
  • In 2004, only 44% of US citizens went to see a dentist. The average treatment took 2.1 sessions and the average cost was US$560.\n
  • In 2004, only 44% of US citizens went to see a dentist. The average treatment took 2.1 sessions and the average cost was US$560.\n
  • In 2004, only 44% of US citizens went to see a dentist. The average treatment took 2.1 sessions and the average cost was US$560.\n
  • In 2004, only 44% of US citizens went to see a dentist. The average treatment took 2.1 sessions and the average cost was US$560.\n
  • Prevention is cheaper than treatment, however most health systems do not pay dentists for prevention or invest in it.\nIn the USA alone, 2.4 million days of work and 1.6 million days of school were lost due to oral disease in 1996.\n
  • Prevention = fluoride, risk-factors, social-determinants\nBehaviour change for population, professionals, policy makers, insurance\nevidence-based such as school health\nTraining dentists is expense and time consuming. Many countries have to send them abroad where they are unlikely to return. Even when they do they work in urban areas. \nSyria has invested significantly in scaling up the dental workforce:\ndentist numbers increased from 1,975 dentists (1981) to 14,610 (2002). However, the percentage of untreated caries and DMFT remained more or less unchanged.\nTraining other health workers to do simple extractions, ART and referral is more realistic\n
  • Prevention = fluoride, risk-factors, social-determinants\nBehaviour change for population, professionals, policy makers, insurance\nevidence-based such as school health\nTraining dentists is expense and time consuming. Many countries have to send them abroad where they are unlikely to return. Even when they do they work in urban areas. \nSyria has invested significantly in scaling up the dental workforce:\ndentist numbers increased from 1,975 dentists (1981) to 14,610 (2002). However, the percentage of untreated caries and DMFT remained more or less unchanged.\nTraining other health workers to do simple extractions, ART and referral is more realistic\n
  • Prevention = fluoride, risk-factors, social-determinants\nBehaviour change for population, professionals, policy makers, insurance\nevidence-based such as school health\nTraining dentists is expense and time consuming. Many countries have to send them abroad where they are unlikely to return. Even when they do they work in urban areas. \nSyria has invested significantly in scaling up the dental workforce:\ndentist numbers increased from 1,975 dentists (1981) to 14,610 (2002). However, the percentage of untreated caries and DMFT remained more or less unchanged.\nTraining other health workers to do simple extractions, ART and referral is more realistic\n
  • Prevention = fluoride, risk-factors, social-determinants\nBehaviour change for population, professionals, policy makers, insurance\nevidence-based such as school health\nTraining dentists is expense and time consuming. Many countries have to send them abroad where they are unlikely to return. Even when they do they work in urban areas. \nSyria has invested significantly in scaling up the dental workforce:\ndentist numbers increased from 1,975 dentists (1981) to 14,610 (2002). However, the percentage of untreated caries and DMFT remained more or less unchanged.\nTraining other health workers to do simple extractions, ART and referral is more realistic\n
  • Prevention = fluoride, risk-factors, social-determinants\nBehaviour change for population, professionals, policy makers, insurance\nevidence-based such as school health\nTraining dentists is expense and time consuming. Many countries have to send them abroad where they are unlikely to return. Even when they do they work in urban areas. \nSyria has invested significantly in scaling up the dental workforce:\ndentist numbers increased from 1,975 dentists (1981) to 14,610 (2002). However, the percentage of untreated caries and DMFT remained more or less unchanged.\nTraining other health workers to do simple extractions, ART and referral is more realistic\n
  • The Atlas can be purchased from www.OralHealthAtlas.org, www.Amazon.co.uk\nFDI Data Mirror is an online tool that will let you play with some of this data\n
  • The Atlas can be purchased from www.OralHealthAtlas.org, www.Amazon.co.uk\nFDI Data Mirror is an online tool that will let you play with some of this data\n

Transcript

  • 1. Social Inclusion mapping global inequality Jon Crail, Phrisk Ltd.Royal College of Surgeons of England Research Symposium - Tuesday, 31 May 2011
  • 2. Social Inclusion mapping global inequality Jon Crail, Phrisk Ltd.Royal College of Surgeons of England Research Symposium - Tuesday, 31 May 2011
  • 3. The challenges
  • 4. The challenges1. Risk factors
  • 5. The challenges1. Risk factors2. Burden of disease
  • 6. The challenges1. Risk factors2. Burden of disease3. Access to services
  • 7. The challenges1. Risk factors2. Burden of disease3. Access to services4. Costs
  • 8. Challenge 1: Risk factorsCommon risk factors
  • 9. Challenge 1: Risk factorsCommon risk factors
  • 10. Sugar
  • 11. Sugaron NORWAY SWEDEN FINLAND SUGAR ESTONIA RUSSIA LATVIA LITHUANIA DENMARK UK RUSSIA IRELAND NETH. BELARUS GERMANY POLAND CZECH UKRAINE ICELAND REP. SLOVAKIA C A N A D A LUX. MOLDOVA FRANCE SWITZ. AUSTRIA SLOV. HUNGARY RUSSIA ROMANIA B-H SERBIA PORTUGAL CROATIA BULGARIA MONT. ALBANIA MACEDONIA SPAIN ITALY K A Z A K H S TA N GREECEperson per year MONGOLIA U S A UZBEKISTAN NORTH KYRGYZSTAN1.3 kg GEORGIA KOREA JAPAN ARMENIA AZERBAIJAN TURKEY TURKMENISTAN TAJIKISTAN SOUTH 14 million KOREA TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN tonnes IRAQ IRAN MOROCCO ISRAEL JORDAN CHINA KUWAIT PAKISTAN NEPAL BAHAMAS MEXICO ALGERIA L I B YA Hong Kong CUBA EGYPT SAR DOMINICAN SAUDI UAE REP. ARABIA INDIA BANGLADESH JAMAICA HAITI BELIZE 29 million MYANMAR LAOS GUATEMALA ST KITTS & NEVIS CAPE MAURITANIA MALI tonnes PHILIPPINES HONDURAS VERDE NIGER SENEGAL CHAD ERITREA YEMEN THAILAND EL SALVADOR VIETNAM NICARAGUA BARBADOS GAMBIA SUDAN BURKINA CAMBODIA TRINIDAD & TOBAGO GUINEA-BISSAU FASO COSTA RICA VENEZUELA GUINEA NIGERIA BENIN GHANA PANAMA TOGO GUYANA CÔTE ETHIOPIA SRI LANKA SIERRA LEONE D’IVOIRE CENTRAL SAMOA SURINAME LIBERIA AFRICAN REP. BRUNEI COLOMBIA FIJI A TASTE FOR SUGAR CAMEROON UGANDA SOMALIA FINLAND MALAYSIA TONGA DEMOCRATIC Annual sugar consumption ECUADOR GABON REPUBLIC OF KENYA NORWAY SINGAPORE CONGO RWANDA SWEDEN kilograms per person CONGO BURUNDI ESTONIA RUSSIA 2007 PERU 33 million TANZANIA LATVIA LITHUANIA I N D O N E S I A PAPUA NEW DENMARK GUINEA tonnes UK RUSSIA 45 kg or more ANGOLA IRELAND COMOROS NETH. BELARUS MALAWI BRAZIL ZAMBIA GERMANY POLAND 30 kg – 44 kg ICELAND MADAGASCAR CZECH UKRAINE REP. SLOVAKIA BOLIVIA 15 kg – 29 kg C A N A D A NAMIBIA ZIMBABWE MAURITIUS LUX. MOLDOVA BOTSWANA FRANCE SWITZ. AUSTRIA SLOV. HUNGARY RUSSIA MOZAMBIQUE ROMANIA PARAGUAY less than 15 kg CHILE PORTUGAL CROATIA B-H SERBIA BULGARIA AUSTRALIA MONT. no data ARGENTINA SOUTH SWAZILAND ALBANIA MACEDONIA AFRICA LESOTHO SPAIN ITALY K A Z A K H S TA N URUGUAY GREECE World average: 30 kg per person per year MONGOLIA Highest: Swaziland 102 kg U S A UZBEKISTAN KYRGYZSTAN Lowest: Dem. Rep. Congo 1.3 kg GEORGIA ARMENIA AZERBAIJAN NEW TURKEY TURKMENISTAN TAJIKISTAN ZEALAND 14 million TUNISIA CYPRUS SYRIA top sugar-cane MALTA LEB. AFGHANISTAN tonnes IRAQ IRAN producers MOROCCO ISRAEL JORDAN CHINA KUWAIT PAKISTAN NEPAL BAHAMAS MEXICO ALGERIA L I B YA Hong K CUBA EGYPT Copyright © - FDI World Dental Federation and Myriad Editions.
  • 12. The social determinants of health
  • 13. The social determinants of health
  • 14. Socio-economic status
  • 15. Socio-economic status
  • 16. Socio-economic status
  • 17. Socio-economic status
  • 18. Challenge 2: Burden of disease
  • 19. Challenge 2: Burden of disease • Caries • Oral cancer • Periodontal disease • Noma • Birth defects • Trauma
  • 20. Challenge 2: Burden of disease 90% of the • Caries worlds • Oral cancer population have had • Periodontal disease oral pain in • Noma their lifetime • Birth defects • Trauma
  • 21. Challenge 2: Burden of disease 90% of the • Caries worlds • Oral cancer population have had • Periodontal disease oral pain in • Noma their lifetime Dental caries is the most common • Birth defects chronic disease • Trauma worldwide
  • 22. Dental caries (DMFT)
  • 23. Dental caries (DMFT)DECAYed, MAPPING DENTAL CARIESent Teeth ICELAND FINLAND NORWAY RUSSIA SWEDEN ESTONIA LATVIA C A N A D A UK DENMARK RUSSIA LITHUANIA IRELAND NETH. BELARUS POLAND BEL. GERMANY UKRAINE K A Z A K H S TA N CZ. LIECHT. REP. SL. MONGOLIA LUX. AUS. HUN. MOLDOVA FRANCE SWITZ. SL. ROM. U S A S. M. CRO. B-H SERB. UZBEKISTAN KYRGYZSTAN NORTHTogo 0.3 PORTUGAL MONT. ALB. BUL. GEORGIA KOREA JAPAN MAC. ARMENIA SOUTH SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN GREECE KOREA TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN CHINA BERMUDA IRAQ IRAN MOROCCO ISRAEL JORDAN KUWAIT PAKISTAN BAHAMAS ALGERIA NEPAL BHUTAN MEXICO L I B YA BAHRAIN Hong Kong CUBA EGYPT SAR SAUDI UAE FED. STATES DOMINICAN Macau MICRONESIA CAYMAN IS. REP. PUERTO RICO ARABIA BANGLADESH SAR HAITI INDIA ANGUILLA LAOS BELIZE JAMAICA CAPE OMAN MYANMAR ST KITTS & NEVIS ANTIGUA & BARBUDA VERDE MAURITANIA KIRIBATI GUATEMALA HONDURAS DOMINICA MALI NIGER PHILIPPINES ST VINCENT & THE GRENADINES MARTINIQUE SENEGAL ERITREA YEMEN THAILAND TUVALU TOKELAU EL SALVADOR ST LUCIA VIETNAM NICARAGUA GAMBIA SUDAN SOLOMON GRENADA BARBADOS BURKINA GUINEA-BISSAU SIERRA CAMBODIA ISLANDS COSTA RICA TRINIDAD & TOBAGO FASO DJIBOUTI LEONE BENIN SAMOA VENEZUELA GHANA PANAMA CÔTE NIGERIA TOGO GUYANA ETHIOPIA SRI LANKA VANUATU COOK D’IVOIRE CENTRAL FIJI ISLANDS CAMEROON AFRICAN REP. COLOMBIA SURINAME BRUNEI TONGA MALDIVES NEW LIBERIA UGANDA MALAYSIA CALEDONIA NIUE DEMOCRATIC SOMALIA FR. POLYNESIA SINGAPORE REPUBLIC OF KENYA ECUADOR GABON CONGO MAPPING DEN RWANDA WORLDWIDE DENTAL DECAY PERU BURUNDI SEYCHELLES I N D O N E S I A PAPUA TANZANIA Average number of Decayed, NEW GUINEA BRAZIL Missing and Filled permanent Teeth ANGOLA MALAWI (DMFT) in 12-year-olds ZAMBIA MADAGASCAR 2008 BOLIVIA ZIMBABWE MAURITIUS NAMIBIA BOTSWANA high; more than 3.5 CHILE PARAGUAY MOZAMBIQUE RÉUNION AUSTRALIA moderate; 2.6 – 3.5 SWAZILAND ARGENTINA SOUTH ICELAND AFRICA LESOTHO low; 1.2 – 2.5 URUGUAY NORWAY FINLAND RUSSIA very low; 0.0 –1.1 SWEDEN ESTONIA LATVIA no data CANADA UK DENMARK RUSSIA LITHUANIA IRELAND NETH. BELARUS POLAND NEW BEL. GERMANY UKRAINE KAZAKHSTAN CZ. World average: 2.0 LUX. LIECHT. REP. SL. AUS. HUN. MOLDOVA ZEALAND MONGOLIA Highest: Croatia 6.7 FRANCE SWITZ. SL. ROM. USA S. M. CRO. B-H SERB. UZBEKISTAN KYRGYZSTAN Lowest: Rwanda, Tanzania, Togo 0.3 PORTUGAL MONT. ALB. BUL. GEORGIA MAC. ARMENIA SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN GREECE TUNISIA Copyright © - FDI World Dental Federation and Myriad Editions.
  • 24. Dental caries (DMFT)DECAYed, MAPPING DENTAL CARIESent Teeth ICELAND FINLAND NORWAY RUSSIA SWEDEN ESTONIA LATVIA C A N A D A UK DENMARK RUSSIA LITHUANIA IRELAND NETH. BELARUS POLAND BEL. GERMANY UKRAINE K A Z A K H S TA N CZ. LIECHT. REP. SL. MONGOLIA LUX. AUS. HUN. MOLDOVA FRANCE SWITZ. SL. ROM. U S A S. M. CRO. B-H SERB. UZBEKISTAN KYRGYZSTAN NORTHTogo 0.3 PORTUGAL MONT. ALB. BUL. GEORGIA KOREA JAPAN MAC. ARMENIA SOUTH SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN GREECE KOREA TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN CHINA BERMUDA IRAQ IRAN MOROCCO ISRAEL JORDAN KUWAIT PAKISTAN BAHAMAS ALGERIA NEPAL BHUTAN MEXICO L I B YA BAHRAIN Hong Kong CUBA EGYPT SAR SAUDI UAE FED. STATES DOMINICAN Macau MICRONESIA CAYMAN IS. REP. PUERTO RICO ARABIA BANGLADESH SAR HAITI INDIA ANGUILLA LAOS BELIZE JAMAICA CAPE OMAN MYANMAR ST KITTS & NEVIS ANTIGUA & BARBUDA VERDE MAURITANIA KIRIBATI GUATEMALA HONDURAS DOMINICA MALI NIGER PHILIPPINES ST VINCENT & THE GRENADINES MARTINIQUE SENEGAL ERITREA YEMEN THAILAND TUVALU TOKELAU EL SALVADOR ST LUCIA VIETNAM NICARAGUA GAMBIA SUDAN SOLOMON GRENADA BARBADOS BURKINA GUINEA-BISSAU SIERRA CAMBODIA ISLANDS COSTA RICA TRINIDAD & TOBAGO FASO DJIBOUTI LEONE BENIN SAMOA VENEZUELA GHANA PANAMA CÔTE NIGERIA TOGO GUYANA ETHIOPIA SRI LANKA VANUATU COOK D’IVOIRE CENTRAL FIJI ISLANDS CAMEROON AFRICAN REP. COLOMBIA SURINAME BRUNEI TONGA MALDIVES NEW LIBERIA UGANDA MALAYSIA CALEDONIA NIUE DEMOCRATIC SOMALIA FR. POLYNESIA SINGAPORE REPUBLIC OF KENYA ECUADOR GABON CONGO MAPPING DEN RWANDA WORLDWIDE DENTAL DECAY PERU BURUNDI SEYCHELLES I N D O N E S I A PAPUA TANZANIA Average number of Decayed, NEW GUINEA BRAZIL Missing and Filled permanent Teeth ANGOLA MALAWI (DMFT) in 12-year-olds ZAMBIA MADAGASCAR 2008 BOLIVIA ZIMBABWE MAURITIUS NAMIBIA BOTSWANA high; more than 3.5 CHILE PARAGUAY MOZAMBIQUE RÉUNION AUSTRALIA moderate; 2.6 – 3.5 SWAZILAND ARGENTINA SOUTH ICELAND AFRICA LESOTHO low; 1.2 – 2.5 URUGUAY NORWAY FINLAND RUSSIA very low; 0.0 –1.1 SWEDEN ESTONIA LATVIA no data CANADA UK DENMARK RUSSIA LITHUANIA IRELAND NETH. BELARUS POLAND NEW BEL. GERMANY UKRAINE KAZAKHSTAN CZ. World average: 2.0 LUX. LIECHT. REP. SL. AUS. HUN. MOLDOVA ZEALAND MONGOLIA Highest: Croatia 6.7 FRANCE SWITZ. SL. ROM. USA S. M. CRO. B-H SERB. UZBEKISTAN KYRGYZSTAN Lowest: Rwanda, Tanzania, Togo 0.3 PORTUGAL MONT. ALB. BUL. GEORGIA MAC. ARMENIA SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN GREECE TUNISIA Copyright © - FDI World Dental Federation and Myriad Editions.
  • 25. Dental caries (% affected)
  • 26. Dental caries (% affected)olds IMPACT OF ORAL DISEASES7 ICELAND C A N A D A NORWAY FINLAND SWEDEN ESTONIA LATVIA DENMARK LITHUANIA UK IRELAND NETH. POLAND BELARUS BEL. GERMANY CZ. REP. SL. FRANCE MONGOLIA AUS. HUN. U S A SWITZ. SL. ROM. UZBEKISTAN CRO. B-H BUL. JAPAN PORTUGAL ITALY MAC. SPAIN TURKEY SOUTH GREECE KOREA CYPRUS TUNISIA LEB. AFGHANISTAN CHINA MOROCCO ISRAEL IRAQ IRAN JORDAN KUWAIT BHUTAN NEPAL MARSHALL ISLANDS MEXICO L I B YA BAHRAIN Hong Kong EGYPT CUBA SAR UAE SAUDI BANGLADESH Macau HAITI ARABIA INDIA SAR MYANMAR LAOS JAMAICA ANTIGUA & BARBUDA OMAN CAPE GUATEMALA HONDURAS ST VINCENT & VERDE NIGER PHILIPPINES THE GRENADINES SENEGAL YEMEN THAILAND GAMBIA VIETNAM NICARAGUA BARBADOS SUDAN CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA-BISSAU FIJI BENIN GHANA PANAMA CÔTE NIGERIA GUYANA SIERRA LEONE D’IVOIRE ETHIOPIA SRI LANKA TONGA BRUNEI CAMEROON MALDIVES MALAYSIA UGANDA KENYA ECUADOR DEMOCRATIC IMPAC REPUBLIC OF SEYCHELLES DENTAL DECAY CONGO BURUNDI TANZANIA I N D O N E S I A PAPUA NEW Percentage of 6–19-year-olds BRAZIL GUINEA with dental decay latest available 1982–2007 ZAMBIA MADAGASCAR BOLIVIA ZIMBABWE 80% or more NAMIBIA MAURITIUS CHILE MOZAMBIQUE 60% – 79% AUSTRALIA ARGENTINA 40% – 59% SOUTH AFRICA LESOTHO ICELAND URUGUAY fewer than 40% CANADA NORWAY FINLAND no data SWEDEN ESTONIA LATVIA DENMARK LITHUANIA NEW World average: 70% IRELAND UK ZEALAND NETH. POLAND BELARUS Highest: Argentina 100% BEL. GERMANY CZ. REP. SL. Lowest: Japan 16% FRANCE AUS. HUN. USA SWITZ. SL. Copyright ROM. © - FDI World Dental Federation and Myriad Editions. UZBEKISTAN CRO. B-H
  • 27. Impact of dental caries
  • 28. Impact of dental caries• 97% of 6-yr-olds had • Number of dental fillings: 0 caries • 30% had lice in hair• 84% had signs of dental • 20% were underweight infection• 20% had pain when Source: 2007 National Oral examined Health Survey Philippines
  • 29. Oral cancer (men)
  • 30. Oral cancer (men) CANCER ORAL ICELAND FINLAND ICELAND FINLAND NORWAY NORWAY SWEDEN ESTONIA SWEDEN ESTONIA RUSSIA RUSSIA LATVIA LITHUANIA LATVIA DENMARK UK RUSSIA LITHUANIA IRELAND DENMARK NETH. BELARUS UK RUSSIA GERMANY IRELAND POLAND BELGIUM UKRAINE CZECH NETH. BELARUS REP. SLOVAKIA GERMANY POLAND LUX. MOLDOVA HUNGARY BELGIUM UKRAINE FRANCE SWITZ. AUSTRIA SLOV. CZECH U S S I A R ROMANIA REP. SLOVAKIA PORTUGAL CROATIA B-H SERBIA LUX. MOLDOVA BULGARIA ITALY MONT. AUSTRIA HUNGARY C A NA ND D A C A AA ALBANIA MACEDONIAFRANCE SWITZ. SLOV. ROMANIA RUSSIA SPAIN KAZAKHSTAN B-H GREECE PORTUGAL CROATIA SERBIA MONGOLIA BULGARIA MONT. UZBEKISTAN U S A GEORGIA ALBANIA KYRGYZSTAN MACEDONIA NORTH KOREA JAPAN AZER. JAPAN SPAINTURKEY TURKMEN. TAJIKISTAN ARMENIA ITALY SOUTH KAZAKHSTAN CYPRUS KOREA TUNISIA SYRIA GREECE C H I N A MONGOLIA AFGHANISTAN WOMEN MALTA LEB. IRAN MOROCCO ISRAEL IRAQ JORDAN UZBEKISTAN U S A BAHAMAS ALGERIA KUWAIT PAKISTAN NEPAL BHUTAN GEORGIA KYRGYZSTAN NORTH KOREA MEXICO LIBYA BAHRAIN CUBA EGYPT QATAR UAE AZER. TURKMEN. JAPAN DOMINICAN TURKEY BANGLADESH TAJIKISTAN MICRONESIA SOUTH HAITI REP. SAUDI ARABIA ARMENIA KOREA MICRONESIA BELIZE JAMAICA INDIA CYPRUS SYRIA LAOS GUATEMALA HONDURAS CAPE VERDE MAURITANIA MALI OMAN TUNISIA MYANMAR VIETNAM IRAN AFGHANISTAN C H I N A MEN NIGER MALTA THAILANDS SOLOMON EL SALVADOR SENEGAL ERITREA YEMEN LEB. IRAQ PHILIPPINES GAMBIA CHAD SUDANMOROCCO SOLOMON ISLANDS NICARAGUA BARBADOS ISRAEL ISLANDS GUINEA-BISSAU B. F. DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA JORDAN KUWAIT BHUTAN BENIN NIGERIA VENEZUELA NEPAL GHANA CÔTE PAKISTAN TOGO SAMOA PANAMA GUYANA ETHIOPIA ALGERIA SRI LANKA SAMOA VANUATU BAHAMAS SIERRA LEONE D’IVOIRE CENTRAL VANUATU FIJI MEXICO SURINAME LIBERIA AFRICAN REP. LIBYA BAHRAIN BRUNEI FIJI COLOMBIA CUBA EQUAT. CAMEROON DEM. REP. UGANDA QATAR GUINEA SOMALIA EGYPT SINGAPORE A L A Y S I A M UAE DOMINICAN CONGO KENYA BANGLADESH ECUADOR HAITI REP. GABON SAUDI ARABIA BELIZE JAMAICA CONGO RWANDA MAURITANIA BURUNDI OMAN I N D O N E S I A INDIA LAOS MICRONESIA PAPUA GUATEMALA CAPE VERDE TANZANIA MALI PAPUA MYANMAR VIETNAMO N E S I A NEW PERU HONDURAS NIGER NEW GUINEA EL SALVADOR BRAZIL SENEGAL ERITREA YEMEN GUINEA THAILAND PHILIPPINES COMOROS SOLOMON NICARAGUA GAMBIA ANGOLA CHAD SUDAN BARBADOS CAMBODIA ISLANDS GUINEA-BISSAU ZAMBIA MALAWI B. F. DJIBOUTI COSTA RICA TRINIDAD & TOBAGO GUINEA BENIN VENEZUELA CÔTE MADAGASCAR NIGERIA GHANA BOLIVIA TOGO PANAMA GUYANA NAMIBIA ZIMBABWE ETHIOPIA SRI LANKA SAMOA SIERRA LEONE D’IVOIRE CENTRAL VANUATU BOTSWANA PARAGUAY SURINAME LIBERIA MOZAMBIQUE MAURITIUS AFRICAN REP. BRUNEI FIJI CHILE COLOMBIA CAMEROON EQUAT. DEM. REP. UGANDA SOMALIA MALAYSIAUSTRALIA SWAZILAND GUINEA AUSTRALIA CONGO SINGAPORE ECUADOR SOUTH LESOTHO KENYA AFRICA GABON URUGUAY RWANDA ARGENTINA CONGO BURUNDI TANZANIA PAPUA PERU I N D O N E S I A NEW BRAZIL COMOROS GUINEA NEW ANGOLA NEW ZEALAND MALAWI ZEALAND ZAMBIA BOLIVIA MADAGASCAR NAMIBIA ZIMBABWE BOTSWANA MAURITIUS PARAGUAY MOZAMBIQUE ORAL CANCER CHILE AUSTRALIA Male and female incident rates SWAZILAND SOUTH LESOTHO per 100,000 people URUGUAY AFRICA 2002 ARGENTINA 10.0 or more 2.5 – 4.9 7.5 – 9.9 fewer than 2.5 NEW Copyright © - FDI World Dental Federation and Myriad Editions. ZEALAND 5.0 – 7.4 no data
  • 31. Oral cancer (women)
  • 32. ORAL CANCER Oral cancer (women) ORAL CANCER ICELAND FINLAND ICELAND FINLAND NORWAY NORWAY SWEDEN ESTONIA SWEDEN ESTONIA RUSSIA RUSSIA LATVIA LITHUANIA LATVIA DENMARK RUSSIA LITHUANIA IRELAND UK DENMARK BELARUS UK RUSSIA NETH. GERMANY POLANDIRELAND BELGIUM CZECH UKRAINE NETH. BELARUS REP. SLOVAKIA GERMANY POLAND LUX. MOLDOVA HUNGARY BELGIUM UKRAINE FRANCE SWITZ. AUSTRIA CZECH S I A RUS SLOV. ROMANIA REP. SLOVAKIA CROATIA B-H SERBIA LUX. MOLDOVA PORTUGAL BULGARIA HUNGARY ITALY MONT. FRANCE SWITZ. AUSTRIA RUSSIA CANADA ALBANIA MACEDONIA SLOV. ROMANIA SPAIN KAZAKHSTAN B-H SERBIA PORTUGAL GREECE CROATIA BULGARIA MONGOLIA ITALY MONT. UZBEKISTAN MACEDONIA U S A CANADA GEORGIA ALBANIA KYRGYZSTAN NORTH KOREA JAPAN SPAIN AZER. JAPAN TURKEY TURKMEN. TAJIKISTAN ARMENIA SOUTH KAZAKHSTAN CYPRUS SYRIA GREECE C H I N A KOREA TUNISIA AFGHANISTAN MONGOLIA WOMEN MALTA LEB. IRAN MOROCCO ISRAEL IRAQ JORDAN UZBEKISTAN U BAHAMAS S A ALGERIA KUWAIT PAKISTAN NEPAL BHUTAN GEORGIA KYRGYZSTAN NORTH KOREA MEXICO LIBYA BAHRAINN CUBA EGYPT QATAR AZER. JAPAN DOMINICAN UAE TURKEY BANGLADESH TURKMEN. TAJIKISTAN HAITI REP. SAUDI ARABIA ARMENIA MICRONESIA SOUTH MICRONESIA INDIA CYPRUS SYRIA LAOS KOREA GUATEMALA BELIZE JAMAICA HONDURAS CAPE VERDE MAURITANIA MALI OMAN TUNISIA MYANMAR VIETNAM AFGHANISTAN C H I N A WOMENS EL SALVADOR SENEGAL NIGER ERITREA YEMEN MALTA LEB. THAILAND IRAN PHILIPPINES SOLOMON NICARAGUA GAMBIA CHAD SUDAN MOROCCO ISRAEL IRAQ SOLOMON ISLANDS BARBADOS ISLANDS GUINEA-BISSAU B. F. DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA JORDAN KUWAIT NEPAL BHUTAN BENIN NIGERIA VENEZUELA PAKISTAN GHANA CÔTE ALGERIA TOGO SAMOA PANAMA GUYANA SRI LANKA SAMOA VANUATU BAHAMAS SIERRA LEONE D’IVOIRE CENTRAL ETHIOPIA VANUATU FIJI MEXICO SURINAME AFRICAN REP. LIBYA BAHRAIN BRUNEI FIJI COLOMBIA CUBA LIBERIA EGYPT QATAR EQUAT. CAMEROON DEM. REP. UGANDA SOMALIA MALAYSIA DOMINICAN GUINEA UAE CONGO KENYA SINGAPORE BANGLADESH MICRONESIA ECUADOR HAITI REP. GABON SAUDI ARABIARONESIA BELIZE JAMAICA RWANDA MAURITANIA OMAN I N D O N E S I A INDIA MYANMAR LAOS CONGO BURUNDI VIETNAM PAPUA GUATEMALA CAPE VERDE TANZANIA MALI PAPUAO N E S I A NEW PERU HONDURAS NIGER NEW EL SALVADOR SENEGAL ERITREA YEMEN THAILAND PHILIPPINESLOMON GUINEA BRAZIL COMOROS GUINEA NICARAGUA GAMBIA CHAD SUDAN SOLOMONANDS BARBADOS ANGOLA ISLANDS GUINEA-BISSAU MALAWI B. F. DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO ZAMBIA GUINEA BENIN VENEZUELA NIGERIA GHANA CÔTE MADAGASCAR TOGO SAMOA PANAMA BOLIVIA GUYANA ZIMBABWE ETHIOPIA SRI LANKA SAMOAUATU SIERRA LEONE NAMIBIA D’IVOIRE CENTRAL VANUATU FIJI BOTSWANA FIJI SURINAME LIBERIA MOZAMBIQUE MAURITIUS AFRICAN REP. BRUNEI COLOMBIA PARAGUAY CHILE EQUAT. CAMEROON DEM. REP. UGANDA SOMALIA MALAYSIAUSTRALIA GUINEA AUSTRALIA SINGAPORE SWAZILAND CONGO ECUADOR SOUTH KENYA AFRICA LESOTHO GABON URUGUAY RWANDA ARGENTINA CONGO BURUNDI I N D O N E S I A PAPUA TANZANIA PAPUA S I A NEW PERU NEW GUINEA BRAZIL COMOROS GUINEA NEW ANGOLA NEW ZEALAND ZAMBIA MALAWI ZEALAND BOLIVIA MADAGASCAR NAMIBIA ZIMBABWE BOTSWANA MOZAMBIQUE MAURITIUS PARAGUAY ORAL CANCER CHILEALIA AUSTRALIA Male and female incident rates SOUTH SWAZILAND LESOTHO per 100,000 people URUGUAY AFRICA 2002 ARGENTINA 10.0 or more 2.5 – 4.9 7.5 – 9.9 fewer than 2.5 NEW NEW ZEALAND Copyright © - FDI World Dental Federation and Myriad Editions. ZEALAND 5.0 – 7.4 no data
  • 33. Noma
  • 34. from 21 African countries countries reporting one or more cases 10,000 or more of noma 1981–2000 1,000 – 5,200 fewer than 1,000 Noma no data UK PORTUGAL U S A ITALY JAPAN PAKISTAN DOMINICAN CUBA REP. MOROCCO ISRAEL MEXICO ALGERIA JAMAICA INDIA MYANMAR EGYPT GUYANA MAURITANIA MALI SURINAME NIGER SENEGAL GAMBIA COLOMBIA CHAD SUDAN BURKINA FASO PAPUA GUINEA BENIN GUINEA- NIGERIA DJIBOUTI NEW TOGO CÔTE GUINEA BISSAU D’IVOIRE CENTRAL ETHIOPIA AFRICAN REP. PERU CAMEROON UGANDA GHANA DEM. REP. OF SOMALIA KENYA CONGO BOLIVIA RWANDA PARAGUAY BURUNDI TANZANIAEstimation of new noma cases URUGUAY ARGENTINA NOMA ANGOLA ZAMBIA MALAWIfor 2006 based on reported numbers ZIMBABWE MADAGASCARfrom 21 African countries NAMIBIA 10,000 or more BOTSWANA MOZAMBIQUE 1,000 – 5,200 fewer than 1,000 SOUTH LESOTHO AFRICA no data
  • 35. from 21 African countries countries reporting one or more cases 10,000 or more of noma 1981–2000 1,000 – 5,200 fewer than 1,000 Noma no data UK PORTUGAL U S A ITALY JAPAN PAKISTAN DOMINICAN CUBA REP. MOROCCO ISRAEL MEXICO ALGERIA JAMAICA INDIA MYANMAR EGYPT GUYANA MAURITANIA MALI SURINAME NIGER SENEGAL GAMBIA COLOMBIA CHAD SUDAN BURKINA FASO PAPUA GUINEA BENIN GUINEA- NIGERIA DJIBOUTI NEW TOGO CÔTE GUINEA BISSAU D’IVOIRE CENTRAL ETHIOPIA AFRICAN REP. PERU CAMEROON UGANDA GHANA DEM. REP. OF SOMALIA KENYA CONGO BOLIVIA RWANDA PARAGUAY BURUNDI TANZANIAEstimation of new noma cases URUGUAY ARGENTINA NOMA ANGOLA ZAMBIA MALAWIfor 2006 based on reported numbers ZIMBABWE MADAGASCARfrom 21 African countries NAMIBIA 10,000 or more BOTSWANA MOZAMBIQUE 1,000 – 5,200 fewer than 1,000 SOUTH LESOTHO AFRICA no data
  • 36. Dental trauma
  • 37. Dental trauma
  • 38. Dental trauma
  • 39. Dental trauma
  • 40. Challenge 3: Access to servicesDentists - numbers, distribution & migration
  • 41. Challenge 3: Access to services Dentists - numbers, distribution & migrationITY OF DENTISTSentist DENTISTS 3,000999,999 ICELAND CANADA NORWAY FINLAND9,999 SWEDEN ESTONIA LATVIAmore UK DENMARK RUSSIA LITHUANIA RUSSIA IRELAND NETH. POLAND BELARUS BEL. GERMANY UKRAINE KAZAKHSTAN CZ. REP. SL. MONGOLIA LUX. AUS. HUN. MOLDOVArage: FRANCE SWITZ. SL. ROM.entist USA CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NORTH KOREA MONT. ANDORRA JAPAN ARMENIA AZERBAIJAN ALB. MAC. PORTUGAL SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN SOUTHe per dentist TUNISIA GREECE CYPRUS SYRIA KOREA MALTA LEB. AFGHANISTAN CHINA IRAQ IRAN ISRAEL people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS LIBYA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE MARSHALL ISLANDS DOMINICAN BANGLADESH Macau FED. STATES JAMAICA HAITI REP. SAUDI INDIA SAR MICRONESIA BELIZE CAPE ARABIA MYANMAR LAOS ANTIGUA & BARBUDA VERDE MAURITANIA OMAN ST KITTS & NEVIS NAURU KIRIBATI GUATEMALA HONDURAS DOMINICA MALI NIGER PHILIPPINES ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN THAILAND EL SALVADOR VIETNAM NICARAGUA GRENADA BARBADOS GAMBIA BURKINA SUDAN TUVALU FASO DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA-BISSAU GUINEA BENIN SAMOA VENEZUELA GHANA PANAMA CÔTE NIGERIA TOGO GUYANA SIERRA LEONE D’IVOIRE CENTRAL ETHIOPIA PALAU FIJI MALDIVES SRI LANKA GLOBAL DENSITY OF DENTISTS COLOMBIA SURINAME LIBERIA CAMEROON EQUAT. AFRICAN REP. MALAYSIA BRUNEI TONGA UGANDA Population per dentist GUINEA KENYA SOMALIA SINGAPORE 2007 ECUADOR SAO TOME GABON & PRINCIPE DEMOCRATIC REPUBLIC OF RWANDA I N D O N E S I A CONGO CONGO BURUNDI PERU PAPUA fewer than 3,000 BRAZIL TANZANIA SEYCHELLES NEW GUINEA SOLOMON COMOROS ISLANDS 3,000 – 19,999 ANGOLA ZAMBIA 20,000 – 49,999 ZIMBABWE ICELAND MADAGASCAR BOLIVIA C A N A D A MAURITIUS NORWAY FINLAND NAMIBIA 50,000 – 199,999 PARAGUAY BOTSWANA MOZAMBIQUE SWEDEN ESTONIA CHILE LATVIA 200,000 or more UK DENMARK RUSSIA LITHUANIA RUSSIA SWAZILAND IRELAND ARGENTINA AUSTRALIA SOUTH NETH. POLAND BELARUS no data AFRICA LESOTHO BEL. GERMANY CZ. UKRAINE K A Z A K H S TA N URUGUAY REP. SL. LUX. MONGOLIA AUS. HUN. MOLDOVA World country average: FRANCE SWITZ. SL. ROM. 5,875 people per dentist U S A CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NEW MONT. ANDORRA ZEALAND ARMENIA AZERBAIJAN ALB. Highest density: SPAIN ITALY MAC. TURKEY TURKMENISTAN TAJIKISTAN PORTUGAL Croatia 568 people per dentist TUNISIA GREECE CYPRUS SYRIA Lowest density: MALTA LEB. AFGHANISTAN CHINA IRAQ IRAN ISRAEL Ethiopia 1,278,446 people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE DOMINICAN Copyright © - FDI World Dental Federation and Myriad Editions. BANGLADESH JAMAICA HAITI REP. SAUDI INDIA Maca SAR
  • 42. Challenge 3: Access to services Dentists - numbers, distribution & migrationITY OF DENTISTSentist DENTISTS 3,000999,999 ICELAND CANADA NORWAY FINLAND9,999 SWEDEN ESTONIA LATVIAmore UK DENMARK RUSSIA LITHUANIA RUSSIA IRELAND NETH. POLAND BELARUS BEL. GERMANY UKRAINE KAZAKHSTAN CZ. REP. SL. MONGOLIA LUX. AUS. HUN. MOLDOVArage: FRANCE SWITZ. SL. ROM.entist USA CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NORTH KOREA MONT. ANDORRA JAPAN ARMENIA AZERBAIJAN ALB. MAC. PORTUGAL SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN SOUTHe per dentist TUNISIA GREECE CYPRUS SYRIA KOREA MALTA LEB. AFGHANISTAN CHINA IRAQ IRAN ISRAEL people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS LIBYA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE MARSHALL ISLANDS DOMINICAN BANGLADESH Macau FED. STATES JAMAICA HAITI REP. SAUDI INDIA SAR MICRONESIA BELIZE CAPE ARABIA MYANMAR LAOS ANTIGUA & BARBUDA VERDE MAURITANIA OMAN ST KITTS & NEVIS NAURU KIRIBATI GUATEMALA HONDURAS DOMINICA MALI NIGER PHILIPPINES ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN THAILAND EL SALVADOR VIETNAM NICARAGUA GRENADA BARBADOS GAMBIA BURKINA SUDAN TUVALU FASO DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA-BISSAU GUINEA BENIN SAMOA VENEZUELA GHANA PANAMA CÔTE NIGERIA TOGO GUYANA SIERRA LEONE D’IVOIRE CENTRAL ETHIOPIA PALAU FIJI MALDIVES SRI LANKA GLOBAL DENSITY OF DENTISTS COLOMBIA SURINAME LIBERIA CAMEROON EQUAT. AFRICAN REP. MALAYSIA BRUNEI TONGA UGANDA Population per dentist GUINEA KENYA SOMALIA SINGAPORE 2007 ECUADOR SAO TOME GABON & PRINCIPE DEMOCRATIC REPUBLIC OF RWANDA I N D O N E S I A CONGO CONGO BURUNDI PERU PAPUA fewer than 3,000 BRAZIL TANZANIA SEYCHELLES NEW GUINEA SOLOMON COMOROS ISLANDS 3,000 – 19,999 ANGOLA ZAMBIA 20,000 – 49,999 ZIMBABWE ICELAND MADAGASCAR BOLIVIA C A N A D A MAURITIUS NORWAY FINLAND NAMIBIA 50,000 – 199,999 PARAGUAY BOTSWANA MOZAMBIQUE SWEDEN ESTONIA CHILE LATVIA 200,000 or more UK DENMARK RUSSIA LITHUANIA RUSSIA SWAZILAND IRELAND ARGENTINA AUSTRALIA SOUTH NETH. POLAND BELARUS no data AFRICA LESOTHO BEL. GERMANY CZ. UKRAINE K A Z A K H S TA N URUGUAY REP. SL. LUX. MONGOLIA AUS. HUN. MOLDOVA World country average: FRANCE SWITZ. SL. ROM. 5,875 people per dentist U S A CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NEW MONT. ANDORRA ZEALAND ARMENIA AZERBAIJAN ALB. Highest density: SPAIN ITALY MAC. TURKEY TURKMENISTAN TAJIKISTAN PORTUGAL Croatia 568 people per dentist TUNISIA GREECE CYPRUS SYRIA Lowest density: MALTA LEB. AFGHANISTAN CHINA IRAQ IRAN ISRAEL Ethiopia 1,278,446 people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE DOMINICAN Copyright © - FDI World Dental Federation and Myriad Editions. BANGLADESH JAMAICA HAITI REP. SAUDI INDIA Maca SAR
  • 43. Challenge 3: Access to services Dentists - numbers, distribution & migrationITY OF DENTISTS WORKFORCE CHALLENG DENTISTSentist 3,000999,999 ICELAND CANADA NORWAY FINLAND9,999 SWEDEN ESTONIA LATVIAmore UK DENMARK RUSSIA LITHUANIA RUSSIA IRELAND NETH. POLAND BELARUS BEL. GERMANY UKRAINE KAZAKHSTAN CZ. REP. SL. MONGOLIA LUX. AUS. HUN. MOLDOVArage: FRANCE SWITZ. SL. ROM.entist USA CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NORTH KOREA MONT. ANDORRA JAPAN ARMENIA AZERBAIJAN ALB. MAC. PORTUGAL SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN SOUTHe per dentist TUNISIA GREECE CYPRUS SYRIA KOREA MALTA LEB. AFGHANISTAN CHINA IRAQ IRAN ISRAEL people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS LIBYA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE MARSHALL ISLANDS DOMINICAN BANGLADESH Macau FED. STATES JAMAICA HAITI REP. SAUDI INDIA SAR MICRONESIA BELIZE CAPE ARABIA MYANMAR LAOS ANTIGUA & BARBUDA VERDE MAURITANIA OMAN ST KITTS & NEVIS NAURU KIRIBATI GUATEMALA HONDURAS DOMINICA MALI NIGER PHILIPPINES ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN THAILAND EL SALVADOR VIETNAM NICARAGUA GRENADA BARBADOS GAMBIA BURKINA SUDAN TUVALU FASO DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA-BISSAU GUINEA BENIN SAMOA VENEZUELA GHANA PANAMA CÔTE NIGERIA TOGO GUYANA SIERRA LEONE D’IVOIRE CENTRAL ETHIOPIA PALAU FIJI MALDIVES SRI LANKA GLOBAL DENSITY OF DENTISTS COLOMBIA SURINAME LIBERIA CAMEROON EQUAT. AFRICAN REP. MALAYSIA BRUNEI TONGA UGANDA Population per dentist GUINEA KENYA SOMALIA SINGAPORE 2007 ECUADOR SAO TOME GABON & PRINCIPE DEMOCRATIC REPUBLIC OF RWANDA I N D O N E S I A CONGO CONGO BURUNDI PERU PAPUA fewer than 3,000 BRAZIL TANZANIA SEYCHELLES NEW GUINEA SOLOMON COMOROS ISLANDS 3,000 – 19,999 ANGOLA ZAMBIA 20,000 – 49,999 ICELAND MADAGASCAR BOLIVIA C A N A D A NAMIBIA ZIMBABWE MIGRATION NORWAY MAURITIUS OF DENTISTS FINLAND 50,000 – 199,999 PARAGUAY BOTSWANA MOZAMBIQUE Major flows SWEDEN ESTONIA CHILE 1999–2000K LATVIA RUSSIA 200,000 or more SWAZILAND IRELAND U DENMARK RUSSIA LITHUANIA ARGENTINA AUSTRALIA SOUTH NETH. POLAND BELARUS no data AFRICA LESOTHO BEL. GERMANY CZ. UKRAINE K A Z A K H S TA N URUGUAY REP. SL. LUX. MONGOLIA AUS. HUN. MOLDOVA World country average: FRANCE SWITZ. SL. ROM. 5,875 people per dentist U S A CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NEW MONT. ANDORRA ZEALAND ARMENIA AZERBAIJAN ALB. Highest density: SPAIN ITALY MAC. TURKEY TURKMENISTAN TAJIKISTAN PORTUGAL Croatia 568 people per dentist TUNISIA GREECE CYPRUS SYRIA Lowest density: MALTA LEB. CHINA Copyright © - FDI World Dental Federation and Myr AFGHANISTAN IRAQ IRAN ISRAEL Ethiopia 1,278,446 people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE DOMINICAN Copyright © - FDI World Dental Federation and Myriad Editions. BANGLADESH JAMAICA HAITI REP. SAUDI INDIA Maca SAR
  • 44. Challenge 3: Access to services Dentists - numbers, distribution & migrationITY OF DENTISTS WORKFORCE CHALLENG DENTISTSentist 3,000999,999 ICELAND CANADA NORWAY FINLAND9,999 SWEDEN ESTONIA LATVIAmore UK DENMARK RUSSIA LITHUANIA RUSSIA IRELAND NETH. POLAND BELARUS BEL. GERMANY UKRAINE KAZAKHSTAN CZ. REP. SL. MONGOLIA LUX. AUS. HUN. MOLDOVArage: FRANCE SWITZ. SL. ROM.entist USA CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NORTH KOREA MONT. ANDORRA JAPAN ARMENIA AZERBAIJAN ALB. MAC. PORTUGAL SPAIN ITALY TURKEY TURKMENISTAN TAJIKISTAN SOUTHe per dentist TUNISIA GREECE CYPRUS SYRIA KOREA MALTA LEB. AFGHANISTAN CHINA IRAQ IRAN ISRAEL people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS LIBYA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE MARSHALL ISLANDS DOMINICAN BANGLADESH Macau FED. STATES JAMAICA HAITI REP. SAUDI INDIA SAR MICRONESIA BELIZE CAPE ARABIA MYANMAR LAOS ANTIGUA & BARBUDA VERDE MAURITANIA OMAN ST KITTS & NEVIS NAURU KIRIBATI GUATEMALA HONDURAS DOMINICA MALI NIGER PHILIPPINES ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN THAILAND EL SALVADOR VIETNAM NICARAGUA GRENADA BARBADOS GAMBIA BURKINA SUDAN TUVALU FASO DJIBOUTI CAMBODIA COSTA RICA TRINIDAD & TOBAGO GUINEA-BISSAU GUINEA BENIN SAMOA VENEZUELA GHANA PANAMA CÔTE NIGERIA TOGO GUYANA SIERRA LEONE D’IVOIRE CENTRAL ETHIOPIA PALAU FIJI MALDIVES SRI LANKA GLOBAL DENSITY OF DENTISTS COLOMBIA SURINAME LIBERIA CAMEROON EQUAT. AFRICAN REP. MALAYSIA BRUNEI TONGA UGANDA Population per dentist GUINEA KENYA SOMALIA SINGAPORE 2007 ECUADOR SAO TOME GABON & PRINCIPE DEMOCRATIC REPUBLIC OF RWANDA I N D O N E S I A CONGO CONGO BURUNDI PERU PAPUA fewer than 3,000 BRAZIL TANZANIA SEYCHELLES NEW GUINEA SOLOMON COMOROS ISLANDS 3,000 – 19,999 ANGOLA ZAMBIA 20,000 – 49,999 ICELAND MADAGASCAR BOLIVIA C A N A D A NAMIBIA ZIMBABWE MIGRATION NORWAY MAURITIUS OF DENTISTS FINLAND 50,000 – 199,999 PARAGUAY BOTSWANA MOZAMBIQUE Major flows SWEDEN ESTONIA CHILE 1999–2000K LATVIA RUSSIA 200,000 or more SWAZILAND IRELAND U DENMARK RUSSIA LITHUANIA ARGENTINA AUSTRALIA SOUTH NETH. POLAND BELARUS no data AFRICA LESOTHO BEL. GERMANY CZ. UKRAINE K A Z A K H S TA N URUGUAY REP. SL. LUX. MONGOLIA AUS. HUN. MOLDOVA World country average: FRANCE SWITZ. SL. ROM. 5,875 people per dentist U S A CRO. B-H SERB. BUL. GEORGIA UZBEKISTAN KYRGYZSTAN NEW MONT. ANDORRA ZEALAND ARMENIA AZERBAIJAN ALB. Highest density: SPAIN ITALY MAC. TURKEY TURKMENISTAN TAJIKISTAN PORTUGAL Croatia 568 people per dentist TUNISIA GREECE CYPRUS SYRIA Lowest density: MALTA LEB. CHINA Copyright © - FDI World Dental Federation and Myr AFGHANISTAN IRAQ IRAN ISRAEL Ethiopia 1,278,446 people per dentist MOROCCO JORDAN KUWAIT PAKISTAN ALGERIA NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN Hong Kong CUBA EGYPT QATAR SAR UAE DOMINICAN Copyright © - FDI World Dental Federation and Myriad Editions. BANGLADESH JAMAICA HAITI REP. SAUDI INDIA Maca SAR
  • 45. Population growth & prevention
  • 46. Population growth & prevention
  • 47. Population growth & prevention"Prevention by daily use of fluorideis the only realistic way of reducing the high burden of dental decay in populations" Global Consultation on Oral Health through Fluoride, 17-19 Nov 2006, Geneva
  • 48. Fluoride: water, salt & milk
  • 49. Fluoride: water, salt & milkFLUORIDE IN WATERPercentage of the population SWEDEN FINLAND FLUORIDEwith access to appropriateadjusted or natural levels <1% DENMARKof fluoride in water IRELAND UK2004 35% POLAND 69% CZECH <1% 76% – 100% GERMANY REP. 5% BELGIUM SLOVAKIA RUSSIA 51% – 75% C A N A D A 8% FRANCE SERBIA 26% – 50% SPAIN AUSTRIA BULGARIA 6% – 25% 3% 88% less than 5% SWITZERLAND U S A no data SOUTH countries with some milk KOREA CYPRUS fluoridation, percentage of children MALTA aged 0–14 years reached ISRAEL countries where fluoridated salt is available and market share if 79% L I B YA Hong Kong SAR known MEXICO 60% CUBA DOMINICAN REP. HAITI PUERTO RICOGLOBAL FLUORIDE USE GUATEMALA 100% JAMAICA KIRIBATI SENEGALNumber of people worldwide using 3% VIETNAMdifferent sources of fluoride COSTA RICA THAILAND2001 PANAMA VENEZUELA NIGERIA GUYANA SRI LANKA FIJI BRUNEIFluoridated milk COLOMBIA MALAYSIA less than 1 million SINGAPORE GABON DEMOCRATIC ECUADORFluoride drops/tablets REPUBLIC OF CONGO 15 million TANZANIA PAPUA NEW GUINEAProfessionally applied topical fluoride PERU BRAZIL 30 million ZAMBIAWater with naturally appropriate levels of fluoride 40% ZIMBABWE BOLIVIA 50 million CHILE PARAGUAYFluoride mouthrinses AUSTRALIA 100 million ARGENTINA 6% URUGUAY 90%Salt fluoridation 160 millionWater fluoridation (adjusted) 368 million NEW ZEALANDFluoride toothpaste 1,500 million Copyright © - FDI World Dental Federation and Myriad Editions.
  • 50. Affordable fluoride toothpaste
  • 51. Affordable fluoride toothpaste
  • 52. Affordable fluoride toothpaste FLUORIDE TOOTHPASTE WORLD TOOTHPASTE MARKET Average annual expenditure per person by region 2006 $8.55 $6.72 1 US$ $4.03 Eastern Europe North Western America Europe $0.74 $1.03 $3.68 Asia–Pacific $6.14 Middle East & Africa Latin America Australasia Copyright © - FDI World Dental Federation and Myriad Editions.
  • 53. Challenge 4: CostsInvestments in health
  • 54. Challenge 4: Costs Investments in healthVISION EXPENDITURE ON DENTAL CARE ECONOMICSct As percentage of ICELAND total health expenditure, NORWAY 8.0% 7.0% FINLAND where known SWEDEN ESTONIA latest available 2004–07 8.5% LATVIA 3.5% DENMARK 2.4% IRELAND UK 7.0% LITHUANIA 6% – 12% NETH. GERMANY 3.6% BELARUS POLAND UKRAINE C A N A D A 6.5% BELGIUM CZECH less than 6% 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA AUSTRIA HUNGARY FRANCE SWITZ. CROATIA ROMANIA 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO ANDORRA ALB. MACEDONIA SPAIN K A Z A K H S TA N 7.6% MONGOLIA SLOVENIA 3.0% 3.0% U S A MONTENEGRO GREECE UZBEKISTAN 0.5% JAPAN NORTHds 15.4% GEORGIA KYRGYZSTAN KOREAnea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN CHINA PALAU MOROCCO IRAQ IRAN MARSHALL ISLANDS ISRAEL JORDAN FED. STATES KUWAIT MICRONESIA ALGERIA 12.0% PAKISTAN NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN KIRIBATI CUBA NAURU EGYPT QATAR DOMINICAN UAE REP. BANGLADESH SOLOMON TUVALU HAITI SAUDI INDIA ISLANDS BELIZE JAMAICA CAPE ARABIA LAOS ANTIGUA & BARBUDA MALI OMAN MYANMAR ST KITTS & NEVIS VERDE MAURITANIA SAMOA GUATEMALA HONDURAS DOMINICA NIGER THAILAND PHILIPPINES VANUATU COOK EL SALVADOR ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN ISLANDS VIETNAM FIJI NICARAGUA GRENADA BARBADOS GAMBIA SUDAN BURKINA CAMBODIA TONGA TRINIDAD & TOBAGO GUINEA- FASO DJIBOUTI COSTA RICA GUINEA NIUE BISSAU SRI LANKA VENEZUELA GHANA NIGERIA TOGO PANAMA CÔTE GUYANA SIERRA D’IVOIRE CENTRAL ETHIOPIA SURINAME LEONE AFRICAN REP. CAMEROON MALDIVES BRUNEI COLOMBIA LIBERIA EQUATORIAL UGANDA MALAYSIA GUINEA 3.0% SINGAPORE KENYA ECUADOR 1.8% SÃO TOMÉ GABON DEMOCRATIC REPUBLIC OF RWANDA ECONO & PRINCIPE BENIN CONGO CONGO BURUNDI HEALTH CARE PROVISION EXPENDITURE PERU BRAZIL TANZANIA SEYCHELLES PAPUA I N D O N E S I A NEW Percentage of ON DENTAL CARE GUINEA EAST TIMOR Gross Domestic Product As percentage of ANGOLA ICELAND COMOROS 5.0% MALAWI spent on health care total health expenditure, ZAMBIA NORWAY FINLAND 8.0% 7.0% MADAGASCAR 2005 where known BOLIVIA ZIMBABWE SWEDEN MAURITIUS ESTONIA less than 4.0% latest available 2004–07 NAMIBIA 8.5% BOTSWANA MOZAMBIQUE LATVIA CHILE PARAGUAY 3.5% DENMARK 2.4% IRELAND UK 7.0% LITHUANIA AUSTRALIA 4.0% – 5.9% 6% – 12% GERMANY SWAZILAND 3.6% NETH. BELARUS ARGENTINA SOUTH POLAND 6.0% – 7.9% CANADA LESOTHO AFRICABELGIUM CZECH UKRAINE 5.8% 6.5% less than 6% URUGUAY 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA 8.0% – 9.9% AUSTRIA HUNGARY FRANCE SWITZ. CROATIA ROMANIA 10% or more 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO no data ANDORRA ALB. MACEDONIA NEW SPAIN KAZAKHSTAN MONGOLIA ZEALAND 7.6% World average: 6.3% USA SLOVENIA 3.0% 3.0% GREECE 0.5% MONTENEGRO UZBEKISTAN NORTH JAPAN Highest: Marshall Islands 15.4% GEORGIA KYRGYZSTAN KOREA Lowest: Equatorial Guinea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA Copyright © - FDI World Dental Federation and Myriad Editions. MALTA LEB. AFGHANISTAN CHINA PA IRAQ
  • 55. Challenge 4: Costs Investments in healthVISION EXPENDITURE ON DENTAL CARE ECONOMICSct $5,000 /yr for oral As percentage of ICELAND total health expenditure, NORWAY 8.0% 7.0% FINLAND where known SWEDEN ESTONIA latest available 2004–07 8.5% LATVIA 3.5% DENMARK 2.4% care & $150 for IRELAND UK 7.0% LITHUANIA 6% – 12% NETH. GERMANY 3.6% BELARUS POLAND UKRAINE C A N A D A 6.5% BELGIUM CZECH less than 6% 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA AUSTRIA HUNGARY FRANCE SWITZ. personal prevention CROATIA ROMANIA 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO ANDORRA ALB. MACEDONIA SPAIN K A Z A K H S TA N 7.6% MONGOLIA SLOVENIA 3.0% 3.0% U S A 0.5% (dental hygienist etc) in MONTENEGRO GREECE UZBEKISTAN JAPAN NORTHds 15.4% GEORGIA KYRGYZSTAN KOREAnea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN CHINA PALAU MOROCCO IRAQ IRAN MARSHALL ISLANDS high income countries ISRAEL JORDAN FED. STATES KUWAIT MICRONESIA ALGERIA 12.0% PAKISTAN NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN KIRIBATI CUBA NAURU EGYPT QATAR DOMINICAN UAE REP. BANGLADESH SOLOMON TUVALU HAITI SAUDI INDIA ISLANDS BELIZE JAMAICA CAPE ARABIA LAOS ANTIGUA & BARBUDA MALI OMAN MYANMAR ST KITTS & NEVIS VERDE MAURITANIA SAMOA GUATEMALA HONDURAS DOMINICA NIGER THAILAND PHILIPPINES VANUATU COOK EL SALVADOR ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN ISLANDS VIETNAM FIJI NICARAGUA GRENADA BARBADOS GAMBIA SUDAN BURKINA CAMBODIA TONGA TRINIDAD & TOBAGO GUINEA- FASO DJIBOUTI COSTA RICA GUINEA NIUE BISSAU SRI LANKA VENEZUELA GHANA NIGERIA TOGO PANAMA CÔTE GUYANA SIERRA D’IVOIRE CENTRAL ETHIOPIA SURINAME LEONE AFRICAN REP. CAMEROON MALDIVES BRUNEI COLOMBIA LIBERIA EQUATORIAL UGANDA MALAYSIA GUINEA 3.0% SINGAPORE KENYA ECUADOR 1.8% SÃO TOMÉ GABON DEMOCRATIC REPUBLIC OF RWANDA ECONO & PRINCIPE BENIN CONGO CONGO BURUNDI HEALTH CARE PROVISION EXPENDITURE PERU BRAZIL TANZANIA SEYCHELLES PAPUA I N D O N E S I A NEW Percentage of ON DENTAL CARE GUINEA EAST TIMOR Gross Domestic Product As percentage of ANGOLA ICELAND COMOROS 5.0% MALAWI spent on health care total health expenditure, ZAMBIA NORWAY FINLAND 8.0% 7.0% MADAGASCAR 2005 where known BOLIVIA ZIMBABWE SWEDEN MAURITIUS ESTONIA less than 4.0% latest available 2004–07 NAMIBIA 8.5% BOTSWANA MOZAMBIQUE LATVIA CHILE PARAGUAY 3.5% DENMARK 2.4% IRELAND UK 7.0% LITHUANIA AUSTRALIA 4.0% – 5.9% 6% – 12% GERMANY SWAZILAND 3.6% NETH. BELARUS ARGENTINA SOUTH POLAND 6.0% – 7.9% CANADA LESOTHO AFRICABELGIUM CZECH UKRAINE 5.8% 6.5% less than 6% URUGUAY 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA 8.0% – 9.9% AUSTRIA HUNGARY FRANCE SWITZ. CROATIA ROMANIA 10% or more 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO no data ANDORRA ALB. MACEDONIA NEW SPAIN KAZAKHSTAN MONGOLIA ZEALAND 7.6% World average: 6.3% USA SLOVENIA 3.0% 3.0% GREECE 0.5% MONTENEGRO UZBEKISTAN NORTH JAPAN Highest: Marshall Islands 15.4% GEORGIA KYRGYZSTAN KOREA Lowest: Equatorial Guinea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA Copyright © - FDI World Dental Federation and Myriad Editions. MALTA LEB. AFGHANISTAN CHINA PA IRAQ
  • 56. Challenge 4: Costs Investments in healthVISION EXPENDITURE ON DENTAL CARE ECONOMICSct $5,000 /yr for oral As percentage of ICELAND total health expenditure, NORWAY 8.0% 7.0% FINLAND where known SWEDEN ESTONIA latest available 2004–07 8.5% LATVIA $0.30 - $0.50 /yr for 3.5% DENMARK 2.4% care & $150 for IRELAND UK 7.0% LITHUANIA 6% – 12% NETH. GERMANY 3.6% BELARUS POLAND UKRAINE C A N A D A 6.5% BELGIUM CZECH less than 6% 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA fluoride toothpaste AUSTRIA HUNGARY FRANCE SWITZ. personal prevention CROATIA ROMANIA 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO ANDORRA ALB. MACEDONIA SPAIN K A Z A K H S TA N 7.6% MONGOLIA SLOVENIA 3.0% 3.0% U S A 0.5% (dental hygienist etc) in MONTENEGRO GREECE UZBEKISTAN JAPAN NORTHds 15.4% GEORGIA KYRGYZSTAN KOREAnea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN CHINA PALAU MOROCCO IRAQ IRAN MARSHALL ISLANDS high income countries ISRAEL JORDAN FED. STATES KUWAIT MICRONESIA ALGERIA 12.0% PAKISTAN NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN KIRIBATI CUBA NAURU EGYPT QATAR DOMINICAN UAE REP. BANGLADESH SOLOMON TUVALU HAITI SAUDI INDIA ISLANDS BELIZE JAMAICA CAPE ARABIA LAOS ANTIGUA & BARBUDA MALI OMAN MYANMAR ST KITTS & NEVIS VERDE MAURITANIA SAMOA GUATEMALA HONDURAS DOMINICA NIGER THAILAND PHILIPPINES VANUATU COOK EL SALVADOR ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN ISLANDS VIETNAM FIJI NICARAGUA GRENADA BARBADOS GAMBIA SUDAN BURKINA CAMBODIA TONGA TRINIDAD & TOBAGO GUINEA- FASO DJIBOUTI COSTA RICA GUINEA NIUE BISSAU SRI LANKA VENEZUELA GHANA NIGERIA TOGO PANAMA CÔTE GUYANA SIERRA D’IVOIRE CENTRAL ETHIOPIA SURINAME LEONE AFRICAN REP. CAMEROON MALDIVES BRUNEI COLOMBIA LIBERIA EQUATORIAL UGANDA MALAYSIA GUINEA 3.0% SINGAPORE KENYA ECUADOR 1.8% SÃO TOMÉ GABON DEMOCRATIC REPUBLIC OF RWANDA ECONO & PRINCIPE BENIN CONGO CONGO BURUNDI HEALTH CARE PROVISION EXPENDITURE PERU BRAZIL TANZANIA SEYCHELLES PAPUA I N D O N E S I A NEW Percentage of ON DENTAL CARE GUINEA EAST TIMOR Gross Domestic Product As percentage of ANGOLA ICELAND COMOROS 5.0% MALAWI spent on health care total health expenditure, ZAMBIA NORWAY FINLAND 8.0% 7.0% MADAGASCAR 2005 where known BOLIVIA ZIMBABWE SWEDEN MAURITIUS ESTONIA less than 4.0% latest available 2004–07 NAMIBIA 8.5% BOTSWANA MOZAMBIQUE LATVIA CHILE PARAGUAY 3.5% DENMARK 2.4% IRELAND UK 7.0% LITHUANIA AUSTRALIA 4.0% – 5.9% 6% – 12% GERMANY SWAZILAND 3.6% NETH. BELARUS ARGENTINA SOUTH POLAND 6.0% – 7.9% CANADA LESOTHO AFRICABELGIUM CZECH UKRAINE 5.8% 6.5% less than 6% URUGUAY 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA 8.0% – 9.9% AUSTRIA HUNGARY FRANCE SWITZ. CROATIA ROMANIA 10% or more 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO no data ANDORRA ALB. MACEDONIA NEW SPAIN KAZAKHSTAN MONGOLIA ZEALAND 7.6% World average: 6.3% USA SLOVENIA 3.0% 3.0% GREECE 0.5% MONTENEGRO UZBEKISTAN NORTH JAPAN Highest: Marshall Islands 15.4% GEORGIA KYRGYZSTAN KOREA Lowest: Equatorial Guinea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA Copyright © - FDI World Dental Federation and Myriad Editions. MALTA LEB. AFGHANISTAN CHINA PA IRAQ
  • 57. Challenge 4: Costs Investments in healthVISION EXPENDITURE ON DENTAL CARE ECONOMICSct $5,000 /yr for oral As percentage of ICELAND total health expenditure, NORWAY 8.0% 7.0% FINLAND where known SWEDEN ESTONIA latest available 2004–07 8.5% LATVIA $0.30 - $0.50 /yr for 3.5% DENMARK 2.4% care & $150 for IRELAND UK 7.0% LITHUANIA 6% – 12% NETH. GERMANY 3.6% BELARUS POLAND UKRAINE C A N A D A 6.5% BELGIUM CZECH less than 6% 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA fluoride toothpaste AUSTRIA HUNGARY FRANCE SWITZ. personal prevention CROATIA ROMANIA 8.0% S. M. B-H SERBIA 3.0% PORTUGAL ITALY BULGARIA RUSSIA MONACO ANDORRA ALB. MACEDONIA SPAIN K A Z A K H S TA N 7.6% MONGOLIA SLOVENIA 3.0% 3.0% U S A 0.5% (dental hygienist etc) in MONTENEGRO GREECE UZBEKISTAN JAPAN NORTHds 15.4% GEORGIA KYRGYZSTAN KOREAnea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA MALTA LEB. AFGHANISTAN CHINA PALAU MOROCCO IRAQ IRAN MARSHALL ISLANDS high income countries ISRAEL JORDAN FED. STATES KUWAIT MICRONESIA ALGERIA 12.0% PAKISTAN NEPAL BHUTAN MEXICO BAHAMAS L I B YA BAHRAIN KIRIBATI CUBA NAURU EGYPT QATAR DOMINICAN UAE REP. BANGLADESH SOLOMON TUVALU HAITI SAUDI INDIA ISLANDS BELIZE JAMAICA CAPE ARABIA LAOS ANTIGUA & BARBUDA MALI OMAN MYANMAR ST KITTS & NEVIS VERDE MAURITANIA SAMOA GUATEMALA HONDURAS DOMINICA NIGER THAILAND PHILIPPINES VANUATU COOK ST VINCENT & THE GRENADINES ST LUCIA SENEGAL CHAD ERITREA YEMEN But only 10-15% of the EL SALVADOR VIETNAM FIJI ISLANDS NICARAGUA GRENADA BARBADOS GAMBIA SUDAN BURKINA CAMBODIA TONGA TRINIDAD & TOBAGO GUINEA- FASO DJIBOUTI COSTA RICA GUINEA NIUE BISSAU SRI LANKA VENEZUELA GHANA NIGERIA TOGO PANAMA CÔTE GUYANA SIERRA D’IVOIRE CENTRAL ETHIOPIA SURINAME LEONE AFRICAN REP. CAMEROON MALDIVES BRUNEI COLOMBIA LIBERIA EQUATORIAL UGANDA MALAYSIA GUINEA 3.0% SINGAPORE worlds population have ECONO KENYA ECUADOR 1.8% SÃO TOMÉ GABON DEMOCRATIC REPUBLIC OF RWANDA & PRINCIPE BENIN CONGO CONGO BURUNDI HEALTH CARE PROVISION EXPENDITURE PERU BRAZIL TANZANIA SEYCHELLES PAPUA I N D O N E S I A NEW Percentage of ON DENTAL CARE GUINEA EAST TIMOR Gross Domestic Product As percentage of ANGOLA COMOROS access to affordable and ICELAND 5.0% MALAWI spent on health care total health expenditure, ZAMBIA NORWAY FINLAND 8.0% 7.0% MADAGASCAR 2005 where known BOLIVIA ZIMBABWE SWEDEN MAURITIUS ESTONIA less than 4.0% latest available 2004–07 NAMIBIA 8.5% BOTSWANA MOZAMBIQUE LATVIA CHILE PARAGUAY 3.5% DENMARK 2.4% IRELAND UK 7.0% LITHUANIA AUSTRALIA appropriate fluoride 4.0% – 5.9% 6% – 12% GERMANY SWAZILAND 3.6% NETH. BELARUS ARGENTINA SOUTH POLAND 6.0% – 7.9% CANADA LESOTHO AFRICABELGIUM CZECH UKRAINE 5.8% 6.5% less than 6% URUGUAY 3.3% LUX. 8.6% REP. SLOVAKIA MOLDOVA 8.0% – 9.9% AUSTRIA HUNGARY FRANCE SWITZ. CROATIA ROMANIA 10% or more S. M. 3.0% WHO World Oral Health Report 2003 8.0% B-H SERBIA PORTUGAL ITALY BULGARIA RUSSIA MONACO no data ANDORRA ALB. MACEDONIA NEW SPAIN KAZAKHSTAN MONGOLIA ZEALAND 7.6% World average: 6.3% USA SLOVENIA 3.0% 3.0% GREECE 0.5% MONTENEGRO UZBEKISTAN NORTH JAPAN Highest: Marshall Islands 15.4% GEORGIA KYRGYZSTAN KOREA Lowest: Equatorial Guinea 1.7% ARMENIA AZERBAIJAN SOUTH 4.5% TURKEY TURKMENISTAN TAJIKISTAN KOREA 5.0% TUNISIA CYPRUS SYRIA Copyright © - FDI World Dental Federation and Myriad Editions. MALTA LEB. AFGHANISTAN CHINA PA IRAQ
  • 58. The price of neglect
  • 59. The price of neglect
  • 60. Solutions
  • 61. Solutions• Prevention
  • 62. Solutions• Prevention• Behaviour change
  • 63. Solutions• Prevention• Behaviour change• Evidence-based interventions
  • 64. Solutions• Prevention• Behaviour change• Evidence-based interventions• Primary healthcare
  • 65. Solutions• Prevention• Behaviour change• Evidence-based interventions• Primary healthcare• Task shifting
  • 66. Thank you
  • 67. Thank you www.OralHealthAtlas.orgwww.fdiworldental.org/data-mirror www.phrisk.co.uk