Ending the neglect of global oral health: time for radical action
Ending the neglect of global oral health: time for radical action
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DOI：
10.1016/s0140-6736(19)31133-x
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发表时间：
2019-07-20
期刊：
影响因子：
168.9
通讯作者：
Benzian, Habib
中科院分区：
文献类型：
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作者：
Watt, Richard G.;Daly, Blanaid;Benzian, Habib
口腔疾病是影响超过35亿人的全球重大公共卫生问题。然而，迄今为止，牙科还无法解决这个问题。现在需要一种根本不同的方法。在口腔健康系列两篇论文的第二篇中，我们提出了对牙科的批评，强调了其主要局限性和系统改革的迫切需要。在高收入国家，目前以治疗为主导、技术含量越来越高、干预主义和专业化的方法并没有解决疾病的根本原因，也没有解决口腔健康方面的不平等问题。在低收入和中等收入国家（LMIC），所谓的西化牙科的局限性最为严重。对于这些人群中的大多数，尤其是农村贫困人口来说，牙科往往无法获得、负担不起且不合适。牙科需要更加一体化，特别是与初级保健服务的一体化，而不是孤立和脱离主流医疗保健系统。全球全民健康覆盖的推动为这种整合提供了理想的机会。牙科保健系统应更多地关注促进和维护口腔健康并实现更大的口腔健康公平。糖、酒精和烟草的消费及其潜在的社会和商业决定因素是与一系列其他非传染性疾病 (NCD) 共有的常见风险因素。需要一致和全面的监管和立法来解决这些共同的风险因素。在本系列论文中，我们重点关注减少食糖消费的必要性，并描述如何通过采取一系列上游政策来实现这一目标，这些政策旨在打击全球食糖行业促进食糖消费和利润的企业战略。目前，制糖业正在通过其完善的企业战略影响牙科研究、口腔健康政策和专业组织。需要制定更清晰、更透明的利益冲突政策和程序，以限制和澄清制糖业对研究、政策和实践的影响。应对口腔疾病和其他非传染性疾病的商业决定因素应成为主要的政策优先事项。
Oral diseases are a major global public health problem affecting over 3.5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.