The integration of oral health into primary health care and public health systems
Oral diseases are a neglected epidemic affecting all ages in every country throughout the world. Oral health must be recognised as a major public health issue due to both the prevalence and the severity of impact of oral diseases. This is particularly so in child health with tooth decay affecting 60 – 90% of school-aged children  causing severe pain, infection and destruction of tissue.
Oral diseases impact on systemic health and wellbeing and also cause a significant burden on primary health care systems globally. All primary health care and public health personnel, not just dental personnel, have a role in preventing oral disease and caring for those with oral disease. Oral diseases have common risk factors with other major chronic and non-communicable diseases . These diseases are preventable through strategies such as the reduction of sugar intake, improved oral hygiene, and reduction of tobacco and alcohol intake which can be addressed through the integration of oral health within public health systems . Public policies such as effective community based prevention programs like community water and salt fluoridation should be the foundation for better oral health for all countries.
The strategies to integrate oral health will vary with context as oral disease is a global problem affecting countries with differing needs and resources. This is highlighted by dentist to population ratios which vary from 1:2,000 persons in industrialised countries to dentist to population ratios in Africa which average 1:150,000 persons .
Scope and purpose
This policy has been developed with the purpose of supporting the integration of oral health within public health systems globally.
In 2014 the World Federation of Public Health Associations (WFPHA) Oral Health Working Group completed an international survey of its member countries on their public health workforce infrastructure . The results indicated that many countries do not have dental personnel in their senior public health teams and that oral health is neglected in the primary health care system. The WFPHA has adopted a resolution that all countries should have an oral health professional with public health training within their health department to support the integration of oral health within public health policy development and planning and to develop national oral health strategies and surveillance plans. Recognizing oral health as an integral part of overall health, public health care systems globally must include a comprehensive approach to oral health using the following strategies: integration of oral health into primary health care systems, mechanisms for inter-professional collaboration, community based prevention, and oral health promotion among all healthcare providers. By doing so, it will be possible to lessen the impacts of the current oral disease epidemic and secure future oral health parity at a national level.
Fields of applications
- Policy: National-wide policy development as well as community-level prevention and health care
strategy development and implementation
- Health Promotion: National-wide health communication plans to improve oral health and health
literacy that lead to behavior changes and major policy changes, including community water and salt
- Health Education: Oral health promotion and education of higher priority audiences (e.g., pregnant
women, children, people with diabetes, elderly, etc.) in primary health care and public settings
- Workforce : training about oral health for the entire public health workforce and dissemination of
- Surveillance and population research about oral health status and access and quality of oral
- Financing model adaptation and modification in order to sustain oral health care services (promotion,
- Quality assurance and quality improvement strategy of oral health services in clinical and community
- Service delivery in primary care settings: expand oral health services within existing primary care
locations – e.g. prenatal clinic, school health clinic, specialized clinics for chronic diseases, urgent care
pharmacy clinics, etc.
- Partnership development with international non-governmental organizations, academia, civil society
organisations, Ministries and Departments of Health, and private entities observing ethical principles
and preventing conflicts of interest.
The WFPHA recommends the integration of oral health within public health systems through:
- Integration of oral health within national health policies, including fluoridation
- Integration of oral health within health service planning, emphasizing primary and preventive oral
- Integration of oral health within public health and primary health care personnel training and
practice, developing the role of primary care personnel to improve oral health
- Inclusion of senior dental personnel with public health training within Departments of Health at
national and local levels to lead the integration of oral health within national public health plans
- Increased research to support and advance the integration of oral health within overall health.
Statement on the integration of oral health into primary health care and public health systems
World Health Assembly, Geneva, 23-28 May 2016
Agenda point 16.1 Health workforce and services
World Federation of Public Health Associations (WFPHA) speaking note
Chairperson, Excellences, and Distinguished Colleagues,
The WFPHA is an international, nongovernmental organization composed of multidisciplinary national public health associations with an oral health working group.
The World Health Organization Global Oral Health Programme has worked hard over the years to put oral health high on the health agenda of policy and decision-makers in the world and has emphasized the importance of an integrated disease prevention approach. Oral diseases have common risk factors with other major chronic and non-communicable diseases and can be addressed through the integration of oral health within public health systems.
The WFPHA is aware that to recognize oral health as an integral part of overall health, public health care systems globally must include a comprehensive approach to oral health using the following strategies: integration of oral health into primary health care systems, mechanisms for inter-professional collaboration, community based prevention, and oral health promotion among all healthcare providers.
If we are to achieve this aim, we need to train a cadre of public health leaders, champions who can drive forward progressive agendas and spearhead systemic change at local, national and global levels, mobilizing a genuine political acknowledgement of, engagement with and leadership for the public’s health supported by a global public health system integrating oral health.
The WFPHA therefore urges that particular attention is paid to addressing this problem through high-level continuous education and training of leaders who can implement strategies and advocate for better oral health. This shall be the beginning of a process embracing the development of strategic capacities for all professionals that will be part of a new health era, more dedicated to common integrated preventive solutions.
- Peterson P.E., Bourgeois D., Ogawa H., Estupinan-Day S., Ndiaye C. The global burden of oral diseases and risks to oral health. Bulletin World Health Organisation 2005; 83:661 – 669.
- Sheiham A., Watt R. G. The common risk factor approach: a rational basis for promoting oral health. Community Dentistry Oral Epidemiology 2000; 28: 399 – 406
- Hummel J, Phillips KE, Holt B, Hayes C. Oral Health: An Essential Component of Primary Care.
Seattle, WA: Qualis Health; June 2015. Accessed http://www.safetynetmedicalhome.org/sites/default/files/White-Paper-Oral-HealthPrimary-Care.pdf
- WHO Global Oral Health Program http://www.who.int/oral_health/action/services/en/
- OHWG 2015 Resolution “Dental Public Health Workforce Infrastructure”. http://www.wfpha.org/images/GC-TC/Kolkata2015/WFPHA_resolution_-_dental_public_health_capacity_-_finalupdated.pdf
You may download the PDF version here.