Interview: “Oral healthcare is a right, and not a luxury”
Though the importance of oral health for systemic health is well established, providing access to affordable preventive dental services continues to be an issue in countries across the world. To learn more about this topic, Dental Tribune International spoke with Dr. Fernando Neves Hugo, associate professor of dental public health at the Federal University of Rio Grande do Sul’s Faculty of Dental Sciences in Brazil. Hugo is also the co-author of a recent article discussing the role of dentistry in global health policy.
Dr Hugo, what are your current research interests and what attracted you to these topics?
I have been working as a public health researcher for more than a decade at this point. Early in my career, I had the opportunity of researching gerodontology and its effect on public oral health. My interest in this subject was motivated by my experiences as a dental student providing care for frail older adults in long-term care facilities in my home town of Porto Alegre. There, I was confronted daily by the challenges of providing much-needed dental care for older, infirm patients with complex care needs.
After finishing my graduate studies, I began working at the Federal University of Rio Grande do Sul in Porto Alegre. As a junior faculty member, I had the opportunity of expanding this research into other topics, including inequalities in oral health, quality of life and health services in Brazil. A lot of people might not be aware that Brazil has the largest and most comprehensive public dental care program in the world. It has more than 28,000 oral healthcare teams within primary healthcare and around 1,100 specialized dental care centers that receive patients referred from these primary care teams and provide care in endodontics, oral surgery, advanced periodontal care, special care dentistry and oral medicine. All of these services are free at the point of care.
More recently, I felt that my research had matured to the point that I could examine themes in global oral health research. This was motivated by a strong belief that oral healthcare is a right, and not a luxury, and that it needs to be incorporated as part of the universal healthcare coverage agenda. I truly believe that pursuing research in global oral health and advocating for its relevance as part of the global health research agenda can make a difference.
From a global health perspective, what role has dentistry traditionally played, and what importance has it held?
While there is unequivocal evidence that oral disorders are the most common diseases affecting humans, dentistry has not been overly successful in having them recognized as such. This is especially critical because of the challenges imposed by ageing populations and the related increase in the financial burdens of treating chronic disease.
As an example, I recently returned to Brazil after a year of working as a visiting professor in the Global Burden of Disease (GBD) Study program, located at the University of Washington’s Institute for Health Metrics and Evaluation in Seattle in the US. The GBD Study is the largest and most comprehensive effort to measure disease, disability and deaths globally and involves more than 500 full-time researchers. Not a single one of these researchers is a dentist, however, and I take this to be an indicator of the relevance that the global health research community places on dentistry and oral disease. Generating attention to and directing resources for oral health represents a major challenge for global oral health in contexts like these.
“We have a failed system of dental care delivery—it is neither affordable nor accessible for a large proportion of the global population”
To your knowledge, what effect has the historical lack of integration between dentistry and other healthcare specialties had on the oral health of populations?
It’s true that dentistry has historically been disconnected from overall health, dentists having to work separately and with little to no interaction with other healthcare professionals or health systems. Dentists now recognize that oral health is an integral part of general health, but much work is still needed to bridge the gap that exists between oral and general health. The result is that dental care has not been included in universal health coverage agendas. While important dental organizations such as FDI World Dental Federation and the International Association for Dental Research are relevant and useful, it is essential to create alliances with external actors and audiences such as the United Nations to ensure that the integration of oral health into primary healthcare occurs.
What can be done at a global level to address existing oral health issues such as inequality of access to treatment?
Any action to address oral health inequalities should start with the recognition that oral health has been neglected by health policies worldwide and that we have a failed system of dental care delivery—it is neither affordable nor accessible for a large proportion of the global population. Change must encompass a common risk factor approach to chronic and oral disease, a health systems reform with the incorporation of oral health within the universal health coverage agenda and the development of research that sustains delivery of cost-effective dental care to all. As my colleagues and I wrote in our article for the Journal of Dental Research, some of the actions needed to address oral health inequalities include:
- revisiting dental curricula and educational methods;
- building interprofessional and inter-sectoral teams to develop competency frameworks that help policymakers tackle the social and commercial determinants of health at all levels;
- identifying strategies to incorporate social policies into health systems; and
- evaluating the impacts of these changes on population oral health.
How can the importance of this be communicated to international audiences and stakeholders?
It is key that we establish coalitions with those outside the oral health arena and preferably outside the health sector. This is crucial if we are to promote the much-needed reform of dental care delivery systems globally. It is also essential to establish institutions that facilitate collective action. Having a global network that supports and recognizes the relevance of dental care, with representation from different segments of society, might be one of the only chances that we have to bring attention to the persistent inequalities in dental care.
“The importance of science in producing effective solutions in record time has never been clearer. Science makes a difference”
In your opinion, what effect has the COVID-19 pandemic had on our general understanding of health as a global, multidimensional issue?
In my 20 years of working in dental public health, I have never experienced a crisis with such impact. It is now clear that the same advances that helped to create a connected planet also contributed to the spread of a respiratory infection across the world within a matter of weeks.
Some of the changes we have experienced as dentists are here to stay. These include significant changes to our biosecurity protocols, fear of contamination and distrust in health professionals in general on the one hand. On the other hand, the importance of science in producing effective solutions in record time has never been clearer. Science makes a difference. Public health measures that were effective in containing the spread of SARS-CoV-2 were in place in many countries in a matter of weeks, and immunologists and basic and clinical scientists developed novel diagnostic tools that scaled up testing within weeks, and we had several effective vaccines in less than a year.
Currently, the only thing that we are absolutely sure of is that the pandemic has exacerbated inequalities between countries. While the majority of developed nations have already vaccinated significant proportions of their populations, many poor nations are yet to start this process.
Editorial note: The article, titled “Role of dentistry in global health: Challenges and research priorities”, was published online on 4 February 2021 in the Journal of Dental Research, ahead of inclusion in an issue.