October 2012, Volume 33, Issue 9
Published by AEGIS Communications
Confronting the Global NCD Epidemic Through Healthy Smiles
Following the issuance of the United Nations’ Political Declaration to Prevent and Control the Non-Communicable Diseases (NCDs) issued on September 20, 2011, in which a.commitment was made by 193 Member Nations to set a global agenda for heart, cancer, diabetes, and respiratory diseases, as well as renal, oral, and visual diseases, the Pan American Health Organization/World Health Organization initiated a process of engagement for all countries in the region of the Americas. The Pan American Forum for Action on NCDs (PAFNCD) was convened in Brasilia, the capitol of Brazil, May 8-9, 2012. The goal was to offer a platform for a “whole of government and whole of society effort” to confront the NCD epidemic in the Americas.
One specific goal was to make sure that not only governmental representatives were being involved in a discussion of how.common risk factors for all these diseases and others could be practically addressed, but also to bring to the table other stakeholders ranging from academia, to not-for-profit organizations, to the for-profit private sector, including major multinational corporations. The PAFNCD was created to not only inform and update all players about potential targets and indicators of the UN mandated initiative, but also to showcase examples of how changing some of the determinants of illness and the associated risk factors (tobacco, alcohol, diet, and physical activity) might be altered to bring about improvements in health and well-being. Sharing information about successful collaborative partnerships was a starting point for a creative discussion of what else might be envisioned and implemented, what of the existing models could be scaled up to reach more people, and what resources could be leveraged in this era of constrained economic capacity to enhance the probability of dealing with this global epidemic.
While Compendium’s April 2012 (pp 234-235) Global Health Through Oral Health column covered the background for addressing oral health as an integrated part of the global NCD package of diseases and.common risk factors, this column highlights a successful case study in partnering in a multi-stakeholder approach to create healthy smiles. A description of why and how the partnership was built, the obstacles and challenges encountered, and the impact interpreted was part of the PAFNCDs and drew an interested audience. Interestingly, the audience seemed filled with multinational corporative executives who wanted to learn practical aspects of how to engage with PAHO/WHO, from legal questions to resource-sharing and more.
Even though NCDs as a group of diseases are characteristically associated with adult populations, the determinants and risk factors associated with their onset and progression often occur earlier in life and can begin in childhood. Consequently, the focus of this case study is the integration of oral health strategies into strategies for the prevention and control of NCDs through maternal and child health. The idea that all societies want and need to build the foundations to allow healthy adult populations to thrive and function as productive citizens creates the background for starting early in the life course with enabling experiences that can instill both the habitual behaviors for health as well as the attitudinal mindset that expects and obtains.comprehensive health services.
A collaborative agreement between PAHO and Colgate-Palmolive Company’s Latin American Division was launched in 2010 with these concepts at the core. This public-private partnership provided the mechanism that enables a.community-based health promotion project to be.comprehensive in scope and harmonious in integrating oral health services into the work plans of primary healthcare workers as they interact with children, adolescents, and their caregivers. The agreement was actually an ou.come of a previous initiative between the.company and PAHO’s effort called Caries-Free Communities Initiative (CFCI) (Compendium, March 2011, pp 10-11) and the mutual trust occasioned by that success permitted a platform to allow more partners to be added in this current arrangement. The intent of such a multidisciplinary approach that targets multiple age groups, multiple healthcare providers,.community workers, and families must engage and.commit organized health professionals, leaders of educational institutions, researchers, and.community organizers, among others. That larger “family” of actors is often referred to as the multi-stakeholders.
One of several achievements of the collaboration has been the development of instruments and reference manuals titled, “Integrated Oral Disease Prevention and Management Modules.” These tools have been tailored to meet the oral health needs of the groups most at risk for dental diseases: 0-5 years olds; 6-12 years olds; and 13-18 years olds. Building capacity of primary healthcare workers to deliver appropriate interventions for oral health for each of these age groups—among all the other interventions they provide for the prevention and control of both infectious and non.communicable diseases of these same populations—is the objective of the materials that were developed. Integrated and embedded into schedules for vaccinations and routine examinations, primary healthcare workers learn to identify, classify, refer, or treat most prevalent oral diseases and the risk behaviors that impact the oral cavity and general health. For children 12 years old and younger, the modules address such behaviors as teeth grinding, thumb sucking, mouth breathing and nail biting, for example. On the prevention side, the modular material addresses oral hygiene, healthy eating, and fluoride varnishes as well as oral health literacy for children and family caregivers. For adolescents, risky behaviors related to tobacco, alcohol, sugary drink consumption, drug use, oral sex, and oral piercing are messages that are integrated into the protocol for interactions. All the modules were reviewed by global experts for evidence-based validity. PAHO partnered with the Pontificia Universidad Javeriana to carry out a 3-month pilot project to assess the efficacy of the modules as utilized by primary healthcare workers as well as patient satisfaction.
The integrated planning necessarily involves several training steps, including train-the-trainer workshops as well as online training. Social media are being employed to market the operation itself, and.comparable efforts are being launched for advocacy to promote.compatible public policy that enables the availability and application of fluoride varnishes to all children less than 12 years of age, and as early as 1 year or younger. Despite these efforts, there have been challenges. Other stakeholders need to be engaged to increase the numbers of people benefitting from the interventions. For example, oral health professionals need to feel empowered to step out of the dental operatory and look at medical conditions associated with NCDs. Existing projects need to be sustained long-term.
While the traditional roles of universities are teaching, research, and application of knowledge and technology, the key tasks in this project were to support the access to the communities of interest, assist in the coordination of the multiple academic disciplines involved in project design and organization as needed, provide the evidence-basis for the specific interventions, and provide the expertise for measurement of impact. The identification of all the aspects relating oral and systemic health was key in making sense of the integrated interventions. Experience with Colgate-Palmolive Company’s grant enabled the production of a text, Periodontal Disease and Overall Health: A Clinician’s Guide (eds., Robert J. Genco, Ray C. Williams, Yardley, PA: Professional Audience Communications, Inc., 2010) and its translation into Spanish. This work in conjunction with a parallel project to develop a periodontal medicine virtual course in collaboration with the Universidad El Bosque in Bogota, Colombia, and some other Brazilian, Colombian, and Chilean researchers with Colgate-Palmolive support will enable its expansion across the Latin American region. This virtual course was introduced in April 2012 to the Latin American Dental Deans attending the Latin American Association of Dental Faculties with the goal of having 50 representative professors of university members participating in this continuous education initiative.
On the basis of this work, the pilot involving PAHO, the private sector, the local government through the Secretary of Health, and representatives of the Pontificia University of Javeriana was launched in Bogota in 2011. The pilot was submitted for approval of the Ethics and Research Committee and the dental school became the bridge between the project and the local government—sharing in the planning and development of the methodology and the health center facility that was covering 1,800 children in the three high-risk categories. The dental school organized and convened the workshops with dental personnel and primary healthcare workers as well as focus groups for evaluation of the materials, surveys of parents and primary healthcare providers, and the analyses of those data.
It is anticipated that the pilot would be scaled up for use in six countries of the region, and once operative and evaluated, would be acceptable as.common practice for integrated approaches from infancy through age 18. The challenge in carrying out the pilot and eventually for the scale-up for larger populations in diverse cultural settings will be the sustainability of the partnership between and among academia, the public health agencies of government, and the not-for-profit and private sectors in each country.
Private Sector’s Role
Corporate social responsibility to engage the.community to advance public health is also good business. Social responsibility activities in the case of Colgate-Palmolive’s Latin American Division clearly paralleled the.company’s staff expertise, as the building of proposals and plans have.come from an intimate knowledge and experience of the very areas of direct interest to the.company. Close partnership with academia is viewed as a necessity to gather knowledge and evidence for whatever the intervention or health technology might be employed. Partnering with PAHO, a UN agency of member nations, allows access to populations that are not readily available in the marketplace but, nonetheless, may be.comprised of vulnerable populations in need of what the.company has to offer.
In his paper describing the Triple Helix Model, Henry Etzkowitz addresses triadic relationships of universities, industry, and government. While such relationships emerge from different institutional starting points in various parts of the world, they have a.common purpose to stimulate knowledge-based economic development, drawing upon the resources from the three partners. He argues that there can be a spiral model of innovation that captures multiple reciprocal relationships at different points in the process of knowledge capitalization. The three partners draw close and b.come interdependent with overlapping interest, resulting in the generation of knowledge, consensus, and innovation. The dynamic of society in the globalized age has weakened rigid boundaries separating organizations and has enabled more flexible overlapping relationships, with the caveat that each can take on.complementary roles in relationship to each other, thus avoiding conflicts of interest.
The “win-win” relationship with each partner providing input according to its strengths and expertise can theoretically nourish the other partner’s knowledge and expertise. In the case of industry, the input from technological, financial, and.communication resources can drive: behaviors that encourage other stakeholders, shareholders, and employees; networking to allow expanded impact and influence; sustainability of programs; and awareness and corporate image reinforcement. To obtain these advantages, it is necessary to identify key performance indicators to allow for tracking progress and assessing “return-on-investment.” The key message is that the goals of.competitiveness and economic development can be achieved, avoiding “conflicts of interest” but focusing instead on “convergence and confluence of interest,” working toward shared values and construction of new paradigms for health for all.
About the Authors
Lois K. Cohen, PhD
Consultant and Paul G. Rogers Ambassador for Global Health Research
National Institute of Dental and Craniofacial Research
National Institutes of Health
Saskia Estupinan-Day, DDS
Regional Advisor for Oral Health,
Pan American Health Organization/World Health Organization,
Cesar Buitrago, DDS, MBA
Scientific Affairs Director
Latin American Division
María Beatriz Ferro Camargo, DDS, MSc
Professor, Pontificia Universidad Javeriana
School of Dentistry
For more information, read UN Summit: Stepping Up Efforts to Address Oral Diseases at dentalaegis.com/go/cced236,
and Oral Health of Haiti: A Year Later at dentalaegis.com/go/cced237