TODAY, November 28, 2022, begins the first session of the Intergovernmental Negotiating Committee to draft a legally binding instrument on plastic pollution. While plastic pollution is a problem in itself, the production, use and disposal of plastics derived from fossil fuels are also linked to the broader issue of climate change. The meeting, called INC1, follows on from COP27. Given the link between plastics and climate change, it is critical that ICN1 delegates gathered in Punta del Este, Uruguay, lay the groundwork for a strong global plastics treaty.
Climate change, stifling plastic pollution, the Covid-19 pandemic that continues to show its ugly face, the deadly war on Ukraine and all its devastating effects – despite these damning realities, the World Health Organization reminds us that care oral health also need our attention, and now.
According to the “Report on the state of oral health in the world – towards universal health coverage for oral health by 2030”, published on November 18, 2022, approximately 3.5 billion people – 44 % of the world’s population – suffer from oral diseases. The most common oral disease is untreated decay of permanent teeth. The fact that it affects approximately 2 billion people makes it the most common non-communicable disease.
The report states that 514 million children suffer from untreated cavities in their baby teeth (baby teeth or first teeth), making it the “most common chronic childhood disease” in the world.
The WHO defines dental caries as “a progressive loss and breakdown (caries) of the hard tissues of the teeth (enamel and dentin) that occur when free sugars in food or drink are converted by bacteria into acids that destroy the tooth over time”. And what are free sugars? These are “all sugars added to foods by the manufacturer, cook or consumer, as well as naturally occurring sugars in honey, syrups and fruit juices. Cavities can lead to cavities, which are damaged areas of permanently on the hard surface of the teeth…”
Consumption of free sugars, according to the WHO, “is the single most important risk factor for dental caries…High sugar intake is directly linked to higher caries activity, and restriction of sugar intake decreases the incidence and severity of dental caries”. Yet companies that manufacture sugary foods and drinks, despite the clear link between the consumption of their products and poor oral health, seek to influence the health and education sectors “to project a socially responsible image, including for example sponsoring school sports activities and events. The WHO warns that “through sophisticated approaches to marketing, promotion and sales, these industries seek to influence consumer behavior and create an environment in which their products are universally available, affordable, accessible and attractive – a powerful and powerful threat to the oral health of the population”.
While the foods and drinks that destroy our teeth are universally available and affordable, even the most basic oral health care is not. According to Oral Health Country Profiles, even fluoride toothpaste is considered unaffordable in the Philippines with 1.2 working days needed to purchase an annual supply of fluoride toothpaste per person. In comparison, in Thailand and Singapore, a person only needs to work 0.6 and 0.1 days, respectively, to earn enough money to buy a year’s worth of toothpaste. The combination of the high price of toothpaste and low per capita income makes toothpaste of the recommended quality and quantity unaffordable for the average Filipino.
Thailand is identified as a model in the Global South by having routine or preventive oral health care, as well as essential and advanced curative oral health care through government funded covered health insurance. WHO’s ambitious goal is – as the title of its report indicates – to include oral health in universal health coverage in all member states by 2030. In the Philippines, I understand, the Oral health care is not yet covered by PhilHealth, with the exception of certain surgical procedures. . The Department of Education promotes oral health through daily toothbrushing with fluoride toothpaste, although this is only done in schools that receive toothpaste. Commercial fluoride toothpastes are expensive, but much cheaper alternatives that meet the recommended fluoride concentration and are locally produced are in fact available. The WHO strongly recommends that “measures to promote the production, marketing and sustainable use of fluoridated toothpaste be taken to counter the observed trends of increasing market share of non-fluoridated toothpaste in some countries. The quality of the products and the sale of counterfeit products must be checked regularly. A test of different brands of toothpaste a few years ago revealed that several brands sold in the Philippines did not contain the minimum recommended concentration of fluoride.
Poor oral health may not be life threatening. However, as Habib Benzian and colleagues pointed out in their commentary to the WHO report (The Lancet, November 18, 2022), “the cumulative negative impacts of oral diseases on societies and economies are unacceptable and harm to human development”. It would be even more unacceptable not to take decisive action to combat poor oral health given the availability of affordable and cost-effective interventions.
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