Context

In the past ten years, further evidence and understanding of the links between social and commercial determinants and oral health has generated an important number of publications and policy statements globally. It is necessary for the FDI World Dental Federation to address these findings in this policy statement to emphasize the wider environmental, socioeconomic and political challenges that affect the oral diseases burden.

Scope

This policy statement presents the broader, environmental, and societal risk factors for oral diseases that are generally shared with other noncommunicable diseases (NCDs). It highlights the importance of upstream policy interventions with a common risk factor approach to reduce oral disease prevalence as well as oral health inequities. Furthermore, the policy statement recognizes that several corporate strategies increase the burden of these NCDs, and therefore supports interventions aimed at reducing this negative influence. 

Definitions

Social determinants of health: the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live and age, the systems put in place to deal with illness and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.¹

Commercial determinants of oral health: are a key social determinant, and refer to the conditions, actions and omissions by commercial actors that affect health. Commercial determinants arise in the context of the provision of goods or services for payment and include commercial activities, as well as the environment in which commerce takes place. They can have beneficial or detrimental impacts on health.²This is especially significant in oral health with the sugar industry.³

Common Risk Factors Approach: addresses risk factors common to many chronic conditions within the context of the wider socio-environmental milieu. Oral health is influenced by diet, hygiene, smoking, alcohol use, stress and trauma.⁴

Principles

This policy statement addresses the challenges presented in the 2022 WHO Global Health Status Report ⁵ as well as the FDI’s Vision 2030.⁶

Policy

FDI supports:

• increasing significance of social and commercial determinants of oral health and care-seeking behaviour in whole populations, and especially in the underprivileged;
• engaging with key stakeholders inside and outside the dental profession to develop an integrated approach to reduce oral health inequities globally and advocate inclusion of oral health in all policies;
• adopting the Common Risk Factor Approach and building links across general health disciplines to learn from others' experiences and to maximize awareness;
• adopting targeted, cost-effective, upstream or community-based interventions, such as water fluoridation, that have the widest benefit for the population and reduce health inequities;
• calling on National Dental Associations to advocate for translation of what is known about health promotion and prevention into practice;
• adopting oral health interventions that include collaborative enabling policies and research that address some of the main determinants of oral diseases, including excessive limited access to care, intake of sugars, tobacco usage, excessive alcohol consumption, poor oral hygiene, stress and socio-economic disparities;
• ensuring greater awareness of all oral health professionals in assessing social and commercial determinants of health, comprehensive health planning and behavioural change;
• evidence-based policy interventions, such as health taxes, that reduce the negative impact of commercial determinants;
• mapping the level of health literacy in the population, and determining how this influences oral health and the strategies necessary to uphold and improve oral health;
• ensuring that, within universal health coverage, oral healthcare is accessible and affordable, acceptable, available, accommodating and aware.

Keywords

Social determinants, commercial determinants, FDI policy

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

References

1. World Health Assembly, 62. (‎2009)‎. Reducing health inequities through action on the social determinants of health. World Health Organization.
2. World Health Organisation ; Commercial determinants of health https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health
3. Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016 Nov 1;176(11):1680-1685. doi: 10.1001/jamainternmed.2016.5394. Erratum in: JAMA Intern Med. 2016 Nov 1;176(11):1729. PMID: 27617709; PMCID: PMC5099084.
4. Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000 Dec;28(6):399-406. doi: 10.1034/j.1600-0528.2000.028006399.x. PMID: 11106011.
5. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO
6. FDI Vision 2030 : https://www.fdiworlddental.org/sites/default/files/2021-02/Vision-2030-Delivering%20Optimal-Oral-Health-for-All_0.pdf

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