Statement by Helen Clark, UNDP Administrator: UN Summit on Non-communicable Diseases Side Event: Putting Teeth into the NCDsSep 19, 2011
“Inter-sectoral Collaboration to Advance Socio-Economic Development and Achieve the MDGs”
New York University College of Dentistry
I begin by commending the President and Government of Tanzania for bringing together this symposium on oral health, and by thanking the event’s co-sponsors and supporters and our hosts at New York University’s College of Dentistry.
In its 2010 Global Status Report on Non-Communicable Diseases the WHO estimated that eighty percent of all deaths caused by NCDs occur in developing countries. These diseases are not therefore a concern only for the developed world.
This Summit is a big opportunity to place combating NCDs, including oral diseases and conditions, prominently on the development agenda.
The development impact of oral diseases
Low and middle income countries face variously alarmingly high and/or rapidly increasing rates of oral diseases, including tooth decay, cancers, and Noma. These challenges can be exacerbated by weak health system capacity, and by a lack of focus on oral health- despite its importance for sustaining overall health.
The result is unnecessary death and disability on a large scale from oral diseases. For example, ninety per cent of children with Noma, a disease associated with poverty, go untreated. 140,000 new cases are reported to the WHO each year, mainly in children under the age of twelve in Africa and Asia. The WHO estimates that eighty to ninety per cent of those affected die from the disease.
Oral diseases are obstacles to development. Something as preventable as tooth decay can impair people’s ability to eat, to interact with others, attend school, or work. These consequences all detract from human wellbeing, economic potential, and development progress.
The 2001 Report of the WHO Commission on Macroeconomics and Health found that extending the coverage of crucial health services to the world’s poor for a relatively small number of specific interventions could save millions of lives each year, reduce poverty, spur economic development, and promote global security. That is a quadruple win for which we should surely be aiming. It is critical for oral health to be part of this agenda.
Mutually reinforcing health and development
UNDP sees improving health as both an objective of development and a means to achieving it. Life expectancy is one of the key components of the Human Development Index, compiled each year by the Human Development Report Office located in UNDP.
A review of four decades of human development conducted for UNDP’s 20th anniversary Human Development Report last year showed that impressive gains in health and education have been made in countries even where growth in income had been modest.
Thus, in the same way that human development isn’t just about income, human health isn’t just about income either. Evidence-based, smart policy choices can make a big difference – and making it possible for countries to make those choices is at the heart of UNDP’s capacity building mandate.
We help countries establish policies, systems, and initiatives which will lead to improvements in the socio-economic conditions of their populations. Those improvements can help prevent the conditions which contribute to oral diseases and other NCDs, and enable more people to access the care and treatment they need to live longer, healthier, and more productive lives.
Seeing health as a development issue is far from being a new concept. As a young Health Minister in New Zealand more than two decades ago, I was inspired by the Alma Ata Declaration of the World Health Organisation’s 1978 International Conference on Primary Health Care. In proclaiming that health was a state of complete physical, mental, and social well-being, and that its attainment rested on socio-economic and other factors far beyond the purview of the health sector, it placed improving health status in a broader developmental context.
Three decades later, the links between health and development were well acknowledged in the Millennium Development Goals, with three of the Goals explicitly targeting health indicators, and other tackling water, sanitation, environmental degradation, women’s empowerment, and education which all impact on health status. To me, the Health for All and development agendas have always been one and the same.
The socio-economic determinants of health
Social, environmental, and economic factors impact on oral health. Poor nutrition and unhealthy diets, especially high rates of sugar consumption, are key factors, especially for tooth decay. Tobacco use and excessive alcohol consumption have been estimated to account for about ninety per cent of cancers in the oral cavity.
Yet, people’s diets and the consumption of tobacco and alcohol are not just behavioral choices made in a vacuum. They may be influenced variously by practices passed down through generations, economic and social pressures, and marketing. With rapid development and globalization, new products with little nutritional value can become status symbols. Understanding such factors gives insights into how to disrupt the chain of events which leads to poor health.
From understanding to action
Our challenge is translating knowledge about the drivers of poor health into action –within both the development and health communities.
We can’t tackle one disease at a time – the task is too huge. We need integrated approaches to disease prevention and health promotion which include tackling poverty, inequality, tobacco and alcohol; promote good nutrition and healthy lifestyles. A focus on oral health in overall primary health care will not only help improve oral health itself, but will also reduce the rate of cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.
Development actors need to be working alongside health actors on integrated approaches which cut across sectors, disciplines, and ministries to address the socio-economic determinants of health fully.