Special Issue ORAL HEALTH INEQUALITIES & HEALTH SYSTEMS IN ASIA-PACIFIC February 2017 Produced in partnership with IF IT’S SCIENCE HAPPENING IN INDIA, IT IS ON NATURE INDIA Log on to www.natureasia.com/en/nindia for the most in-depth coverage of Indian science. The award winning website features the latest research, science news, jobs and events from India. 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Register free today for the latest updates on India’s Science: http://www.natureasia.com/en/nindia Follow us on : https://www.facebook.com/npgindia https://twitter.com/NatureInd For advertising solutions, please contact: Sonia Sharma Advertising & Sponsorship Manager - India | [email protected] | +91 (0)124 3079657, Mobile: +91 9650969959 CONTENTS Oral Health Inequalities & Health Systems in Asia-Pacific EDITORIAL COUNTRY PROFILE Special Issue S1 Oral health inequalities and health S12 Oral health inequalities in Australia systems in Asia-Pacific: A call for Marco A Peres & Liana Luzzi ORAL HEALTH INEQUALITIES & HEALTH SYSTEMS IN ASIA-PACIFIC action S14 Challenges for Brunei Darussalam February 2017 Marco A Peres, David S Brennan & Madhan Balasubramanian Karen G. Peres, Malissa SY A.Sikun, Paulina KY Lim & Kaye Roberts-Thomson COMMENTARY S16 Oral healthcare delivery in China S3 Oral health inequalities: A major Edward C. M. Lo public health challenge for S18 Dental practice, education and Asia–Pacific research in India David Williams & Manu R Mathur Balaji S Muthiah & Vijay P Mathur S5 Societal determinants of oral health S20 Oral health inequality in India: inequalities in Asia–Pacific Perspectives and solutions Produced in partnership with Ankur Singh Om P Kharbanda & Kunaal Dhingra S7 Challenges in reducing oral health S22 Roadblocks to reducing oral health inequalities in Asia–Pacific inequalities in New Zealand Cover art: Jun Aida W. Murray Thomson Ajay Kumar Bhatt S9 Dentist migration in Asia Pacific: S24 Oral health in Papua New Guinea problems, priorities and policy recommendations Leonard A Crocombe, Mahmood Siddiqi & Gilbert Kamae Madhan Balasubramanian, Jennifer E Gallagher, Stephanie D Short & S26 Oral health inequalities in an David S Brennan emerging economy – a case of Vietnam Loc G Do & Diep H Ha Disclaimer Australian Research Centre Nature India This supplement is published in collaboration with the for Population Oral Health (ARCPOH) Registered Office: 7th Floor, Vijaya Building, University of Adelaide as knowledge partners. The Adelaide Dental School 17, Barakhamba Road, New Delhi - 110 001, India. content has not been written or reviewed by Nature The University of Adelaide Email: [email protected] India editors, and Nature India accepts no responsibility Level 1, 122 Frome St Web: www.nature.com/nindia for the accuracy of the information provided. Adelaide SA 5005 Web: www.adelaide.edu.au/arcpoh Oral health inequalities & health systems in Asia–Pacific EDITORIAL Oral health inequalities and health systems in Asia-Pacific: A call for action Marco A Peres1, David S Brennan2, Madhan Balasubramanian3 Marco A Peres David Brennan Madhan Balasubramanian Nature India Special Issue doi: 10.1038/nindia.2017.20 sia-Pacific is home to about half the world’s population. It is a diverse region comprising 38 countries, including the World Health Organ- A ization’s Western Pacific and South-East Asian regions. Six coun- tries (Australia, Brunei, Japan, New Zealand, South Korea and Singapore) are high-income; two are low-income (Nepal and North Korea), and rest are clas- sified as middle-income. China, India, Malaysia, Thailand, Indonesia, and the Philippines are among the fastest growing economies in the world. Health is an intrinsic factor in economic development in the region1, and central towards achieving global Sustainable Development Goals2,3. Oral health describes the health of the mouth and adjacent structures. Tooth decay, gum disease and tooth loss rank among the most common con- ditions in the world4. They cause pain, infection, difficulty in eating, and can have a negative impact on quality of life and social functioning. Oral diseases are also linked with other systemic conditions, such as cardiovascular diseas- es5,6. The cost of treating oral diseases account for a large proportion of overall expenditure on health. For example, direct treatment costs of oral diseases were estimated at US$298 billion a year globally, an average of 4.7% of the global health expenditure7. Even though oral diseases are largely preventable, oral healthcare is a neglected area and given low priority in most systems8. ORAL HEALTH INEQUALITIES AND HEALTH SYSTEMS In simple terms, oral health inequalities refer to the uneven distribution of proportionally affect the poor and socially disadvantaged, who are have great- oral health or oral health resources amongst the population. Oral diseases dis- er exposure to risk factors and have inadequate access to necessary health 1Professor of Population Oral Health and Director of the Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Australia ([email protected]); 2Professor, ARCPOH, Adelaide Dental School, the University of Adelaide, Australia (david.brennan@adelaide. edu.au); 3Research Associate, ARCPOH, Adelaide Dental School, University of Adelaide, Australia; Honorary Associate, Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, University of Sydney ([email protected]). February 2017 S1 PERES ET AL. services. Denied or delayed access to dental care is influenced by factors such Kharbanda & Kunaal Dhingra), New Zealand (by W. Murray Thomson), Papua as the availability of practitioners and cost of dental services. Inequalities in New Guinea (by Leonard A. Crocombe, Mahmood Siddiqi & Gilbert Kamae) oral health are seen both within and across several countries in the Asia-Pa- and Vietnam (by Loc Giang Do & Diep Hong Ha). While these are not a com- cific region. The global dental research community has consistently argued plete representation, they represent a cross-section – geographically, cultural- that these inequalities are both unfair and unjust and demand the immediate ly and economically – to reflect the region’s diversity. attention or policy-makers9. A health system comprises all organizations, people and actions whose SIGNIFICANCE AND FUTURE IMPLICATIONS aim is to promote, restore or maintain health10. Strengthening these systems There is an urgent demand for collaboration among researchers, policymak- is fundamental to address oral health inequalities and this include efforts to ers, public health practitioners, clinical teams and public, to improve oral influence determinants of health as well as more direct health-improving ac- health in the Asia-Pacific region. Based on the London Charter for Oral Health tivities. The six building blocks of health systems include: workforce, service Inequalities9, we stress the importance of advocacy on oral health inequalities delivery, information; medical/dental products; technologies; financing; and in the region. We widen the agenda to strengthen essential aspects of health leadership and governance10.