Considering Sentinel Indicators to Promote Integrating Oral Health Care in UHC and Primary Care.

Abstract

The World Health Organization (WHO) recently adopted the Global Oral Health Action Plan (GOHAP) at its 76th World Health Assembly in May 2023 (WHO 2023), stating the need to integrate oral health care into primary health care and universal health coverage (UHC). The WHO and all signatory countries agree that oral health is integral to health and that it must be part of national health plans and systems. They do so for a few salient reasons: oral diseases are the most common noncommunicable diseases globally; significant inequity exists in oral health and oral health care both between highand low-income countries and within them, with poor and marginalized groups having the highest levels of disease and the poorest access to care; and our current largely privatized, siloed model of dental care provision is not working (Watt et al. 2019). While much of what needs to be done to improve oral health and reduce inequity is upstream and unrelated to health care delivery, significant changes to oral health care delivery are needed to better address the needs of all populations. And if we are to make progress on this much needed work, we must monitor and measure the effects of the changes made. Furthermore, to make progress in the desired direction, we must define and measure the pathway and related goals within a guiding framework. Within the GOHAP, the WHO has created such a framework, identifying 11 core and 29 complementary indicators, with the aim that all countries collect the core data, while the remainder are for countries to choose from according to their own contexts (WHO 2023). Among the core indicators, 2 are overarching global targets for oral health care to be incorporated in UHC and the reduction of the global burden of oral diseases (i.e., “Proportion of the population entitled to essential oral health interventions” and “Prevalence of the main oral diseases and conditions”). The majority, however, concern the presence or absence of a range of policies in each country (e.g., a national oral health policy, a national oral health research agenda, policies to reduce sugar intake, workforce training, optimal fluoride delivery, etc.). Among the complementary indicators suggested, 4 cover topics that are highly relevant to integrating oral health care into UHC (unmet oral health care needs, outof-pocket payments [OPPs] for oral health care, catastrophic spending on oral health care, and consulting an oral health care professional). However, other complementary indicators cover the same broad topics as core indicators but get into more detail. Among these are disease burden, assessed largely using classic clinical indicators and selfreported oral health status with questions on oral function, symptoms, and days off work or school (WHO 2023). This framework represents an excellent direction to promote the adoption of oral health care within UHC and primary care. Nevertheless, further reflection and clarification are needed. To move in the direction outlined by the WHO, we need to identify appropriate sentinel indicators that are affordable and feasible to regularly JCTXXX10.1177/23800844231195265JDR Clinical & Translational ResearchShort Title editorial2023