Envisioning sustainable oral health through effective advocacy

Abstract

In recent years, global commitments have endeavored to reduce the burden of oral diseases. To maintain this momentum, effective advocacy for sustainable oral health is needed to raise public awareness, garner support, and guide policy makers. However, there has been limited use of evidence-based frameworks and approaches to design and measure the impact of oral health advocacy efforts. The 2nd Global Oral Health Forum (GOHF II) was hosted in April 2024 over a 2-day period to reflect on and discuss effective advocacy approaches and strategies for sustainable oral health. Four thematic sessions were organized around advocacy including health policies, health economics, patients, and planetary health. Each session featured eminent transdisciplinary speakers followed by group discussions centered around ideas, experiences, and perspectives from forum participants. The outcome of the forum was a compilation of ten actionable recommendations for moving forward with effective advocacy in oral health. These recommendations are envisioned to help build and strengthen coalitions of like-minded stakeholders in and outside the oral health community to advocate for policies that support sustainable oral health and equitable access to oral health care.

Background

Oral diseases are the most common non-communicable diseases (NCDs) and have a significant impact on disability and quality of life [1]. Historically, many measures to prevent and control oral diseases have been unplanned, reactive rather than proactive, and largely unsuccessful. As countries across the globe have set out to design or reshape national programs for achieving the 17 Sustainable Development Goals (SDGs) and their targets including Universal Health Coverage (UHC/SDG 3.8) [2], the WHO resolution, global strategy, and action plan positions oral health within a broader health and development policy environment [3]. Despite a surge in global commitment towards reducing the burden of oral diseases, much work remains to be done. Visions for social change, such as UHC and achieving sustainable oral health through appropriate social, financial, and environmental action, will need effective and coordinated advocacy that raises public awareness, garners support, and adopts the whole of government, whole of society approaches (4–6).

Advocacy is defined as the strategic effort to support, recommend, defend, or argue for a particular cause or issue to effect change, and it is essential for developing enduring policies that effectively address society’s needs, leading to evolving policy change [7]. However, in oral health, few evidence-based frameworks and approaches have been used to design and measure the impact of sustainable oral health advocacy efforts [8].

To initiate formal discussions around effective advocacy for oral health, policymakers, legislators, civil society partners, academicians, industry, non-profit organizations, and community representatives, from across the globe (Additional file 1) met under the aegis of Global Oral Health Forum II (GOHF II), convened on April 16–17, 2024, in Philadelphia, USA [9]. A series of thematic sessions were organized over 2 days, discussing strategies to develop recommendations to help reshape paradigms of oral health advocacy. Each session commenced with detailed presentations by a roster of distinguished speakers, which set the stage for the subsequent discussions.(9) The discussions were conducted to foster an environment conducive to in-depth dialogue and collaboration among participants (Additional file 1). The format encouraged participants to interact, discuss, and deliberate on thematic areas, thereby enhancing the collaborative spirit of the forum.

The proceedings

The forum’s agenda revolved around four main topics, each designed to tackle different facets of oral health advocacy. These sessions were:

• 1. Advocacy in Health Policies: Person-Centered Decisions and Actions

• 2. Advocacy and Health Economics: Resource Allocation and Priorities

• 3. Patients and Health Advocacy: Where Are the Patients’ Voices?

• 4. The Planet and Health Advocacy: The Emergence of Planetary Health

Prof. Dr. Judith Mackay set the stage by presenting her keynote on the topic, “Advocacy: countering the obstacles to oral health.” She gave examples of her personal experiences in creating a consensus among civil society groups, academia, and policymakers to prepare, present, ratify, and implement the Framework Convention on Tobacco Control [10]. She highlighted the strengths, opportunities, key challenges, and threats ahead for the oral health community to be mainstream in the broader health and development discourse.

The discussions in the first session on person-centered decisions and actions highlighted that oral health policies and programs will be successful if people are engaged not only in the demand, but also delivery of health services [4]. Participants stressed that there are successful examples that demonstrate how person-centered advocacy can catalyze sustainable health reforms. Examples from the discussions included advocacy efforts toward maternal and child health program reform in South Asia, universal immunization program, global tobacco control movement (through the voice of tobacco victims), and initiation and integration of mental health programs in many countries [11]. The group was unanimous in suggesting that the oral health community needs innovative methods to increase intellectual and emotive engagement among various advocacy and community groups.

Engagement with policymakers by presenting an economic argument is a potent tool for effective advocacy messaging as discussed during the second session on optimizing resource use to improve oral health. Advocacy plays a critical role in resource allocation and priority setting for oral health interventions and programs [8]. The session focused on how to create, execute, and reinforce the economic argument in oral health advocacy. The discussion centered on the cyclical nature of this advocacy process as it relates to the economic argument to engage policymakers, which begins with building trust with policymakers, understanding the type of evidence needed for sensitizing policymakers, using health economic tools to process and present evidence, and data harmonization leading to the development of easy-to-understand decision aids.

In the third session, there was a consensus that patient-centered advocacy is essential for improving oral health outcomes, addressing inequalities, and fostering a healthcare environment where patients feel respected and engaged [4, 8]. By prioritizing the needs and preferences of patients, advocates can drive meaningful changes in oral health systems and policies, ultimately leading to better health not only for individuals but also for the wider communities.

A clear and mounting body of evidence shows we are moving beyond the safe operating space in six of the nine planetary boundaries, which increases the risk of generating irreversible damage to our planet and way of life. Planetary boundaries concept is based on scientific evidence and describes nine critical processes that regulate the stability and resilience of the Earth system [12, 13]. Planetary boundaries which include climate change are interrelated processes meaning we can not consider them in isolation in any decision-making on sustainability. Governments recognize that climate change will have a major impact on multiple sectors of our society including the health sector, highlighting the urgent need to build climate-resilient and sustainable health systems [14]. The presenters in the fourth session showcased how current approaches to oral health advocacy are no longer sufficient to address complex, transboundary, multi-level, sector-wide challenges confronting health systems around the world [15]. A new set of competencies and skills is required to equip oral health professionals to participate in multisectoral advocacy at the community, sub-national, national, regional, and global levels [16]. It will be essential to ensure oral health policies contribute to action in five areas of critical importance for humanity and the planet. These areas, people, planet, prosperity, peace, and partnership, should be closely aligned with the new roles and responsibilities for oral health professionals [17].

After the presentation of the thematic sessions, attendees were either assigned to or volunteered for workgroups to discuss and formulate thematic recommendations. These recommendations were then presented in a general session, where further discussion and input led to the creation of the final recommendations.

Key recommendations

Promote oral health diplomacy by mainstreaming it in the sustainability discourse

Advocate for sustainable oral health by highlighting the long-term benefits of improved oral health outcomes, such as reduced costs to society and enhanced quality of life across generations. Advocate for a comprehensive shift toward oral health diplomacy to strengthen partnerships and decision-making across sectors through health in all policy approaches [18, 19]. Excluding oral health from the sustainability discourse will have consequences for both overall health and the sustainability of the oral health profession. Oral health diplomacy could be defined as influencing the policy and decision-making of governments, non-governmental institutions, and society by building and maintaining relationships; promoting discussion and dialogue using tact and mutual respect; and finding agreement through negotiation and common ground. This includes strategies for adaptation, mitigation, and proactive disaster preparedness at all levels—from community and subnational to global. By framing and aligning oral health priorities within health and development goals, oral health diplomacy can foster a more resilient and coordinated response to emerging challenges.

Engage diverse civil society stakeholders

Foster partnerships with a broad spectrum of civil society organizations, including patient organizations, community groups, and professional associations. Such partnerships can mobilize communities, hold policymakers accountable, and amplify the impact and reach of oral health advocacy efforts.

Leverage data and emotional appeals

Combine data-driven arguments with stories and lived experiences of those affected by poor oral health. This dual approach can evoke empathy and build a compelling narrative, making the case for informed research for sustainable oral health both emotionally resonant and factually robust.

Center advocacy on lived experiences

Highlight the voices and experiences of those directly impacted by oral health disparities, particularly marginalized communities. Using these narratives in advocacy campaigns ensures that solutions are person-centered, relevant, and more likely to resonate with diverse audiences.

Build strategic coalitions across sectors

Form coalitions with stakeholders from sectors such as labor, education, and social services. These alliances increase advocacy power, allowing for resource pooling, aligned goals, and greater influence over comprehensive, multi-sectoral solutions.

Strengthen research and education on oral health

Advocate for investment in research focused on social determinants of health, health economics, and equitable interventions. Evidence-based research is essential for informing policy, developing sustainable practices, and ensuring data supports targeted actions in oral health [16]. Implement needs-adaptive planning of human resources for oral health, and redesign workforce training and education to foster transdisciplinary collaboration, emphasizing skill diversification and lifelong learning. Engage dental students and professionals in climate action and sustainability efforts, equipping them to support climate-resilient oral health systems. By bridging education with service delivery and empowering future leaders, this approach prepares the workforce to meet evolving global health demands.

Empower community leaders as advocates

Identify and support passionate, influential leaders within communities to lead oral health advocacy. These leaders can effectively mobilize their networks, inspire broader community engagement, and sustain advocacy momentum over time.

Adapt successful campaign strategies

Study and incorporate strategies from effective advocacy campaigns in other fields. Align oral health initiatives with trending policy issues to increase visibility and leverage public interest, ensuring oral health remains a recognized priority.

Address commercial determinants of oral health

Target commercial influences on oral health, such as sugar and tobacco. Collaborate with the private sector to encourage healthier alternatives and support policies regulating the availability of detrimental products to improve population health outcomes.

Use economic evidence for policy influence

Utilize economic evaluation to showcase the socio-economic benefits of oral health investments. Develop accessible and actionable policy recommendations using evidence on affordability, access, and cost-savings to guide informed policymaking and resource allocation.

Way forward

Realizing the Global Strategy and Action Plan on Oral Health 2023–2030 [20] requires a transdisciplinary advocacy approach. Impactful advocacy for oral health should be informed by evidence, person-centered, patient-oriented, planetary health-focused, and aimed at best-possible resource prioritization to optimize oral health (value-for-money) (Fig. 1). Effective advocacy efforts for oral health can be more effective, sustainable, and impactful if they begin with meaningful conversations focused on the importance of oral health, its link to overall health, and the need for policy changes to improve access to oral healthcare. These conversations should lead to co-option, incorporating the perspectives and interests of various stakeholders into the advocacy agenda. The co-option should lay the foundation of a collaboration that can strengthen advocacy efforts by pooling resources, expertise, and networks. These collaborations should eventually lead to the development of successful coalitions bringing together diverse groups with shared interests and goals to amplify their collective voice and influence policy changes.

Fig. 1

The 4 Ps of effective advocacy for integrated and sustainable optimal oral health