By: Mark Mwenda
The World Health Organization’s (WHO) Global Oral Health Status Report of 2022 presents a concerning reality: an estimated 3.5 billion individuals worldwide, representing approximately 50% of the global population, suffer from various forms of oral diseases. Among these, untreated dental decay (both in deciduous and permanent teeth), severe periodontal disease, toothlessness, and cancer of the lip and oral cavity stand as leading causes of oral health burdens. Additionally, congenital malformations, notably cleft palate (affecting an estimated 4.6 million cases globally), noma (with no available surveillance data), and traumatic dental injuries (estimated at 1 billion cases globally), contribute significantly to the overall oral disease burden.
What is even more alarming is that the global caseload of oral diseases has surpassed the estimated population growth rate, indicating a failure in current measures and policies to mitigate the spread of oral diseases. Between 1990 and 2019, while the global population grew by approximately 45%, the prevalence of oral diseases increased by 50%.
Understanding the root causes behind this significant burden is crucial. The report identifies three primary factors. Firstly, social determinants such as income level, access to healthcare, and education play a critical role, mirroring those affecting other non-communicable diseases. Secondly, the widespread influence of targeted commercial advertisements promoting unhealthy products (such as food and beverages high in sugar,tobacco and alcohol) has skewed the balance, promoting unhealthy habits and affecting public awareness and knowledge. Lastly, the negligent attitude of policymakers and insurance companies towards including oral health care in universal health coverage intensifies inequality in access to oral health services, especially considering that most dental practices operate within the private sector.
Inadequate funding for oral health research and a lack of proper surveillance tools further compound the challenges. The WHO estimates that there are just under four million oral care providers globally, though these figures may be significantly overestimated.
The prevalence of oral diseases across various age groups has profound implications, because oral health problems extend beyond the mouth: for example, sleep disturbances, social isolation, pain, anxiety, and functional limitations. Severe periodontal diseases have also been linked to broader health issues such as malnutrition, diabetes mellitus, and cardiovascular diseases.
Addressing these gaps requires a multifaceted approach focusing on prevention, early diagnosis, and effective treatment of oral health diseases. Primary prevention emerges as a critical strategy, given that most oral conditions are preventable. This presents an opportune moment, especially as global healthcare shifts towards a primary healthcare approach, to leverage community health workers (CHWs) to deliver promotive and preventive oral health services in their communities.
Recognizing the pivotal role CHWs can play in combating oral health diseases, the WHO and the Harvard School of Dental Medicine launched the Oral Health Training Course for Community Health Workers in Africa in 2023. This English, French and Portuguese language open access, self-paced course aims to empower CHWs with the knowledge and skills necessary for oral health promotion, disease prevention, and control. By integrating oral health into broader non-communicable disease prevention efforts within the context of Universal Health Coverage, this program seeks to strengthen oral health systems and address unmet oral health needs.
The pilot phase of the training program is underway in Angola, Kenya, Liberia, and Senegal. In Kenya, the pilot phase of this training program was implemented in four counties (Kiambu, Nairobi, Kakamega & Tharaka-Nithi), with the first cohort of 400 Community Health Promoters (CHPs) from Kiambu County graduating on March 20, 2024, coinciding with World Oral Health Day. Equipped with skills in identifying oral diseases and conditions, promoting oral health in schools and communities, and monitoring oral health at the grassroots level, these CHPs are poised to make a tangible difference.
Functioning as trusted members of their communities, CHPs will play a vital role in raising awareness about oral health risks, dispelling myths, conducting community screenings, and facilitating access to treatment and referrals where needed.
In alignment with the theme of the 2024 World Oral Health Day, “A happy mouth is a happy body,” the combined efforts of CHWs in promoting and preventing oral health issues at the community level are instrumental in achieving Universal Health Coverage.
As we strive towards global health and well-being by 2030, it is imperative for stakeholders and nations to prioritize oral health alongside other health conditions. Leveraging CHW programs globally presents a promising avenue, given their proven effectiveness in expanding healthcare access and advancing Universal Health Coverage. By investing in oral health and supporting initiatives like CHW training, we can create a world where everyone can enjoy the benefits of a healthy smile.
References
Global oral health status report: towards universal health coverage for oral health by 2030
Kenya National Oral Health Policy 2022 – 2030
Kenya National Oral Health Strategic Plan 2022 – 2026
Kwan, S. Y., Peterson, P. E., Pine, C. M., & Borutta. A. (2005). Health promoting schools: An opportunity for oral health promotion. Bulletin of the World Health Organization, (83)9, 677-685.
Strengthening Primary Health Care through Community Health Workers
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