Preventing Non Communicable Diseases throughout the health system - the role of the dental workforce 23rd CONGRESS EADPH 24º CONGRESS SESPO Palma De Mallorca 18-20 October 2018 Dr Natasha Azzopardi-Muscat University of Malta President European Public Health Association @natasha_azzmus
Trends in NCDs & Risk Factors in Europe
Burden of Disease in the European Region Measured in Disability Adjusted Life Years (DALYs) 2016
Probability of dying between ages 30 and 69 years from four major NCDs in the WHO European Region, 1990 2015 and projections to 2030
Regional trends in the probability of dying between ages 30 69 years from the major NCDs in Europe
Trends in disability from NCDs among men and women in subregions of Europe, 1990 2016
Probability of premature mortality and gross national income per capita for the WHO European Region
Prevalence of current tobacco smoking in European countries among women and men, 2009 and 2013
Reductions in mortality from coronary heart disease: summary of IMPACT and other studies
Jakab M, Farrington J, Borgermans L, Mantingh F, editors (2018). Health systems respond to NCDs: time for ambition. Copenhagen: WHO Regional Office for Europe.
Tackling NCDs - the multiplier effect Sustainable Development Goal (SDG) 3 - target 3 4 to reduce premature NCD mortality by a third by 2030. NCDs are a barrier to achieving SDGs 1, 2, 4, 5, and 10 Productivity gains from preventing and managing NCDs will contribute to SDG 8. SDG 11 and SDG 12 offer clear opportunities to reduce the NCD burden and to create sustainable and healthy cities. Nugent et al Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals Lancet 2018; 391: 2029 35
EUPHA survey
The increasing disparities in life expectancy are not the inevitable consequence of some law of nature and not even a direct effect of political, economic or cultural conditions but partly result from how active countries have been in implementing preventive interventions. Mackenbach, J. 2013 The Unequal health of Europeans NCDs are heavily clustered in people with low socioeconomic status Enormous health gains could be achieved if all countries would follow best practice but this requires the removal of barriers related to both the will and the means to implement effective health policies.
Mackenbach, J. 2013 The Unequal health of Europeans Why should it be different?
Tobacco Frame Convention on Tobacco Control (WHO) EU legislation Plain packaging, taxation, regulation Still a major issue the endgame is not in sight Dissonance between popular trends and public health messages Major contributor to health inequalities Development of e cigarettes -???? Recreational marijuana New ways of thinking!! - Tobacco free investments
Alcohol European Union has been reluctant to take serious measures Scotland won its right to minimum pricing Public health community seen as kill joys Very particular consumption patterns across different countries Even small amounts of alcohol can be harmful Link to cancers
Diet and physical activity Obesity a major challenge for children and adolescents Food industry - powerful in Europe Very timid steps with regards to sugar (regulation, taxation)particularly in Europe Common agricultural policy Urban design
Lots of activity in recent months
How do we reorient our health systems? - WHO Sitges report
Oral health and public health systems in Europe Oral health care in Europe is provided by a diverse range of services. In the Nordic countries, children are eligible for public dental services, whereas adults and the majority of older people receive health care from private dental practitioners with national and local co-payment systems. In southern Europe, private dental practitioners dominate, and third-party payment is based on private insurance or costs are paid by employers. In eastern Europe and central Asia, oral health services are based on a blend of public and private systems.
Current situation The use of oral health services varies significantly by country In all countries the poor and disadvantaged population groups are underserved. Oral diseases are preventable; however, most oral health services in Europe are largely treatment oriented.
Reorienting Health Systems From a conventional model of restorative dentistry Towards a preventive model of care Integrated into health systems at all levels Strengthening oral health for universal health coverage Fisher et al. The Lancet Vol 392 September 15, 2018
Nine cornerstones of a comprehensive and aligned health system response to NCDs Strengthened governance ensures coherent policy frameworks and sustainable intersectoral action on NCDs, connecting national, regional and local levels Adequately regionalized specialist services provide efficient and timely care for acute conditions Well resourced public health services lead health promotion and disease prevention activities with an focus on equity People-centredness is reflected in all health system functions Multiprofile integrated primary health care proactively manages community health and well-being A fit-for-purpose health workforce delivers peoplecentred interventions and services based on evidence Adequate and prioritized health financing ensures that coverage of important services and incentives are aligned with service delivery goals Access to quality medicines is ensured through reliance on comprehensive coverage and pricing policies and on promotion of generics Information solutions serve population health management, condition management in primary care, coordination across providers for seamless care, and self-
Jakab M, Farrington J, Borgermans L, Mantingh F, editors (2018). Health systems respond to NCDs: time for ambition. Copenhagen: WHO Regional Office for Europe.
Health system barriers to the delivery of core NCD interventions and services Jakab M, Farrington J, Borgermans L, Mantingh F, editors (2018). Health systems respond to NCDs: time for ambition. Copenhagen: WHO Regional Office for Europe.
Oral Health and UHC A distant dream? An opportunity to frame the issue? Oral diseases affect half of the world s population (Global Burden of Disease Study 2016) Oral health is a neglected area of global health that could make a contribution to achieving universal health coverage UHC UHC can help frame policy dialogue to address weak and fragmented primary oral health services, and address substantial out-of-pocket expenses associated with oral health care in many countries Strengthening oral health for universal health coverage Fisher et al. The Lancet Vol 392 September 15, 2018
An integrated approach to oral health & NCDs Major oral diseases and noncommunicable diseases are closely linked and share common risk factors unhealthy diet, poor nutrition, use of tobacco harmful consumption of alcohol
Oral cancer Prevention of oral cancer should be incorporated into national cancer programmes and include early detection and referral for specialist care. Managing associated behavioural risk factors, such as alcohol and tobacco use, can reduce rates of oral cancer. Oral health professionals are in a prime position to screen patients for early signs of oral cancer and quickly refer them for specialist care.
Focus on periodontitis Oral health is closely related to systemic health. Periodontitis interacts with a variety of noncommunicable diseases (NCDs). It is a risk factor in the complex pathogenesis of diabetes mellitus and cardiovascular disease As periodontitis shares many common risk factors with NCDs, close collaboration between physicians and dentists is needed to increase the chance of early detection and improve the prevention and control of these conditions
Where is the oral health workforce? The unequal distribution of oral health personnel and the absence of appropriate facilities in many countries means disadvantaged communities have limited or no access to primary oral health care
Role expansion Dentists are generally underused in the management of other NCDs and are well placed to assume an enhanced role Where there are no dentists, the health workforce might be more fully used to expand and extend oral health
A life course approach to oral health Pregnancy presents an opportunity School based programmes Orthodontics in adolescents Adults who are otherwise hard to reach Persons with chronic illness (Diabetes, HIV) Elderly persons
Dentist/Doctor collaboration for NCDs Improved collaboration between dentists and physicians is required Interaction between dentists and physicians is necessary to optimise screening Early detection of NCDs and oral diseases is essential Common risk factors require common/coordinated preventive strategies between dentists and physician Obstacles to the communication and exchange of information should be eliminated Dorfer et al The relationship of oral health with general health and NCDs: a brief review: International Dental Journal 2017; 67: 14 18
A prescription for change 1. Integrate essential oral health services into the basic package of healthcare 2. The oral health workforce should be geared towards population health needs and the social determinants of health Health workforce education Inter-professional education? 3. Step up financial protection through the inclusion of dental care coverage in health insurance packages Strengthening oral health for universal health coverage Fisher et al. The Lancet Vol 392 September 15, 2018
Strengthening public health services in Europe A common understanding of what constitutes public health and public health services is lacking Skills and infrastructure across the European Region are patchy In many Member States the capacity to meet contemporary public health challenges remains limited In some countries, public health development has been held back by lack of political commitment
A vision for public health practice in Europe Three core public health functions: Intelligence gathering Communication and dissemination (politicians, health workforce, civil society, general public, media) Appropriate governance (policies, structures, funding, services) New approaches to each function continuously adapting to change
Oral Health & NCDs: Accelerating integrated global progress To strengthen political commitments at the highest levels to address oral health as one of the priority areas of the NCD agenda; To mobilize resources and promote investment at country level to enhance multisectoral collaboration and partnerships. These should support implementation of cost-effective interventions on oral health as part of NCD programmes; To strengthen integrated oral disease prevention into NCDs prevention by addressing common risk factors; and To include essential oral health care services as part of Universal Health Coverage initiatives to ensure that no one is left behind!" UN 3 rd High level Meeting in NCDs Sep2018
Assessment Organisation of oral health services throughout Europe often tends to exacerbate inequities Oral health is a missed opportunity to prevent NCDs Oral health must become part of the conversation of UHC The oral health workforce has a role to play in NCDs prevention and management but the health system has to bring them in contact with the target population groups
Building bridges, joining forces for advocacy
NCD declaration 2011 that renal, oral and eye diseases pose a major health burden for many countries and these diseases share common risk factors and can benefit from common responses to noncommunicable diseases. This key milestone was essential to ensure that oral health be included within the context of the NCD agenda and represents a real opportunity for oral health to be integrated into general health and treated as a priority issue.
Tackling NCDs Will Political commitment Business support Professional engagement Population support Means Knowledge and information Institutional arrangements Organizational effectiveness Financial resources
Working in partnership Sustainable advancements in public health and health services can only be achieved through collaboration. EUPHA is dedicated to working in partnership with European and international intergovernmental and non-governmental organisations as well as national institutes and organisations that are aligned with EUPHA's values and commitment to improve current and future health in Europe.
Building coalitions Alone public health associations are too small to counteract Governments and powerful providers By building successful coalitions with other organisations sharing similar values we can make a difference!
Join us in Marseille!
Thank you for listening!