The integration of oral health into primary health care and public health systems

The integration of oral health into primary health care and public health systems

Introduction

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 [1] 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 [2]. 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 [3]. 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 [4].

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 [5]. 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
  fluoridation
• 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
  integration models
• Surveillance and population research about oral health status and access and quality of oral
  healthcare services
• Financing model adaptation and modification in order to sustain oral health care services (promotion,
  prevention, treatment)
• Quality assurance and quality improvement strategy of oral health services in clinical and community
  settings
• 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.

Main content

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
  health care
• 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.