Interview: “The sugar industry is a powerful and influential player”
Two papers recently published in The Lancet have focused on universal health care in the U.S. and globally. Co-authored by Dr. Habib Benzian, Associate Director of Global Health and Policy for the New York University College of Dentistry’s World Health Organization (WHO) Collaborating Centre for Quality-Improvement, Evidence-Based Dentistry, the articles call for urgent reform with a focus on prevention. In an interview with Dental Tribune International, Benzian gives more insight into the challenges facing the health sector to implement the changes and some possible avenues for exerting more pressure and raising awareness.
Dr. Benzian, do you have confidence that the changes you have called for can be implemented?
The recommendations we make in the two papers are, admittedly, bold and ambitious but they are not entirely new. We were just able to create a new level of attention through publication in The Lancet.
The current situation of health internationally, as well as in a number of individual countries, is favorable, so that we are optimistic that progress can be achieved. Oral diseases are recognized in the category of noncommunicable diseases, political attention is growing and oral health will be included in the political declaration of the upcoming United Nations General Assembly meeting on universal health coverage. These developments provide a fertile ground for change. However, there are still many challenges that need to be overcome.
Can you elaborate on that?
While we continue to advocate for radical reform, as pointed out in the series, we are also aware that the overdue changes require a concerted effort from many different stakeholders, including policymakers, oral health professionals, researchers, professional associations, the private sector and patients. It would be naïve to think that it will be easy. However, I believe we are at a crucial point in time where chances for fundamental change have greatly improved. The U.S. Surgeon General’s report on oral health will be published next year, as well as a global report on oral health by WHO. Both reports will spark a broad public debate about the need to change current paradigms and to ensure access to oral health care for all.
Sugar and its negative effects on oral health have been gaining more track for some time, and in some countries, there is change afoot with things like sugar tax. Why do you think it has taken the U.S. health sector so long to get on board and really press for changes?
The sugar industry is a powerful and influential player that has tried to manipulate research, lobby and pressure politicians and decision-makers, and mislead consumers. At the same time, the sugar industry puts a lot of effort into avoiding and undermining any endeavors to reduce sugar consumption, such as the introduction of a sugar tax or the reduction of sugar content in foods and beverages, as this would mean a decrease in profits and the need to reformulate product ingredients.
While sugar taxes and particularly taxes on sugar-sweetened beverages have already been introduced in more than 60 countries around the globe, the situation in the U.S. is more complex due to state autonomy. That said, a number of states and even communities have shown that it is possible to establish such taxes with successful health outcomes if the political will and civil society support are strong enough. It should also be noted that this is not an issue that concerns the health sector alone. Taxation requires close collaboration with the finance and broader economic authorities.
Why do you think dental caries, periodontal disease and oral cancers have gone largely unnoticed?
I would not say that oral diseases have gone unnoticed. It is rather that they have not been adequately addressed. The reasons are complex and have many layers. To start with, many countries lack up-to-date quality data to grasp the extent and the causes of the burden. For many populations and their decision-makers, the priority is to focus on diseases that actually kill, such as infectious conditions. In addition, the professional oral health community is fragmented and largely separated from the mainstream of health and public health, leading to a silo mentality. A key aspect is also the lack of pressure from civil society groups. We have virtually no advocacy groups for patients suffering from oral diseases, unlike many other health conditions, where we find an abundance of self-help and community support groups. This points to a degree of social acceptance of oral diseases and their impact as unavoidable.
What are the next steps the health care sector needs to take to make sure some reform is made and some positive steps are taken?
We are calling for full integration of basic oral health care in universal health coverage. We consider that this the most promising entry point for change. This means that everyone, irrespective of socio-economic status, should have access to quality oral health care, including preventive services, at a cost that does not lead to financial hardship. Many countries have shown that this is possible and realistic.
Going forward, what will your involvement be in advancing the goals set out in The Lancet?
At New York University’s College of Dentistry we are hosting the only WHO collaborating center on oral health in the Americas. This gives us and our work particular relevance in supporting WHO and countries in their reform efforts. We are currently working on the development of oral health investment cases, aiming to show how smart investments in cost-effective interventions can address oral diseases with realistic government spending.
We are also organizing, together with The Lancet, a side event to the upcoming United Nations High-Level Meeting on Universal Health Coverage, highlighting the need to integrate oral health care in any effort to strengthen and reform health care systems. The event will be supported by the UN delegations of Thailand, Japan and other countries and will hopefully result in broad attention and awareness.
Editorial note: The articles, titled “Oral diseases: A global public health challenge” and “Ending the neglect of global oral health: Time for radical action,” were published on July 20, 2019, in The Lancet.