International Dental Journal (2008) 58, 115-121
The World Health Organization (WHO) Global Oral Health Programme has worked hard
over the past five years to increase the awareness of oral health worldwide as an important
component of general health and quality of life. Meanwhile, oral disease is still a major
public health problem in high income countries and the burden of oral disease is growing
in many low- and middle income countries. In the World Oral Health Report 2003, the
WHO Global Oral Health Programme formulated the policies and the necessary actions
for the improvement of oral health. The strategy is that oral disease prevention and the
promotion of oral health needs to be integrated with chronic disease prevention and general
health promotion as the risks to health are linked. The World Health Assembly (WHA) and
the Executive Board (EB) are supreme governance bodies of WHO and for the first time
in 25 years oral health was subject to discussion by those bodies in 2007. At the EB120
and WHA60, the Member States agreed on an action plan for oral health and integrated
disease prevention, thereby confirming the approach of the Oral Health Programme. The
policy forms the basis for future development or adjustment of oral health programmes
at national level.
© 2008 FDI/World Dental Press
World Health Organization global
policy for improvement of oral health
– World Health Assembly 2007
Key words: Oral health, general health, WHO, EB120, WHA60
Poul Erik Petersen
World Health Organization
In 2002, the World Health Organization (WHO) Global
Oral Health Programme was reoriented according to a
new strategy of integration with chronic disease preven-
tion and general health promotion. Chronic diseases,
which continue to dominate in middle- and high income
countries, are becoming increasingly prevalent in many
of the poorest developing countries. They create a dou-
ble burden on top of the infectious diseases by which
these countries continue to be afflicted1. A somewhat
similar pattern is observed for the unresolved burden
of oral disease2-9. As for the major chronic diseases,
socio-environmental factors are distal causes of oral
disease10, moreover, a core group of modifiable risk fac-
tors is common to many chronic diseases and injuries,
and most oral diseases. These common risk factors are
however preventable as they relate to lifestyles, such as
dietary habits, use of tobacco and excessive consump-
tion of alcohol, and the standard of hygiene.
The objectives of the WHO Global Oral Health Pro-
gramme, one of the technical programmes within the
Department of Chronic Disease and Health Promotion,
imply that greater emphasis is put on developing glo-
bal policies based on common risk factors approaches
and which are coordinated more effectively with other
programmes in public health. The policy of the WHO
Global Oral Health Programme emphasises that oral
health is integral and essential to general health, and
that oral health is a determinant factor for quality of life.
The policy is detailed in the World Oral Health Report
20032. The report provides a comprehensive analysis of
the global burden of oral disease and additional infor-
mation of oral health is further described in a Special
Theme of the Bulletin of the World Health Organization,
WHO priority action areas for the improvement of
oral health worldwide are:
• Effective use of fluoride12-15
• Healthy diet and nutrition16-17
• Tobacco control18-21
International Dental Journal (2008) Vol. 58/No.3
• Oral health of children and youth through Health
• Oral health improvement amongst the elderly24
• Oral health, general health and quality of life25
• Oral health systems26
• HIV/AIDS and oral health9,27
• Oral health information systems, evidence for oral
health policy and formulation of goals28-30
• Research for oral health31-32.
Major actions undertaken by the WHO Global Oral
Health Programme are detailed in the references given
and further information is available from the WHO web
site www.who.int/oral_health. Elements of the global
priorities are also part of the activities undertaken by the
oral health programmes of WHO Regional Offices. The
Office for the Americas (http://www.paho.org/, 10-
year Regional Plan on Oral Health/CE138/14) and the
Office for Africa (http://www.afro.who.int/oralhealth)
have distinct oral health programmes whereas the four
other regional offices incorporate oral health into pro-
grammes for prevention of chronic disease.
Some activities have been carried out in collabora-
tion with the 32 WHO Collaborating Centres in Oral
Health, the two non-governmental Organizations in
official relationship with WHO, i.e. Federation Den-
taire Internationale/World Dental Federation, and
International Association for Dental Research (IADR),
or other Organizations such as Aide Odontologique
Internationale working for oral health. Several WHO
co-sponsored meetings have contributed to sharing of
experiences within the oral health community and dis-
semination of essential messages to the general public,
e.g. the WHO/FDI/IADR Global Consultation on use
of fluoride for oral health 2006; FDI/WHO/IADR
fluoride consultation for China and South-East Asia
2007; WHO/IADR symposium on diet and nutrition
2005; Global conference on tobacco or health 2003;
Health Promoting Schools meetings in Thailand, China
and India 2003-5; IADR/WHO 5th global workshop on
HIV/AIDS in oral health 2004; WHO/IADR sympo-
sium on oral health in elderly; WHO/IADR meeting on
oral health in Africa and the Middle-East 2004: WHO/
FDI meeting on planning of oral health in Africa 2004;
WHO/IADR/BASCD meeting on preventive dentistry
2005, and the WHO/AAPD meeting on preventive
dentistry in Asia.
The WHO Global Oral Health Programme works
from the principles of the Ottawa Charter for Health
Promotion33. As underlined by the most recent Bang-
kok Charter for Health Promotion34, the promotion
of health and disease prevention both have established
repertoires of evidence-based strategies which need to
be fully utilised, especially for low- and middle income
countries. The Liverpool Declaration35 is an oral health
follow-up of the Bangkok Charter, which provides in-
formation about the necessary actions to be undertaken
by countries for the improvement of oral health.
Progress towards a healthier world requires strong
political action, broad participation and sustained advo-
cacy. The WHO Oral Health Programme has worked
hard over the years to put oral health high on the health
agenda of policy and decision makers worldwide. Re-
cently, the WHO was given the mandate for strength-
ening the work for oral health by its two governing
bodies, i.e. the Executive Board, and the World Health
Assembly. The WHO statement will be an impetus
for countries to develop or adjust national oral health
programmes, and the policy is a strong support to the
global actions carried out by the WHO Oral Health
The World Health Assembly is the supreme decision-
making body for WHO. It meets each year in May in
Geneva, and is attended by delegations from all 193
Member States. The Executive Board is composed of
34 members technically qualified in the field of health.
The main Board meeting, at which the agenda for the
forthcoming Health Assembly is agreed upon and
resolutions are adopted for forwarding to the Health
Assembly, is held in January.
In January 2007, the Executive Board at its 120th
session discussed the subject of oral health on the
basis of the report prepared by the WHO Oral Health
Programme36, and the Board subsequently considered
a related draft resolution (EB120.R5.).
Below is the WHO Oral Health Programme’s contri-
bution to the Sixtieth World Health Assembly held from
14-22 May 2007 which is entitled ‘Oral health: action
plan for promotion and integrated disease prevention’,
and the subsequent final Resolution WHA60.1737, as
confirmed by the Member States.
Oral health: action plan for promotion and
integrated disease prevention - Report by the
Oral disease, such as dental caries, periodontal disease,
tooth loss, oral mucosal lesions, oropharyngeal can-
cers, oral manifestations of HIV/AIDS, necrotising
ulcerative stomatitis (noma), and orodental trauma, is a
serious public-health problem. Its impact on individu-
als and communities in terms of pain and suffering,
impairment of function and reduced quality of life,
is considerable. Globally, the greatest burden of oral
diseases lies on disadvantaged and poor populations.
The current pattern of oral disease reflects distinct risk
profiles across countries related to living conditions, be-
havioural and environmental factors, oral health systems
and implementation of schemes to prevent oral disease.
In several high-income countries with preventive oral-
care programmes prevalence of dental caries in children
and tooth loss among adults has dropped. Globally, the
Petersen: WHO global policy for improvement of oral health
burden of oral disease is particularly high among older
people and has a negative effect on their quality of life.
In most low- and middle-income countries, the general
population does not benefit from systematic oral health
care, nor have preventive programmes been established.
In some countries the incidence of dental caries has
increased over recent years and may further increase
as a result of the growing consumption of sugars and
inadequate exposure to fluorides.
Tobacco-related oral diseases are currently prevalent
in several high-income countries. With the growing con-
sumption of tobacco in many low- and middle-income
countries, the risk of periodontal disease, tooth loss
and oral-cavity cancer is likely to increase. Moreover,
periodontal disease and tooth loss are linked to chronic
diseases such as diabetes mellitus; the growing incidence
of diabetes in several countries may therefore have a
negative impact on oral health. People living with HIV/
AIDS suffer from specific oral disease; HIV infection
has a negative effect on oral health and quality of life
because of, for example, pain, dry mouth and difficulty
in chewing, swallowing and tasting food.
Noma, a debilitating orofacial gangrene, is an im-
portant contributor to the disease burden in certain
low- and middle-income countries, particularly in Af-
rica and Asia; the key risk factors are poverty, severe
malnutrition, unsafe drinking water, deplorable sanitary
practices and such infectious diseases as measles, ma-
laria, and HIV/AIDS.
Oral disease is the fourth most expensive disease
to treat. In high-income countries, the burden of oral
disease has been tackled through the establishment of
advanced oral-health services which offer primarily
treatment to patients. Most systems are based on de-
mand for care provided by private dental practitioners,
although some high-income countries have organised
public oral-health systems. In most low- and middle-
income countries, investment in oral health care is low
and resources are primarily allocated to emergency oral
care and pain relief.
Most oral diseases and chronic diseases have com-
mon risk factors. As is the case for major chronic dis-
eases, oral diseases are linked to unhealthy environments
and behaviours, particularly widespread use of tobacco
and excessive consumption of alcohol or sugar. In ad-
dition to healthy behaviour, promotion of oral health
depends on clean water, adequate sanitation, proper oral
hygiene and appropriate exposure to fluoride. National
health programmes that include health promotion and
measures at individual, professional and community
levels are cost-effective in preventing oral diseases.
Framing policies and strategies for oral health
Promotion of oral health is a cost-effective strategy
to reduce the burden of oral disease and maintain oral
health and quality of life. It is also an integral part of
health promotion in general, as oral health is a determi-
nant of general health and quality of life.
One of the main lines of WHO’s global strategy
for the prevention and control of chronic non-com-
municable diseases is to reduce the level of exposure to
major risk factors. Prevention of oral disease needs to
be integrated with that of chronic diseases on the basis
of common risk factors.
Some high-income countries have built national
capacities in oral-health promotion and oral-disease
prevention over the past decades, mostly as isolated
components of national health programmes. A number
of low- and middle-income countries do not yet have
policies on, or financial and human resources for, sus-
tainable, effective oral-health programmes to counter
risks and their underlying determinants.
To strengthen the formulation or adjustment of poli-
cies and strategies for oral health and its integration in
national and community health programmes, particular
emphasis should be laid on the following elements:
• Promotion of a healthy diet, particularly lower con-
sumption of sugars and increased consumption of
fruits and vegetables, in accordance with WHO’s
Global Strategy on Diet, Physical Activity and
Health, and reduction of malnutrition.
• Prevention of oral and other diseases related to to-
bacco use (smoking and use of smokeless tobacco),
by involving oral-health professionals in tobacco
cessation programmes and discouraging children and
young people from adopting the tobacco habit.
• Provision of access to clean drinking water, general
hygiene and better sanitation for proper oral hy-
• Establishment of national plans for use of fluoride,
based on appropriate programmes for automatic ad-
ministration of fluoride through drinking-water, salt,
or milk, or topical use of fluoride such as affordable
fluoride toothpaste. Salt fluoridation programmes
should be linked to iodisation schemes.
• Prevention of oral-cavity cancer and oral pre-cancer
by involving oral health professionals or specially
trained primary health-care workers in screening,
early diagnosis and referral for care, and appropriate
interventions on the risks of tobacco use and exces-
sive consumption of alcohol.
• Strengthening of management of HIV/AIDS
through oral-health professional screening for HIV/
AIDS-related oral disease, early diagnosis, prevention
and treatment, with emphasis on pain relief and
improved quality of life and on reduction of the
double burden of oral disease and HIV infection in
low- and middle-income countries.
International Dental Journal (2008) Vol. 58/No.3
• Building of capacity in oral-health systems oriented
to disease prevention and primary health care, with
special emphasis on meeting the needs of disadvan-
taged and poor populations. Oral-health services
should be set up, ranging from prevention, early
diagnosis and intervention to provision of treat-
ment and rehabilitation, and the management of
oral health problems of the population according to
needs and to resources available. In countries with
critical shortages of oral-health personnel, essential
care may be provided by specially trained primary
• Promotion of oral health in schools, aiming at devel-
oping healthy lifestyles and self-care practices in chil-
dren and young people. An integrated approach that
combines school health policy, skills-based health
education, a health-supportive school environment
and school health services can tackle major common
risk factors and contribute to effective control of
• Promotion of oral health among older people, aim-
ing at advancing oral health, general health and well-
being into old age through a life-course perspective
in health promotion, integrated disease prevention
and emphasis on age-friendly primary health care.
• Development of oral-health information systems
as an integral part of national surveillance of oral
health and risk factors, in order to provide evidence
for oral health policy and practice, formulation of
goals and targets, and measurement of progress
in public health. Instruments have been designed
in the framework of the WHO Global InfoBase
and the WHO STEPwise approach to surveillance
• Promotion of research in oral health, aimed at
bridging gaps in research between low- and mid-
dle-income, and high-income countries, conduct of
operational research, and translation of knowledge
about oral-health promotion and disease prevention
into public-health action programmes.
Working with other international entities involved in oral
health, WHO will provide support to Member States in
raising awareness of the determinants of oral and general
health, and fostering health-promoting environments,
healthy behaviour and prevention-oriented oral-health
systems. WHO will further strengthen its support for
building capacity at national and community levels to plan
and implement comprehensive and integrated oral-health
programmes, particularly in low-and middle-income
countries and for poor and disadvantaged groups.
WHO will continue to provide technical support
for, and guidance on, the design, implementation and
evaluation of evidence-based community demonstration
projects worldwide, contribute to sharing of experiences
among countries and disseminate lessons learnt through
the publication of guidelines. Its expanded evidence
base provides a basis for oral-health policies and for
investigating the cost and effectiveness of national and
community oral health interventions. WHO will also
offer technical advice on establishment of integrated
oral-health surveillance systems, based on the WHO
Global InfoBase and the STEPS methodology. It will
also further expand its work with the WHO collaborat-
ing centres on oral health and nongovernmental organi-
zations, including the FDI World Dental Federation and
the International Association for Dental Research.
In order to respond to the many global changes and
trends that directly or indirectly affect oral health and
well-being, WHO will further expand its interaction and
partnership with other international entities involved in
oral health and the private sector within the framework
of its overall leadership in health promotion and inte-
grated disease prevention.
SIXTIETH WORLD HEALTH ASSEMBLY WHA60.17
Oral health: action plan for promotion and integrated
The Sixtieth World Health Assembly,
Recalling resolutions WHA22.30, WHA28.64 and
WHA31.50 on fluoridation and dental health,
WHA36.14 on oral health in the strategy for health
for all, WHA42.39 on oral health; WHA56.1 and
WHA59.17 on the WHO Framework Convention on
Tobacco Control; WHA58.22 on cancer prevention
and control; WHA57.14 on scaling up treatment and
care within a coordinated and comprehensive response
to HIV/AIDS; WHA57.16 on health promotion and
healthy lifestyles; WHA57.17 on the Global Strategy
on Diet, Physical Activity and Health; WHA58.16 on
strengthening active and healthy ageing; WHA51.18
and WHA53.17 on prevention and control of noncom-
municable diseases, and WHA58.26 on public-health
problems caused by harmful use of alcohol;
Acknowledging the intrinsic link between oral health,
general health and quality of life;
Emphasizing the need to incorporate programmes
for promotion of oral health and prevention of oral
diseases into programmes for the integrated prevention
and treatment of chronic diseases;
Aware that the importance of the prevention and con-
trol of noncommunicable diseases has been highlighted in
the Eleventh General Programme of Work 2006–2015;
Petersen: WHO global policy for improvement of oral health
Appreciating the role that WHO collaborating cen-
tres, partners and nongovernmental organizations play
in improving oral health globally,
URGES Member States:
(1) to adopt measures to ensure that oral health is incor-
porated as appropriate into policies for the integrated
prevention and treatment of chronic noncommunicable
and communicable diseases, and into maternal and child
(2) to take measures to ensure that evidence-based
approaches are used to incorporate oral health into na-
tional policies as appropriate for integrated prevention
and control of noncommunicable diseases;
(3) to consider mechanisms to provide coverage of the
population with essential oral-health care, to incorpo-
rate oral health in the framework of enhanced primary
health care for chronic noncommunicable diseases,
and to promote the availability of oral-health services
that should be directed towards disease prevention and
health promotion for poor and disadvantaged popula-
tions, in collaboration with integrated programmes for
the prevention of chronic noncommunicable diseases;
(4) for those countries without access to optimal lev-
els of fluoride, and which have not yet established
systematic fluoridation programmes, to consider the
development and implementation of fluoridation pro-
grammes, giving priority to equitable strategies such as
the automatic administration of fluoride, for example,
in drinking-water, salt or milk, and to the provision of
affordable fluoride toothpaste;
(5) to take steps to ensure that prevention of oral
cancer is an integral part of national cancer-control
programmes, and to involve oral-health professionals or
primary health care personnel with relevant training in
oral health in detection, early diagnosis and treatment;
(6) to take steps to ensure the prevention of oral disease
associated with HIV/AIDS, and the promotion of oral
health and quality of life for people living with HIV,
involving oral-health professionals or staff who are
specially trained in primary health care, and applying
primary oral-health care where possible;
(7) to develop and implement the promotion of oral
health and prevention of oral disease for preschool and
school children as part of activities in health-promoting
(8) to scale up capacity to produce oral-health personnel,
including dental hygienists, nurses and auxiliaries, pro-
viding for equitable distribution of these auxiliaries to
the primary-care level, and ensuring proper service back-
up by dentists through appropriate referral systems;
(9) to develop and implement, in countries affected
by noma, national programmes to control the disease
within national programmes for the integrated manage-
ment of childhood illness, maternal care and reduction
of malnutrition and poverty, in line with internation-
ally agreed health-related development goals, including
those contained in the Millennium Declaration;
(10) to incorporate an oral-health information system
into health surveillance plans so that oral-health objec-
tives are in keeping with international standards, and to
evaluate progress in promoting oral health;
(11) to strengthen oral-health research and use evidence-
based oral-health promotion and disease prevention in
order to consolidate and adapt oral-health programmes,
and to encourage the intercountry exchange of reliable
knowledge and experience of community oral-health
(12) to address human resources and workforce planning
for oral health as part of every national plan for health;
(13) to increase, as appropriate, the budgetary provisions
dedicated to the prevention and control of oral and
craniofacial diseases and conditions;
(14) to strengthen partnerships and shared responsibility
among stakeholders in order to maximize resources in
support of national oral health programmes;
REQUESTS the Director-General:
(1) to raise awareness of the global challenges to im-
proving oral health, and the specific and unique needs
of low- and middle-income countries and of poor and
disadvantaged population groups;
(2) to ensure that the Organization, at global and regional
levels, provides advice and technical support, on request,
to Member States for the development and implemen-
tation of oral-health programmes within integrated ap-
proaches to monitoring, prevention and management of
chronic noncommunicable diseases;
(3) continually to promote international cooperation
and interaction with and among all actors concerned
with implementation of the oral-health action plan, in-
cluding WHO collaborating centres for oral health and
(4) to communicate to UNICEF and other organizations
of the United Nations system that undertake health-re-
lated activities, the importance of integrating oral health
into their programmes;
(5) to strengthen WHO’s technical leadership in oral
health, including increasing, as appropriate, budgetary
and human resources at all levels.
International Dental Journal (2008) Vol. 58/No.3
Oral health services development and
The WHO Global Oral Health Programme gives priority
to the organization of oral health services that matches
the needs of the population2,26. In several industrialised
Western countries, oral health services are made avail-
able to the population, either based on public or private
systems. Meanwhile, people in deprived communities,
homebound and disabled individuals, old-age persons,
and certain ethnic minorities are not sufficiently covered
by oral health care. Social inequality in oral health status
and use of services is somewhat universal, even in the
Nordic countries with public responsibility in financing
and delivery of oral health care remarkable differences
are observed by social class38. Outreach services may be
necessary to tackle the burden of poor oral health of
people with limited resources and lack of tradition of
regular oral health care.
By and large, the industrialised countries show ap-
propriate numbers of dentists whereas there is shortage
of dental ancillary personnel to carry out preventive care
and health promotion. The problem of production of
inappropriate types and numbers of oral health profes-
sionals is still being faced by most of the industrialised
countries. In some countries, the introduction of ancil-
lary personnel has been delayed. It has been reported,
particularly in countries where over-production exists
and the oral health of the population has improved,
that duties which traditionally have been performed by
assisting personnel are now being carried out by dentists
While there is a need for adjustment of oral health
services in high-income countries, services are often not
available or accessible for the general population in the
majority of developing countries. This is particularly the
case for Latin America, Asia and the poor countries of
Africa. There is significant lack of oral health personnel,
the WHO Global Oral Health Programme has drawn a
global map demonstrating that Sub-Saharan countries
have a critical shortage of oral manpower26. Moreover,
cost of oral health services is high, the use of services
is often prompted by symptoms and services are mostly
oriented towards relief of pain39. Oral health care is
generally provided by hospitals located in urban centres
whereas limited care is offered in rural areas. In the
majority of countries in Africa and Asia little attention
is given to oral health of people living with HIV/AIDS
who are less aware of the oral manifestations of infec-
tion than the general symptoms40.
The lack of oral health services highly reflects the
low priority to oral health by policy makers and decision
makers in these countries and oral health staff or chief
dental officers are most often not available within min-
istries of health. In the future, strong emphasis should
be given to the effective implementation of integrated
primary oral health care according to the WHO Primary
Health Care concept in 197941.
Worldwide, the priority given to prevention of oral
disease and health promotion is far too low. In 1986,
the so-called Ottawa Charter on Health Promotion33
emphasised that health services should be effectively
oriented towards prevention and health promotion.
The need is still high for adjustment of programmes
in countries with existing oral health services and for
countries in the process of developing oral health pro-
grammes strong efforts should be made towards the
implementation of prevention and health promotion.
For all countries the adjustment or development of
national oral health programmes should incorporate
systematic activities towards oral cavity cancer and the
oral manifestation of HIV/AIDS, including early diag-
nosis and referral for specialist care.
The 2005 Bangkok Charter for Health Promotion in
a Globalized World34 states that the evidence is available
on the effectiveness of chronic disease prevention and
health promotion, and the challenge for national health
authorities and health care providers is urgently to trans-
late this knowledge into practise for the benefit of the
disadvantaged people or nations. Health services should
be financially fair and be based on outreach principles
in order to cover the whole population. The Liverpool
Charter on Oral Health Promotion35 gives direction to
oral health planners and oral health providers for imple-
mentation of appropriate oral health programmes based
on the wealth of evidence on oral disease prevention
and oral health promotion. As underlined by the WHO
Global Oral Health Programme2, it is most relevant to
ensure that such programmes are not isolated activities
but integrated with national health programmes. WHO
has designed an operational plan for oral health glo-
bally and the WHO Global Oral Health Programme
is prepared to assist the national health authorities in
this effort and in partnership with non-governmental
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Correspondence to: Dr. Poul Erik Petersen, World Health Organi-
zation, Global Oral Health Programme, Department of Chronic
Disease and Health Promotion, 20 Avenue Appia, CH-1211, Geneva
27, Switzerland. Email: firstname.lastname@example.org