Oral Health: A Window into the Prevention of Noncommunicable Diseases

Each year at the World Health Assembly (WHA), global health leaders meet to discuss leading causes of death and disease and coordinate around global strategies. This year’s Assembly, from May 22 to 28, 2022, is the 75th such convening. 

Global strategy on oral health is on the agenda this year, an issue that intersects with several areas within Vital Strategies’ portfolio of key concerns–particularly tobacco control, food policy, and alcohol policy. Improving oral health is a cross-cutting issue that could strengthen health systems and improve equitable outcomes. Recognizing that oral health is poorly integrated within most health systems, yet drives numerous noncommunicable diseases (NCDs), countries passed a 2021 resolution on oral health (WHA74.5), tasking the World Health Organization (WHO) to develop a strategy. 

Oral diseases are the most prevalent globally, affecting around 3.5 billion people–almost half of the world’s population. Oral infections and cancers, if not treated in a timely fashion, can be disabling and deadly. This oral health strategy, under consideration for approval by the 75th World Health Assembly, will guide the development of an action plan. Public consultation to further develop the action plan is expected later in 2022, with measurable goals to be achieved by 2030. The resolution–and now the oral health strategy–has brought considerable attention to the links between oral health and NCDs, and the need to integrate oral health into overall health care as part of the NCD response. 

Oral diseases and other NCDs share modifiable risk factors, such as all forms of tobacco use, sugar intake, and alcohol use. Hence, joint prevention benefits are possible through cost-effective solutions that already exist, as outlined by the NCD ‘best buys’ and other recommended interventions. 

Role of Oral Health Professionals

Like medical doctors, oral health professionals can be allies of tobacco control and food policy advocates for the regulation of NCD risk factors. They can address both patients and governments as experts and use the power of social media to get out their message. In many countries, for example, medical professionals are trusted allies in tobacco use reduction. They also play a critical role in detecting oral disease early enough for treatment, dispelling cultural myths that perpetuate high rates of smokeless tobacco use, and can provide referrals to cessation support for all types of tobacco use for people who want to quit. Oral health professionals also have the opportunity to discuss and make recommendations for healthy diets to boost oral health. 

Tobacco Use

In Southeast Asia, where 90% of the world’s smokeless tobacco (SLT) users live, the burden of oral cancer caused by smokeless tobacco use is disproportionately high. Many are unaware of the health risks posed by smokeless tobacco, because the tobacco industry deceptively markets SLT by suggesting that it can clean teeth, freshen breath, or even relieve toothaches, gastric disturbances, abdominal pain, stress, and morning sickness. Long-term use can be a death sentence, especially because smokeless tobacco is used disproportionately by people living in poverty, who are least likely to have the resources to deal with the resulting diseases SLT can cause. As a result, treatment for problems like gum disease, tooth decay, and cancer is often delayed until it’s too late. A campaign Vital Strategies supported across India shares the story of Sunita Tomar, a young mother of two, and how her use of tobacco products led to oral cancer. This campaign, and Sunita’s advocacy, helped to ensure that all tobacco products in India have larger graphic health warnings. This is a recommended policy intervention to educate the public about the harms of tobacco use.

Interventions outlined in the global strategy on oral health’s action plan could help to address current gaps in global tobacco policies regarding smokeless tobacco. These include: ensuring that SLT is treated like other tobacco products, with graphic health warning labels; bans on advertising, promotion and sponsorship; excise tax rates; and preventing youth access by raising the legal age of consumption to 21. 

Food Policy

This oral health strategy also highlights sugar’s influence on oral health, yet another pathway for negative health impacts, including cavities. Dental cavities are the most widespread NCD; they affect almost half the world’s population. 

Public health advocates have long sought to establish sugar as a central consideration within the World Health Organization’s NCD work. WHO’s High-level Commission on NCDs squarely tackles tobacco use and sodium consumption as risk factors for noncommunicable diseases, but only briefly mentions the role of sugar consumption. We recommend proven food policy and systems interventions focused on sugar consumption. This includes implementing warning labels on the ultra-processed foods, often packed with sugar, which dominate unhealthy diets and cause 11 million preventable deaths a year.

Draft recommendations for the prevention and management of obesity is another key issue to be discussed at the World Health Assembly. These call for systemic approaches that prevent conflicts of interest when it comes to industry actors, promoting food policies that limit consumption of ultra-processed foods, and implementing front-of-package labeling to warn consumers against products high in sugar, salt, and fat. Regulating sugary drinks and ultra-processed foods clearly has potential cross benefits for both oral health and obesity prevention.

In New Zealand, for example, the national dental association successfully engaged health professionals and civil society to restrict access to sugar-sweetened beverages. Starting with one hospital in Nelson in 2014, the policy was adopted by all hospitals throughout the country within 18 months. Advocacy efforts then trickled down to schools, which eventually led to the . the Ministry of Education urging schools throughout New Zealand to adopt a water-only policy.  

Alcohol Policy

The Global action plan (2022-2030) to strengthen the implementation of the Global Strategy to Reduce the Harmful Use of Alcohol is another issue worthy of attention at this year’s WHA. There is strong scientific evidence of a causal relationship between alcohol use and other types of cancer, including cancers of the head, neck, and mouth. 

This alcohol-focused action plan also includes parameters to effectively control and regulate commercial determinants of health, notably the alcohol industry. Across alcohol, tobacco, and food policy, it is crucial to keep the influence of industries that produce harmful commodities from the regulatory and policy-making process. Simultaneously, we must shift the focus away from self-regulation toward policy regulation, which has proven to be a more effective way to improve public health and address the systemic issues that otherwise produce and reinforce inequities–including racial health inequities. This underscores the need for civil society advocates and policy experts to maintain a robust role in global health processes to counter commercial influences, whether they be related to alcohol, food, or tobacco.

About Vital Strategies

Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible. To find out more, please visit vstrategystage.wpengine.com or Twitter @VitalStrat.