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Welcome to Oral Health Matters, a brand new podcast from the Dental Public Health Group at University College London and presented by eminent dental public health expert Professor Richard Watt.
Richard Watt 00:04
Welcome to Oral Health Matters, a podcast that shines a spotlight on oral health and calls for it to be embraced as a key part of the global public health agenda. I'm Richard Watt, Professor of Dental Public Health at University College London. In this second series of our podcast, I'll be in conversation with leading researchers and policymakers from around the world who are working in the fields of global health or public health, and who are interested in issues of equity, community action and the politics of health. In this episode, we are focusing on global oral health and reflecting on the WHO Bangkok declaration. The WHO Bangkok meeting took place in November 2024, and it brought together policy makers, community organisations and various high-level stakeholders from over 100 countries to discuss and debate the way forward for oral health as a global health priority. Although the geopolitical landscape has dramatically changed in the last 12 months, it will be interesting to reflect on the impact of the Bangkok declaration at national levels and its potential longer-term legacy. I'm thrilled to be joined by two global leaders in oral health, Paula Vassallo, Chief dentist in Malta, and a prominent advocate for oral health across the EU and other international organisations. My second guest, Irving McKenzie, is Chief dentist in Jamaica and a high-profile policy figure across the Caribbean and the Americas. So, let's start our conversation. All three of us were very lucky to be attendees at the Bangkok meeting back in in November 2024 I'd like to ask both of you a sort of opening question, what was your experience of the meeting? So maybe Paula tells us a little bit about what you recall from that WHO Bangkok meeting.
Paula Vassallo 02:16
First of all, I think I'd like to start by saying, in my public health career, and I think it was the highlight. It was, I think the first ever global oral health meeting, which was convened by WHO and it brought together, I think all the advocates, all the researchers, all the people who are really fighting to put oral health on the agenda. And allowed us to meet with like-minded colleagues and understanding that we face similar opportunities and similar challenges to ensure that oral health is always on the agenda,
Richard Watt 02:52
Good, so that that's a nice, positive start. Irving, what was your memories of the Bangkok meeting?
Irving McKenzie 03:00
Well, I do concur with my colleague Paula that it was indeed a memorable moment on the Global Agenda for oral health. For me, it also represents a strong point of support for local and regional programs in that we felt that the world at last, was a global village. Most importantly, it gave me a better understanding of what is taking place globally, so that I could tailor make my programs thinking globally but acting locally.
Richard Watt 03:41
Thank you for that, that opening again, some interesting points that we might explore in our conversation. But I wonder, just for both of you, I think we had, was it a four-day meeting? What were the real ingredients of the success of that meeting? Because it took a lot of planning, I think, for WHO. But from each of you, what do you think were the ingredients, we had different stakeholders, Paula, you mentioned that, but any other ingredients of the success of the meeting for you personally?
Paula Vassallo 04:10
As Irving, my colleague said, it was a turning point for advocacy and visibility, seeing that the different stakeholders who were present, and it was not only the converted or the oral health experts who are present, provided a turning point for advocacy and visibility. I think it was also a pivotal platform for global health diplomacy and collaboration. I am still collaborating with colleagues from different countries who I had the opportunity to meet in Bangkok, and it was a transformational in terms of the adoption of the Bangkok declaration, no health without oral health which I continue to advocate for and push for. It elevated also other diseases as a global public health priority. It was very much inclusive. If you know we had, I think, 100 countries present very much forward looking, aligning oral health with the UHC, NCD and planetary health agendas. And also allowed that oral health was actually included for the first time in the draft political declaration of the fourth UN high level meeting.
Richard Watt 05:21
Okay, so a lot of really important ingredients for the overall success and Irving, I wonder from from your particular perspective, we had civil society organisations present in Bangkok. We had a large presence of delegates from low- and middle-income countries in the global south. Do you think that added to the success of the meeting?
Irving McKenzie 05:45
Absolutely, from the point of advocacy and camaraderie, it is very, very important to ensure that our coalition is very broad based. Actually, there were some 12 ministers of health there. There was the chief medical officers, I think there's one from the Philippines that I met. There are also UHC coordinators that were non-dental personnel that I think added to the ingredient of ensuring that this conference was indeed a success. I would also state that the conference was so well structured in that we had a nascent draft of the Bangkok declaration. It avoided delays in terms of streamlining or causing us to focus exactly on what we need to focus so that we could actually leave the conference with a Bangkok decoration. No health without oral health. Also, the fact that we had a structured program looking on the national oral road map. There were worksheets on rapid oral health assessment situations, looking at national oral health scorecards and also national oral health priority tools. So what basically happened, apart from the main plenary sessions, there was this grouping from various regions where we could get down to the detail and to the hard work of doing the rapid assessment, so that we can, from our national level and regional level, actually focus or coordinate the activities towards promoting this call for the Global Oral Health action plan that is out there already for 2023, 2030. I also think the fact that we had the national or LED road map, the Bangkok Declaration and the global oral health, global coalition and oral health as you mentioned, civil society and others, those were three major outcomes, and I think that is what were the ingredients for success.
Richard Watt 08:08
I think we're, we're in agreement across our different experiences, that it was a special event.
Paula Vassallo 08:15
One point we also need to mention, it's Thailand's leadership. I think, as the host country they showcased also its successful model of integrating oral health into universal health coverage program. I think, you know, it was a blueprint for us and for all nations. So, I think that should not go unmentioned.
Richard Watt 08:32
It was a unique setting. But as a country, Thailand has led in many different initiatives in terms of oral health and global health. So, I think a very good point Paula, in terms of the location, wasn't by accident, it really added to the event. And I think what I'd like to now do actually, is continue this discussion and think about the impact of the declaration and of the tools, including the road maps, that different countries and regions were developing in Bangkok, 12 months well, 18 months later. Now, what do you think is, has been the impact of the declaration and associated documents? Have they helped you at a national level, move the oral health agenda forward? Maybe let's start with Irving. What's your experience in Jamaica, has it really made a difference for you?
Irving McKenzie 09:24
Yes, it has made a difference. But first, I like to share a little personal experience. When I became the chief Dental Officer of Jamaica, oral health was not a priority. It was just a program that was buried in a family health program, and my priority and my job description was to look at salt fluoridation, strategy, public health strategy that we had implemented in the 1980s and in which we had successfully implemented and our DMF level that fell from 6.7 to 1.808 actually. So, it was like we have solved Jamaica's oral health problem, let's move on. Secondly, the whole aspect of corporate dentistry and dentistry oral being on the periphery of the national health agenda. The impact that the Bangkok conference or the Bangkok meeting really had, it let me know that you're not alone in this world in terms of being the voice of advocacy and the voice of reasoning and the voice of promoting oral health in your respective country. I totally enjoy your presentation, Professor Watt on upstreaming of the programs. And I can tell you one of the impacts that we now have, a program that we call ICAP, which is the integrated oral care of antenatal patients, where we believe in looking at oral health, we need to look at oral health across the life stages, starting with the mother and child. So, by empowering, by taking the care of our pregnant women and pregnant adolescent girls, empowering them, teaching them, sensitising them to the importance of their oral health, caring for them, that they internal pass on these values and practices to their children. So currently, now in Jamaica, we have seven oral programs. So, when I sit with my medical colleagues, they'll talk about immunisation program, reproductive health and what have you, chronic non-communicable diseases. We have seven oral programs from the school-based program, where we target children in elementary schools using the public health approach, health promotion and health education and promotion, preventive services, curative services, rehabilitative and palliative services, looking at that level and ensuring we move from the school, the community, special needs, etc. So quickly, I tell you, apart from the antenatal program, we also have a program focusing on IDD special needs, looking on individual with intellectual and developmental disabilities. So how did we reach this point, the worksheet, the rapid assessment that enable us to look at our nation, look at our situation, apply a metric that you could see where we are orally, you know, so to speak, bringing out those points in an empirical way and promoting it. And we have had some success, but more help is needed.
Richard Watt 12:46
Good well, that that sounds some very tangible progress. Which is good to hear and again, good to hear about the value of the different documentation and support materials that that were produced at Bangkok, which, again, thanks to WHO staff you really think help things. Across to Paula back in Malta, do you feel since Bangkok, have things move forward for you and let's be honest, because sometimes things have not moved forward. But what's your view Paula from Malta?
Paula Vassallo 13:19
Even for Malta, I think first having, you know, the rapid assessment sheet and also the roadmap has helped us in developing our, we're working on our roadmap and our action plan, which is being developed as a vertical strategy from the non-communicable disease prevention framework, we've made sure that oral health was included within the prevention framework, and we had political also support on the development of our vertical strategy for oral health. It has allowed oral health to be included in most of our strategies. And recently, also, we've made sure that in our diabetic clinic within the hospital that now oral health is being recognised also as an important referral point for our diabetic patients. For the small country like ours, I think it was also the lessons I learned from other small countries around the world of what they are doing and trying to adapt them also in our own small island.
Richard Watt 14:26
That's interesting, because I think that almost that sense of almost empowerment of us as different stakeholders is potentially another impact.
Paula Vassallo 14:35
I think it was also it gave us the more momentum, more drive, you know, more encouragement to actually take it forward with the renewed passion, let's listen, we can do it. My colleagues are facing similar challenge, and they have achieved it. So let me go home, renewed determination to be able to take oral health forward.
Richard Watt 14:58
Irving, you were going to add something.
Irving McKenzie 15:00
In agreeing with Paula, I just like to say also for from our NCD perspective, we have developed a screening tool for diabetics that we give to our medical doctors and our public health nurses that when they see the diabetic patients, they will start the screening of these patients, very simple tool and refer to oral health. So, we are using the integration on two level, integration of the services where there's referral, and integrating of the services where oral health teams are present at the time when the diabetic clinics are going on, where those NCDs clinics are being instituted, so to speak, so the patients have a seamless approach to accessing care.
Richard Watt 15:50
Great, so that that really integrated model, moving from the isolated silo working that we often feel we're stuck into an integrated approach, sounds very tangibly a good impact. Can we move on, I think both of you have mentioned another part of the success of the meeting was the ability for us to look at our colleagues and partners across the regions in which we're based. So, the workshops in the Bangkok meeting, when we were looking at roadmaps, where that was in Europe or in the Americas, did you feel there's progress been made in working collaboratively across countries, either regional level or even at a global level? Paula, what's your view? Did that experience help to foster links across Europe?
Paula Vassallo 16:44
It definitely did help us, maybe we want more, but it did help and we're working together with Chief Dental Officers, some other European countries, even having discussions when we attend the Joint Chief Medical Officer, Chief Dental Officer, Chief Nursing Officer meeting, and we're discussing certain challenges we're facing in developing our own roadmaps and learning some other colleagues of how they have achieved it. So having been together also with some colleagues which we have never met before at a European level, it allowed us for more collaboration to take it forward, but we do want to see, I think, more collaboration on this, so that we can drive it forward at the European level.
Richard Watt 17:28
And across into the Americas, Irving, for you, did it foster collaboration across countries?
Irving McKenzie 17:34
Not the way I would have anticipated. But I must say that the PAHO WHO has made a concerted effort to have region wide meeting, I think we have a two so far in which we as a region discuss the rapid oral health assessment tools, the national oral health score card and the priority aspect for our region, looking at individual countries, but on a country to country and regional kind of collaboration, we are not seeing that, I must say, contrary to what we see with our physician colleagues, where there's a chief medical officers meeting in the region, like in the CARICOM and CARICOM is for the Caribbean Common Market, like in the Caribbean region, those Chief Medical Officers meet, but there are no Chief Dental Offices meeting. So, we are trying, led by myself and Dr. Joy C. Pickstock, Chief Dental Office of Bermuda to host and have Caribbean wide meetings where we can share what we have learned from the Bangkok meeting, where we can also share our own experience that we can help to others, smaller and developing countries like ourselves, to implement the strategies to advance oral health.
Richard Watt 19:00
That sort of cross-country collaboration is work in progress. And it clearly there are some challenges there, and there are resource requirements, but it sounds like we are making progress in different ways, which is which is very encouraging. I suppose my next question is that now in 2026 the geopolitical landscape has changed dramatically since we were all in Bangkok. And as I think many people know, WHO funding has been challenged, and with the withdrawal of Argentina, the US, funding resources for WHO has been significantly reduced. So I suppose my question to both of you is, WHO helped us when we were in Bangkok, who helped to empower us, inspire us. Is there anything we can do to support WHO now that they need some support? Paula, what's your view on that?
Paula Vassallo 20:00
It's, in fact something that we are currently working on also at the European level. What we're trying to do is to when the European countries have the EU presidency, we're trying to ensure that WHO will also be invited to help support in taking the lead at an, at least at an EU level, because they are they're holding the EU presidency, to take forward the Bangkok declaration, and also to ensure that oral health gets, let us say, dimension and the recognition that it deserves. But I think what we need to continue doing is to take forward that Bangkok spirit, to continue driving it forward, not only as Member States, but also working together with non-governmental organisations, which also have a very strong voice.
Richard Watt 20:50
So that Bangkok spirit is a nice phrase for us to think about and Irving from your side with WHO being challenged, and its resources being reduced. Does that affect you in any sense directly, or is it too far removed from your personal and country experience?
Irving McKenzie 21:08
Well, first of all, I like to say that, from my perspective, the WHO footprint has been sort of small because of Jamaica and some of the countries in the Caribbean being in a form of what we call epidemiological transition, where we're not having only having issues with non-communicable diseases, but we're having issues also with those new and re-emerging diseases. So, it caused that epidemiological transition, so from a policy maker perspective, in the Ministry of Health, we have these competing priorities. So normally, from the WHO perspective, there's always been preponderance, so to speak, or preoccupation and looking at those other issues and oral health has always been on the lower end of the priority spectrum. I however, do believe that with the geopolitical changes that there are opportunities, so we need to transform these challenges into opportunities for collaborations between, say, Chief Dental Officers, which could be facilitated by the FDI and academia, like, for example, the University College of London, with FDI, academia and dental associations, we can pick up where WHO may have fallen short because of funding. And I believe that this change in geopolitics may actually be just a transient change, and it won't be persistent. That's my firm belief, because the global community needs global leadership. So in the interim, I do believe we need to form alliances at the level of the CDOs, at the levels of other public health agency, at the level of academia, Dental Association and the FDI, and we can make a valid effort to strategize, using WHO strategies to broaden our coalition, sensitise the political directorate, have civil society on board, and what was, what at one of the outcome that had, that we had achieved with the Bangkok meeting this global coalition on oral health, we need to actually ensure that we maintain that coalition on the prosperity of dentistry for the global community.
Richard Watt 23:54
Well, that that's a really nice way, optimistic way of perhaps ending our discussion because we are living through difficult times, for sure, but there's a way forward, and opportunities emerge, and different partnerships can move forward. So, I would like to you know, just to thank both of you for that interesting, thoughtful conversation. The Bangkok declaration was historic, it was transformative, it was empowering, and I think, you know, we would encourage all our listeners to look at the declaration, the published declaration, and associated papers behind it, because the agenda moves forward. And I think we appreciated the Thai government's organisation and the WHO's expertise and Secretariat for pulling us all together and moving this agenda forward. Thanks to our guests, Paula Vassallo and Irving McKenzie, and to you for listening. I hope you found our conversation interesting and do please join us for our next episode, which will be published in two weeks’ time. You can follow the dental public health group on LinkedIn, blue sky and Instagram. Oral Health Matters is produced by the Dental Public Health Group at UCL, with production support from Research Podcasts and funding from the National Institute for Health and Care Research.