Change the change

Writing a guest editorial for the first issue of a new journal is certainly a great honor. Everybody’s eyes will be attracted by the newborn star on the scientific heaven, and the first question coming up will be if the topic global oral health justifies an own standing journal considering that journals dealing with global health already exist.[1] Moreover, if oral health is a core element of general health and well-being and a basic human right, as pointed out in the Liverpool Declaration,[2] why diversify? The reasons for its realization are numerous.

Unfortunately, oral health remains a neglected area and its political priority on most national agendas is low.[3] Multinational financial holdings identify dentistry as one of the most flourishing businesses and the commercialization of the profession is often times linked to crime;[4] a phenomenon that threatens patients’ oral health and increases the number of complaints.[5]

Oral health is defined since 2016 and it will be measurable very soon, as declared at the 2018 Annual World Congress of the FDI World Dental Federation.[6] No definition of global oral health is available. Considering the aforementioned, it could be included in the definition of global health, which is the health of populations in a global context: The area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Besides, the solution of purely medical problems, Health for all includes also the elimination of malnutrition and the availability of safe drinking water, two fundamental ingredients to realize FDI’s vision: Optimal oral health for all peoples.[7]

More than 3.9 billion people are affected by oral diseases.[8] Untreated caries of permanent teeth is the most prevalent preventable disease on the globe and no low cost, no cost, and decades lasting oral prevention campaigns supported by business stakeholders could shake this first rank position. Edentulism is on a rise.[9] However, 90% of oral diseases are preventable and considerable improvements can be made if appropriate and effective public health programs are established. These programs must be based on available, non-biased, and sound science, the political will of responsible decision makers with a strong statesman attitude and caring of future generations, and an ethics-oriented health-care profession ready to be a conscientious obeyer when other than health becomes a priority. This said, all physicians, the dentist as an oral health physician by competence included, need to pull the same string. Joint action on prevention is the only option to shift the importance from doing something to patients/people to doing something for patients/people. Shaping a healthy future is best assisted by applying the values of the Hippocratic Oath as aspirational and visionary instruments. Will it be enough to change the change?

Since 1943 important documents evidencing the relationship between sugar intake and heart disease were hidden. Are not the emerging data from the Global Burden of Disease Study and its updates sufficient to understand that the burden of NCDs is on a vertiginous rise and that almost no health-care system will survive beyond the middle of the next decade if no drastic action on sugar taken? Is it not alarming that the excellent results of delivering safe water and sanitation - Sustainable Development Goal 6 of the United Nations 2030 Agenda - is breaking into pieces as significantly less money is allocated to SDG 6 since 2014? Since then, the number of people lacking access to safe water has increased from 1.8 billion to over 2.2 billion.[10] The right way to achieve Universal Health Coverage until 2025 needs to be guided by quality, guaranteeing for patient safety, patient health improvement, and earning their trust and let the term quality care fall into disuse as there is no other kind.[11,12]

The latter statement has been made by the Director General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus. The answer to all the questions raised before as well as the respect for his wish can be found in the recently released report of the WHO, the World Bank and the Organization for Economic Co-operation and Development, OECD, which outlines key actions all of us can take on to enhance quality. A starting point could be the WHO Initiative on National Quality Policy and Strategy, which will support countries in realizing the key actions. We from the Academy of Dentistry International could not agree more with the WHO Director-General that quality is not a given and that it takes vision, planning, investment, compassion, meticulous execution, and rigorous monitoring, from the national level to the smallest, remotest clinic. It needs two fundamental ingredients more: Courage and the cancellation of non-sense.

A Portable Aqua Units for Lifesaving, PAUL,[13] working with no other energy than gravity, filtering 1300 L/day as a minimum, and eliminating up to 999,999% of bacteria and adenoviruses can be brought to the remotest area of the world and make any kind of water transportation unreasonable and expensive.[14] The access to oral health of approximately 3.5 million people, guaranteed by only one dentist in some countries, produces similar oral health damages as the creation of a professional plethora in others; commercial interests seem to destroy just as much healthy tooth substance as Streptococcus mutans. We need definitely more than an executing workforce.

We need a global group of leading dentists, who have the courage to include all those who can contribute to shape global health starting from the mouth. My very first target group, before the educators, physicians, and industry people, would be the mothers of this world. Their responsibility is high. Their success depends on our capacity to transfer knowledge to increase global oral health literacy. There is no other way to change the reasons that have changed our healthy habits, our healthy lifestyle, and our values. It is the change we need to achieve the Sustainable Goals of the UN 2030 Agenda and support our countries to guarantee Universal Health Coverage for their people. May the Journal of Global Oral Health be one of the light towers in the darkness of global health.