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1. Dental Public Health
[Type the document subtitle]

2. Table of Contents
Introduction .......................................................................................................................................3
Role of FDI World Dental Federation ..................................................................................................5
Strategies & Management of Oral Diseases..........................................................................................6
National Dental Associations (NDAs): Area of Action..........................................................................7
Indicators for Oral Health....................................................................................................................9
The UN Political Declaration.............................................................................................................10
Government Commitments & National Actions ..................................................................................13
Conclusion.......................................................................................................................................16
References .......................................................................................................................................17

3. Introduction
On 19-20th September 2011, a high level meeting on non-communicable diseases was held by the
United Nations General Assembly that presented the international community with a unique
opportunity to take measures against epidemics and augment developmental initiatives as a
means of saving millions of lives. This United Nations meeting served the purpose of raising
awareness regarding the recent increase of non-communicable diseases in the developing and
developed worlds, at an international level. The meeting was prepared for by stakeholders such
as professional organisations, non-governmental organisations, private sector, academia and
organisations of the civil society (United Nations, 2011).
Among the non-communicable diseases recognised by the World Health Organization, the four
major non-communicable diseases are cardiovascular diseases, cancer, chronic lung diseases and
diabetes (Fig. 1); these are seen as major threats to the world development (Ministry of health,
2003). During the meeting, the socio-economic impact of non-communicable diseases and their
increasing burden on the community was identified; several commitments were made towards
taking severe actions on both national and global level so as to treat and prevent non-
communicable diseases. Fig. 1: (Ministry of health, 2003)
Major Non
Communicable
Diseases
Cardiovascular
Diseases
Cancer
Chronic Lung
Diseases
Diabetes

4. The FDI World Dental Federation that is in line with the World Health Organisation recognises
oral diseases as a significant part of the non-communicable disease group and used this
opportunity i.e. the high level UN meeting, to elevate their profile and promote the requirement
of improved oral health at both national and global level (United Nations, 2011).. It is necessary
to understand that non-communicable diseases are often caused by factors including tobacco &
sugar intake, unhealthy diet, access alcohol consumption and reduced physical activity levels.
These factors are similar to those involved in causing oral diseases. Hence, during the meeting,
the UN Political Declaration identified the common risk factors shared by oral diseases with non-
communicable diseases and established that these may benefit from the responses to non-
communicable diseases.
The rising burden of non communicable diseases is majorly hindering global development along
with accomplishment of several goals; it is necessary to understand that non-communicable
diseases to a great extent contribute to hunger & poverty and play a significant role in the
unequal distribution of heath across countries (United Nations, 2011).. Additionally, the global
burden exerted by oral diseases continues to grow every minute; their impact is noticeable in
terms of reduced life quality, impaired functioning, pain & suffering and treatment cost. Similar
to the inequalities of other non-communicable diseases, the unequal distribution of the outcomes
of oral health are now unacceptable. Thus, promotion of health equity became the major focus
during the meeting and several declarations were made towards the reduction of such
inequalities.
The following report discusses the concepts of the UN strategy for reduction of non-
communicable diseases and the policies that the dental professional should adopt so as to prevent
oral diseases and other non-communicable diseases. It is necessary to understand that several
concepts were underlined during the high level UN meeting and only some of them, specifically
those that discuss & elaborate the policies and methods for reduction and prevention of oral
diseases are discussed in the following report.
Determinants of Chronic Diseases:
Sheiham & Watt (2000) describe some of the determinants of the chronic diseases. They say that
health factors are influenced by some key variables as well as the reasons why a person may

5. catch a disease. (Sheiham & Watt, 2000) The prompt reasons for the real dental sicknesses,
caries and periodontal illness are eating regimen, Normal danger element approach plaque and
smoking. Oral mucosal injuries, oral malignancy, temporomandibular joint brokenness and
torment are identified with tobacco, liquor and stress and injury to teeth and wounds (Fig. 2). As
these reasons are normal to various other endless infections, for example, coronary illness,
tumor, and strokes, it is normal to utilize a typical danger element approach
Fig. 2: (Sheiham & Watt, 2000)
Role of FDI World Dental Federation
The FDI World Dental Federation plays an essential role when discussing reduction and
prevention of oral diseases on a global scale (WHO, 2011). A policy statement prepared by FDI
containing the oral health policies will serve the purpose of an advisory document for NDAs i.e.
National Dental Associations. The statement generated by FDI takes into account the UN
Obesity
Diabetes
Cancers
Cardiovascular
Diseases
RespiratoryDiseases
Mental Illness
Dental Carries
SkinDiseases
Periodontal Diseases
Trauma – Teeth&
Bones
Diet
Control
Stress
Excercise
Alcohol
Smoking
Injuries
Hygiene

6. Political Declaration of non-communicable diseases and the outcomes of the Rio Summit
conducted on Social Determinants of Health; these are expected to directly affect the oral health
sector which in turn will help in the expansion of the scope of dentistry nationally and globally.
In other words, FDI aims on playing a crucial role and part in the current and future agendas for
global health.
FDI effectively recognizes that health along with the economic and psychosocial impact of oral
diseases across developed and developing countries have not been effectively integrated into the
global response that happens to be proportionate to the scale of their impacts. Thus, the FDI
should aim to:
1. Become a part of the initiatives for global health improvement and integrate oral health
onto the agenda of non-communicable diseases. This will allow for improvement of oral
health and health on a global scale, especially in countries with insufficient knowledge
regarding dental personnel.
2. Continue to explore the establishment of Oral Health Alliance for the promotion of
improvement of oral health on a national and global scale with stakeholders; they should
continue to collaborate in the private sector along with NGOs. Similarly, it will be
beneficial for them to continue to actively collaborate with NCD Alliance and WHPA.
3. Explore and discuss with IADR and World Health Organisation the possibilities of
constructing guidelines for the development of goals of oral health where these goals
may include any sociodental goals in terms of oral health. Any need of manpower in
terms of determining the social determinants of health should be mentioned.
Strategies & Management of Oral Diseases
Earlier on, a 2007 World Health Organisation had been working on integrating oral health into
the list of prevention programmes for chronic diseases. The approaches used for the purpose of
prevention and control of oral diseases had turned out to be ineffective. Though, there are several
existing approaches and methods that can be used in prevention of large proportion of oral
diseases. Considering these, the FDI aims to encourage;
1. Reduction of the “knowledge-implementation gap.” This can be achieved by
recommending guidelines that health promotion activities based on evidence.

7. 2. Following the principles outlined and mentioned in the Ottawa Charter for Promotion of
Health care; these principles recommend the need of shifting from vertical to horizontal
approaches and encourages involvement and integration with those who are actively and
currently combating non-communicable diseases.
As previously mentioned, the UN Political Declaration identified the common risk factors shared
by oral diseases with non-communicable diseases and established that these may benefit from the
responses to non-communicable diseases (WHO, 2011). It is evidence that several oral diseases
share common risk factors with other non-communicable diseases such as diabetes, cancer,
cardiovascular diseases etc. For this reason, the prevention of oral diseases needs to be integrated
with prevention of other non-communicable diseases and should be outline in the Common Risk
Factor Approach (CRFA) which is known to address the risk factors that are common to other
chronic conditions. Additionally, any evidence based strategies should be comprehensible,
participatory and multidisciplinary in nature; they should address the social determinants
involved in improvement of oral health. Also, there should be a focus on encouraging
interventions that are worldwide and factors that allow promotion of health along with the
interventions that result in reduction of burdens caused by diseases, on a global level.
National Dental Associations (NDAs): Area of Action
From research, it is evident that there is a strong relationship between oral diseases and the rest
of the non-communicable diseases such as cancer, diabetes, respiratory and cardiovascular
diseases. For instance, diabetes mellitus has been recognised for influencing the developing of
periodontal diseases; apart from the expected results, the treatment of periodontal diseases has
proved beneficial in controlling blood glucose levels (United Nations, 2011).. It is necessary to
understand that periodontal diseases are also well connection to cardiovascular diseases. When
discussing cancer, oral cancer is enlisted among the most common cancers across the globe,
where intake of alcohol and use of tobacco are enlisted as the most common and major risk
factors. Similarly, respiratory or lung diseases may also be result of oral microflora.
Practical and manageable options for combating oral diseases are to be presented by FDI &
national dental associations in terms of social determinants of oral health and non-communicable
diseases. Within national dental associations, authorities must be informed of and possess

8. knowledge regarding the relationship between various oral diseases and other non-communicable
diseases along with their common risk factors (AOK Health Grant, 2003). The authorities should
be well aware of the considerable amount of suffering & pain caused by oral diseases, the day-
to-day life disruption and the economic burden they have on the society.
As the global movement of awareness regarding non-communicable diseases continues to gain
momentum, determinants of non-communicable diseases will be majorly impacted; some of
these include reduction of tobacco and sugar intake which may potentially reduce oral diseases
and in turn effect dental practices globally, the number of dental health practitioners and
manpower infrastructure involved. Hence, the worldwide consideration of non-communicable
diseases movement is necessary for the dentistry industry so as to effectively reduce the burden
of oral diseases; for this direct participation of the dental profession is crucial. In other words, it
is highly essential for national dental associations to remain pro-active in the current health
initiative taken at a global scale.
National dental associations and dentists play a crucial role in combating non-communicable
diseases and their primary principle role is of an advocate; this refers to their role of advocating
the integration and implementation of well-developed interventions that may be within or outside
the health sector (Ministry of health, 2003). They are required to consider ways that would allow
creation and enhancement of synergies among various sectors such as employment, education &
agriculture. Additionally, they are also required to inform & educate government, community
leaders and policy marks regarding the impact and necessity of oral health and its well being
(AOK Health Grant, 2003). For instance, they should be well informed regarding the influences
of sugar and tobacco control within their food and tobacco industries.
National Dental Associations should combating oral diseases, as a part of the current non-
communicable diseases agenda, by using the common risk factor approach and the available
evidence that will allow prevention, when discussing the determinants of oral health. This
approach will not benefit the improvement of oral health along with the evidence based oral
health care but will also result in reduction of rates of non-communicable diseases.

9. Indicators for Oral Health
When discussing the indicators and targets, three such global indicators and target in terms of
Oral Health may be discussed and should be considered (AOK Health Grant, 2003). They are as
following:
Indicators Target Note
1.
The proportion of number
of children with caries.
This proportion of number
is reduced by…
According to
www.fdiworlddental.org/data-
mirror, the dental cares in
young adults aged between 6
and 19 years, is used as an
indicator.
2.
The number of days lost in
school due to oral diseases
The number of days lost
in school due to oral
diseases can be reduced
by…
According to FDI’s oral
health Atlas, in 2008,
approximately 1900 hours of
school were lost per 1000
children, in Thailand due to
oral health problems.
3.
The number of national
health care facilities
available so as to provide
urgent and safe treatment to
those in need.
The number of health care
facilities available on a
national scale can be
increased by…
Research states that oral pain
is ranked high in the health
complaints made by patients
who intend to seek health at
such primary health care
facilities. For this reason, the
appointment of highly skilled
health workers who are
capable of using emergency
oral care, is essential. In
complicated cases, the
patients can be referred to
next level of health care by

10. such workers; this can be
used as a means to increase
safety and ensure affordable
oral care.
The UN Political Declaration
As previously mentioned, UN Political Declaration identified the common risk factors shared by
oral diseases with non-communicable diseases and established that these may benefit from the
responses to non-communicable diseases (AOK Health Grant, 2003). It is important to
understand that the UN Political Declaration defined and identified a global response to non-
communicable diseases; the problems and the need to act further so as to combat these problems
were recognised. The declaration contains a series of commitments made that ensure action,
unlike the previous documents on non-communicable diseases that simply urge and advice
measures. One should understand that a declaration holds crucial importance since it is a
powerful tool used by the UN to ensure action and cooperation internationally.
The contents of the Declaration can be analysed under themes including national leadership &
ownership, diagnosis & treatment, prevention, improving health systems, research &
development, resources, global development agenda and NCDs, partnered NGOs, monitoring
and evaluation, plan of action.
Subject Commitments
National Leadership
& Ownership
 Establishing and strengthening national non-communicable diseases
policies and plans by 2013
 Integrate the non-communicable disease policies into the national
health planning programs and develop further agendas
 Promotion of “whole-of-government” and “whole-of-society”
concepts across the private sectors.
Early diagnosis &
Treatment
 Prioritizing the need of early detection, diagnosis, screening and
treatment of non-communicable diseases.
 Increasing affordability, safety, effectiveness and quality of

11. medicines & technologies with the help of generics and patent
licensing.
 Increasing accessibility to such medical health care.
 Increasing maintenance and accessibility of equipment and
technologies
 Promotion of patient empowerment
Prevention
 Promotion of health policies national and globally
 Implementing and strengthening population wide and cost effective
interventions so as to reduce the risk factors associated with non-
communicable diseases
 Promoting intake of healthy diets by implementing the
recommendations of the world health organisation onto food and
beverages manufactured for children. This can be further achieved by
eliminating trans fats; reducing salt, saturate fats & sugars;
encouragement of politics that support manufacturing and promotion
of healthy food products.
 Increasing awareness regarding the need of physical activity for
children; physical activity should be prioritized in all educational
sectors. For instance, prioritizing physical education in schools.
Additionally, awareness regarding physical activity can be ensured in
areas such as urban planning, transportation, work-site healthy
lifestyle programmers, public parks and other recreational spaces.
 Accelerate the implementation of control on tobacco use and control
by State parties and encourage countries who have not done so to
consider to agree.
 Promotion and creation of implementation of healthy behaviours in
working environments such as among workers; one way would be
creating tobacco free workplaces.
 Promotion of prevention of non-communicable diseases and
implementing control within the reproductive and sexual, maternal &

12. child health programmes such as breastfeeding for the first 6 months.
Improvement of
Health System
 Strengthening health systems that support universal coverage, cost
effective services and healthcares that work towards preventing,
detecting, treating and caring for non-communicable diseases.
 Promotion of training and retention of health care workers
 Strengthening the information system used in planning and managing
health care support systems
 Strengthening the infrastructure within healthcares which will further
allow feasible procurement, distribution and storage of medicines and
equipments.
Research &
Development
 Strengthening the capacity for research and development on non-
communicable diseases on a national level and ensuring its
integration into the programmes designed by health care systems.
Resourcing
 Identifying, mobilizing, predicting & sustaining the financial
resources through regional, domestic, bilateral & multilateral
channels and other financing mechanisms.
 Providing other countries with technical assistance and the capacity
building for the purpose of development and enhancing aid quality
along with fulfilling any commitments related to Official
Development Assistance (ODA).
 Prioritizing the financial allocations for non-communicable diseases
on a national level and establishing taxation measure where needed
and appropriate.
Global Development
Agenda
 Encouragement of inclusion of non-communicable diseases into the
cooperation development agenda and health care initiatives like the
millennium development goals.
Collaboration with
NGOs
 Promote and encourage partnerships between governments and civil
societies
 Ensuring the active and complete participation of civilians with non-
communicable diseases during national responses; encouraging the

13. community to take part in such activities so as to create awareness
 Promotion of building of non-communicable disease related NGOs
regionally and nationally; will help creating awareness regarding non-
communicable diseases and provide civilians with education on the
matter.
Monitoring &
Evaluation
 Strengthening the surveillance and monitoring systems of the country
 Developing a global monitoring framework for non-communicable
diseases and setting up targets globally along with indicators
 Considering and outlining the various national targets and indicators
Follow up Action
 The UN Secretary General is to present any recommendations for the
bilateral and multisectoral non-communicable disease partnership, in
2012.
 The UN Secretary General is to present a progress report on the non-
communicable diseases and on the impact made developmental goals
that are agreed up internationally, in 2013.
 The UN is to hold a meeting that will aim to review and assess the
progress of what was been achieved till date, in 2014.
Government Commitments & National Actions
The timeframe outline for the action continues to evolve with the progress in the process i.e.
within the UN & WHO. As per research, the upcoming global action plan on non-communicable
diseases is expected to run from 2013-2020
(World Economic Forum, 2010-2030). The key messages offered by FDI for national dental
associations include:
1. The dental profession should commit to contribute to the prevention and potential early
diagnosis of non-communicable diseases. Due to the shared common risk factors, the
dental professionals are obligated to contribute to the mission.

14. 2. The dental profession shall be considered a unique position in supporting the national
non-communicable disease policies and strategies. Due to their access to “healthy”
patients in their daily work life, they are obligated to raise awareness regarding the risk of
oral diseases and hence, increase prevention.
3. Dental professionals should understand the scarcity of resources and that they should be
willing to contribute effectively, with all their forces and combining with others during
establishment and implementation of prevention strategies. They should be highly
focused on the achieving the enlisted objective in the Millennium Development Goals.
4. Dental professionals should recognise the close link and relationship between oral health
and other non-communicable diseases and that oral disease are a non-communicable
disease risk facto itself.
Along with the above mentioned key messages, several national priorities were made (Ministry
of health, 2003). The Political Declaration emphasises the commitments that are to be advocated
at a national level, which include:
1. Adaptation of an integrated approach towards determinants of the non-communicable
diseases; this is of high priority since recommended by the World Health Organisation
Commission to the Social Determinants of Health.
2. Establishment of multisectoral policies and plans for improvement of oral health and non-
communicable diseases, which ensure the use of common risk factor approach. It is
necessary for oral diseases to have major determinants that are common with those of
other non-communicable diseases.
3. Tested and evidence based health promotion strategies should be devised and awareness
should be increased through campaigns that discuss prevention of oral diseases and non-
communicable diseases along with promoting health literacy and education.
4. It is essential for the national authorities to produce, train and retrain health workers in
order to work on prevention and treatment of oral diseases and other non-communicable
diseases.
5. The national authorities should provide predictable, sustainable and adequate resources
that will be required for the promotion of oral health and prevention of oral diseases and
other non-communicable diseases.

15. 6. There should be a major focus on strengthening information systems that allow and
encourage health planning and management.
7. There should be a major focus on strengthening the national non-communicable disease
and oral health surveillance; efficient monitoring systems should be developed so as to
evaluate the existing policies.
8. Encouraging the involvement of communities and civilians while developing,
implementing and evaluating the non-communicable disease/oral health plans, policies
and programmes.
9. The national capacity for increased research and development in context of oral diseases
and other non-communicable diseases should be building and strengthened.
10. Use of gender-disaggregated data so as to promote gender based approaches to non-
communicable diseases. (Ministry of health, 2003).
Along with the above national priorities, several actions at regional level were planned for
(Ministry of health, 2003). These include:
1. Continue to follow up on the regional commitments made in the UN Political
Declaration.
2. Development of regional strategies by the FDI that monitor the implementation and
progress of the declaration.
3. Encouraging regional funding sources such as development banks to integrate oral health
and non-communicable diseases into their organisation’s health and development
programmes.
4. Using World Health Day as a means and opportunity to approach regional organisations
to consider the necessity of raising awareness regarding oral health and discuss the
policies their organisations have outline when implementing political declaration.
5. Ensuring that at least five of the regional organisations receive publications from the
operating national dental associations within the given region so as to increase their
knowledge and awareness regarding oral health and prevention of other non-
communicable diseases.
6. Ensuring continous inclusion of sessions such as meetings, conferences, at both regional
and sub regional level. For instance:

16. a. Periodical high level meetings of Health ministers and Head government officials
b. World Health Organisation Commission regional meetings
c. Meetings for regional banks to carry out strategic planning
d. Regular meetings between multilateral banks and NGOs to discuss country
strategies. (Ministry of health, 2003).
Conclusion
The rising burden of non communicable diseases is majorly hindering global development along
with accomplishment of several goals; it is necessary to understand that non-communicable
diseases to a great extent contribute to hunger & poverty and play a significant role in the
unequal distribution of heath across countries. Additionally, the global burden exerted by oral
diseases continues to grow every minute; their impact is noticeable in terms of reduced life
quality, impaired functioning, pain & suffering and treatment cost.
This United Nations meeting served the purpose of raising awareness regarding the recent
increase of non-communicable diseases in the developing and developed worlds, at an
international level. Among the non-communicable diseases recognised by the World Health
Organization, the four major non-communicable diseases are cardiovascular diseases, cancer,
chronic lung diseases and diabetes; these are seen as major threats to the world development.
During the meeting, the socio-economic impact of non-communicable diseases and their
increasing burden on the community was identified; several commitments were made towards
taking severe actions on both national and global level so as to treat and prevent non-
communicable diseases (United Nations, 2011).. It is important to understand that the UN
Political Declaration defined and identified a global response to non-communicable diseases; the
problems and the need to act further so as to combat these problems were recognised. The
declaration contains a series of commitments made that ensure action, unlike the previous
documents on non-communicable diseases that simply urge and advice measures
From research, it is evident that there is a strong relationship between oral diseases and the rest
of the non-communicable diseases such as cancer, diabetes, respiratory and cardiovascular
diseases (Hamburg Forum, 2005). As previously mentioned, the UN Political Declaration
identified the common risk factors shared by oral diseases with non-communicable diseases and

17. established that these may benefit from the responses to non-communicable diseases. It is
evidence that several oral diseases share common risk factors with other non-communicable
diseases such as diabetes, cancer, cardiovascular diseases etc. For this reason, the prevention of
oral diseases needs to be integrated with prevention of other non-communicable diseases and
should be outline in the Common Risk Factor Approach (CRFA) which is known to address the
risk factors that are common to other chronic conditions.
The FDI World Dental Federation plays an essential role when discussing reduction and
prevention of oral diseases on a global scale (United Nations, 2011).. A policy statement
prepared by FDI containing the oral health policies will serve the purpose of an advisory
document for NDAs i.e. National Dental Associations. National dental associations and dentists
play a crucial role in combating non-communicable diseases and their primary principle role is of
an advocate; this refers to their role of advocating the integration and implementation of well-
developed interventions that may be within or outside the health sector. National Dental
Associations should combating oral diseases, as a part of the current non-communicable diseases
agenda, by using the common risk factor approach and the available evidence that will allow
prevention, when discussing the determinants of oral health. This approach will not benefit the
improvement of oral health along with the evidence based oral health care but will also result in
reduction of rates of non-communicable diseases.
References
1. Rio Political Declaration on Social Determinants of Health. Signed by WHO Member
States in Rio de Janeiro, Brazil, on 21 October 2011.
2. The AOK Health Grant. The AOK-Health Grant 2003 Announcement.
3. The Hamburg Forum [homepage on the Internet]. Quality in Health Service. Available
from: http://www.quantforum.de/veranst/hh_forum_3/forum3_info.html (Accessed:
October 12, 2005).
4. The Jannsen-Cilag GmbH. Future Grant 2002. Broshure n.d

18. 5. The Ministry for Health, Social Issues, Women and Family of the North Rhine-
Westphalia region. Healthy Region North Rhine-Westphalia. The Project Association
2002. Announcement and invitation to participate 2003. Bielefeld, 2003.
6. The Ministry for Health, Social Issues, Women and Family of the North Rhine-
Westphalia region. The QualityForum in Health Service. Quality in Health Service –
Patient-security and risk-management. Folder, 2003.
7. United Nations: Political Declaration of the High Level Meeting of the General Assembly
on the Prevention and Control of NCDs. Signed by 193 Member States at the 66th UN
General Assembly on the 19th September 2011.
8. WHO: Oral health: action plan for promotion and integrated disease prevention
9. WHO Global Status Report on NCDs 2010. Outlines the global burden of NCDs, their
risk factors and determinants.
10. WHO Scaling up Action on NCDs: How Much Will it Cost? A financial planning tool for
delivering cost-effective interventions in low- and middle-income countries.
11. World Economic Forum: Global Economic Burden of NCDs. Report detailing estimates
of the economic impact of NCDs from 2010-2030.