Prioritizing population oral health through public policy in Australia: the Victorian experience.

Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011-2015 and 2019-2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases.

Global plastic waste recycling and extended producer responsibility laws.

In the USA, 8.66% of municipal solid waste (MSW) plastic was recycled and 75.9% landfilled (2018). Some critical challenges in widespread adoption of post-consumer recycled (PCR) plastic include high collection costs, sortation complexity, inconsistent feedstock properties, and unknown contamination leading to safety considerations. The objective of this review is to discuss global Extended Producer Responsibility (EPR) policies/regulations and their ability to facilitate coordination of domestic/international policies and business to overcome critical recycling complications. Global EPR and recycling laws were examined to compare and contrast initiatives to increase recycling and avoid plastic waste generation. EPR laws increase producers' liability towards product generation, marketing, and disposal by applying fees and taxes on products depending on product recyclability and volume generation. Countries with established plastic EPR regulations and landfill bans often possess higher recycling rates. The results of this research can facilitate development of local regulatory mandates to increase recycling rates.

Platform for Better Oral health in Europe / La plateforme pour la santé orale en Europe

The Platform for Better Oral Health in Europe brings together five European organizations (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Foundation-UK) along with eighteen other associated European or national organizations. The platform aims to encourage oral health promotion and the prevention of oral diseases as fundamental components of good general health. The aim is thus to strengthen oral health promotion in Europe through integrating oral health into the relevant public health policies. It also aims to address the issue of oral health inequality, particularly among vulnerable populations such as children and adolescents, older adults, and people with particular needs. The platform is therefore a European-level resource for providing evidence-based information on best practice in oral health promotion and for guiding oral health policies. It also works to reinforce communication at the European level between stakeholders, policy makers, health professionals, and the public, in order to improve awareness of oral health issues.

La « plateforme pour une meilleure santé orale en Europe ¼ réunit six associations européennes (Council of European Chief Dental Officers, Association for Dental Education in Europe, European Association of Dental Public Health, Pan European-International Association For Dental Research, Oral Health Fondation-European Federation of Periodontology) en lien avec dix-neuf organisations européennes ou nationales associées. Elle a pour objectif d'encourager la promotion de la santé orale et la prévention des maladies bucco-dentaires en tant qu'éléments fondamentaux d'une bonne santé générale. L'objectif est aussi de renforcer la politique de promotion de la santé orale en Europe, y compris par l'intégration de la santé orale dans des politiques de santé publique pertinentes. Il s'agit également de prendre en compte la question des inégalités en matière de santé orale, notamment au sein des populations vulnérables comme les enfants et les adolescents, les personnes âgées et les personnes ayant des besoins spécifiques. La plateforme constitue ainsi une ressource au niveau européen pour fournir des informations fondées sur des preuves concernant les meilleures pratiques en promotion de la santé orale et pour l'orientation des politiques en matière de santé orale. Elle travaille aussi à développer les relations au niveau européen avec les parties prenantes, les décideurs politiques, les professionnels de santé, le public, afin d'améliorer la prise en compte des enjeux concernant la santé orale en Europe.

Street-level implementers of population-based oral health policies: the case of water fluoridation supply in Brazil's small towns.

BACKGROUND: Knowledge of conditions influencing the performance of street-level operators when implementing population-based policies could increase the understanding of local implementation dynamics. OBJECTIVE: We analyzed how street-level operators claim to act to implement fluoridation policy in the water treatment units of small Brazilian municipalities and identified conditions shaping behavior against adherence to policy. METHODS: A case study using narratives obtained through in-depth interviews with key informants in two pairs of municipalities with contrasting levels of implementation. Analysis identified themes in the data and in the street-level bureaucracy literature. RESULTS: Institutional characteristics such as administrative fragility of local entities, low priority given locally to policy, poor physical structure of the water treatment plants, isolated working relations, low effectiveness of monitoring devices, and local actors' uncertainties about the policy favored the expansion of the discretionary power of street-level operators configuring important barriers for water fluoridation. CONCLUSION: These data highlight the complexity of policy implementation and inform policymakers about the importance of inter-federal and inter-sectoral coordination when implementing population-based health policies in small towns.

What are the features of targeted or system-wide initiatives that affect diversity in health professions trainees? A BEME systematic review: BEME Guide No. 50.

BACKGROUND/PURPOSE: There is interest to increase diversity among health professions trainees. This study aims to determine the features/effects of interventions to promote recruitment/admission of under-represented minority (URM) students to health professions programs. METHODOLOGY: This registered BEME review applied systematic methods to: title/full-text inclusion review, data extraction, and quality assessment (QA). Included studies reported outcomes for interventions designed to increase diversity of health professions education (HPE) programs' recruitment and admissions. RESULTS: Of 7225 studies identified 86 met inclusion criteria. Interventions addressed: admissions (34%), enrichment (19%), outreach (15%), curriculum (3%), and mixed (29%). They were mostly single center (76%), from the United States (81%), in medicine (45%) or dentistry (22%). URM definition was stated in only 24%. The dimension most commonly considered was ethnicity/race (88%). The majority of studies (81%) found positive effects. Heterogeneity precluded meta-analysis. Qualitative analysis identified key features: admissions studies points systems and altered weightings; enrichment studies highlighted academic, application and exam preparation, and workplace exposure. DISCUSSION/CONCLUSIONS: Several intervention types may increase diversity. Limited applicant pools were a rate-limiting feature, suggesting efforts earlier in the continuum are needed to broaden applicant pools. There is a need to examine underlying cultural and external pressures that limit programs' acceptance of initiatives to increase diversity.

Understanding Optimum Fluoride Intake from Population-Level Evidence.

Policy on fluoride intake involves balancing caries against dental fluorosis in populations. The origin of this balance lies with Dean's research on fluoride concentration in water supplies, caries, and fluorosis. Dean identified cut points in the Index of Dental Fluorosis of 0.4 and 0.6 as critical. These equate to 1.3 and 1.6 mg fluoride (F)/L. However, 1.0 mg F/L, initially called a permissible level, was adopted for fluoridation programs. McClure, in 1943, derived an "optimum" fluoride intake based on this permissible concentration. It was not until 1944 that Dean referred to this concentration as the "optimal" concentration. These were critical steps that have informed health authorities through to today. Several countries have derived toxicological estimates of an adequate and an upper level of intake of fluoride as an important nutrient. The US Institute of Medicine (IOM) in 1997 estimated an Adequate Intake (AI) of 0.05 mg F/kg bodyweight (bw)/d and a Tolerable Upper Intake Level (UL) of 0.10 mg F/kg bw/d. These have been widely promulgated. However, a conundrum has existed with estimates of actual fluoride intake that exceed the UL without the expected adverse fluorosis effects being observed. Both the AI and UL need review. Fluoride intake at an individual level should be interpreted to inform more nuanced guidelines for individual behavior. An "optimum" intake should be based on community perceptions of caries and fluorosis, while the ultimate test for fluoride intake is monitoring caries and fluorosis in populations.

Portland Water Fluoridation: A Newspaper Analysis.

Portland, Oregon is the largest city in the United States without community water fluoridation (CWF). A newspaper analysis was conducted of the failed 2013 CWF campaign to evaluate anti-fluoridation and pro-fluoridation messaging provided by newspapers during the campaign. News content was categorized by type and slant (pro-fluoridation, anti-fluoridation, or neutral) and 34 variables were tabulated (23 anti-fluoridation, 11 pro-fluoridation). Results showed overall messaging was slightly pro-fluoridation, as compared to anti-fluoridation or neutral content (35%, 32%, and 33% respectively). Editorial content was 85% pro-fluoridation and 15% anti-fluoridation. The most frequent anti-fluoridation variables were alternatives to water fluoridation, mass/forced medication and concerns about the political process. Conversely, tooth decay and social justice were the most commonly cited pro-fluoridation variables. Newspapers can be influential in shaping public policy opinions in the fight for community water fluoridation.

An analytical hierarchy process-based study on the factors affecting legislation on plastic bags in the USA.

Annually, a large number of used plastic shopping bags are released into the environment, posing significant threats to public health and wildlife. Owing to these concerns, many local, regional, and national governments around the world have passed legislation to ban or restrict the use of plastic shopping bags. However, in the USA there are only 18 states that have approved plastic bag bans/fees, and even within these states these regulations do not cover all cities or counties. There are many factors that could affect the development and implementation of these regulations. This article employs an analytical hierarchy process to analyse the factors that could impact the enactment of plastic bag regulations. Five impact factors are identified based on statistical data, that is, geographical location, interest of industry achievable, cost of living, level of economic development, and educational level of population. The weights of the five impact factors are determined and it is found that the possibility of banning or restricting plastic bags in general follows a certain pattern among all states.

Oral health-related quality of life and associated factors in Southern Brazilian elderly.

OBJECTIVE: The aim of the present study was to describe oral health-related quality of life (OHRQoL) and associated factors in elderly individuals treated at Family Health Units in urban areas of the city of Pelotas, Brazil. METHODS: The sample was composed of 438 individuals aged 60 years old or older. Demographic, socio-economic, general health and behavioural variables were collected using standardised questionnaires. OHRQoL was measured with the oral health impact profile (OHIP-14). Poisson regression analysis was employed to identify factors associated with OHRQoL. RESULTS: The mean total OHIP-14 score was 9.1 (standard deviation: 10.6), and major impacts were related to feeling conscious of psychological discomfort (28.1%) and difficulty eating (24.4%) due to teeth, mouth or dentures. The multivariate analysis revealed higher oral health impact scores among non-White individuals [Prevalence ratios (PR) = 1.33, 95% CI: 1.07-1.66; p = 0.011], those with depressive symptoms (PR = 1.61, 95% CI: 1.30-1.99; p < 0.001), tobacco users (PR = 1.46, 95% CI: 1.07-1.99; p = 0.016), non-denture users (PR = 1.42, 95% CI: 1.10-1.85, p = 0.008), those with a perceived need for dental treatment (PR = 1.99, 95% CI: 1.58-2.51; p < 0.001) and those with poor or very poor self-rated oral health (PR = 2.86, 95% CI: 1.93-4.24; p < 0.001). Lower scores were found among individuals aged 80 years or older (PR = 0.52, 95% CI: 0.33-0.82; p = 0.005) and those with household income of more than 1.5 times the minimum wage (PR = 0.65, 95% CI: 0.46-0.93; p = 0.018). CONCLUSIONS: The findings of the present study underscore the need for public policies aimed at reducing social inequalities and providing adequate dental treatment to improve OHRQoL among elderly individuals.

Conundrums in merging public policy into private dentistry: experiences from Australia's recent past.

Oral disease continues to be a major problem in Australia impacting quality of life, the economy and broader health system. Although the understanding of caries and periodontal disease has improved along with increased government support, oral diseases continue to be the most prevalent among all health conditions. This is despite unprecedented levels of funding in the Chronic Disease Dental Scheme and the Teen Dental Plan. Access to primary care dentistry in the private sector, where the majority of dental services are provided, remains a critical issue. Under the current system of dentistry, it cannot be assumed that the practice of dentistry represents a prioritised approach to combat disease patterns based on scientific evidence in primary health and prevention. Drawing on data in relation to these two programs, the present study highlights issues impacting dental service provision. This includes issues such as access and affordability to dental care, sustainability of policy and its unintended consequences, private practice pressures and the impact of remuneration on treatment. This paper argues that without structural reform there will continue to be barriers in implementing policies capable of improving oral health.

Planning the diffusion of a neck-injury prevention programme among community rugby union coaches.

BACKGROUND: This paper describes the development of a theory-informed and evidence-informed, context-specific diffusion plan for the Mayday Safety Procedure (MSP) among community rugby coaches in regional New South Wales, Australia. METHODS: Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation. RESULTS: Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory. CONCLUSIONS: This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher-practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.

Pro-environmental behavior regarding single-use plastics reduction in urban-rural communities of Thailand: Implication for public policy.

The study investigates residents' behavior towards reducing the use of single-use plastic (SUP), specifically in the context of food packaging. The widespread view holds that pro-environmental behavior (PB) results from a person's moral and rational deliberations. In reducing single-use plastic (SUP) consumption and waste, the relative roles of rationality and morality models in validating PB among rural and urban residents are not yet clear. In this empirical study, we compared the relative efficacy of two models for explaining people's SUP reduction behavior: the theory of planned behavior (TPB; rationality) and the value belief norm (VBN; morality). We investigated Thailand's rural (Sichang Island) and metropolitan (Nonthaburi city) areas. As a result, we surveyed people living on Sichang Island (n = 255) and in Nonthaburi city (n = 310). We employed structural equation modeling (SEM) for data analysis in this study. Findings showed that while morality better justified all the study participants' SUP reduction behavior, rationality underpinned behaviors of rural residents, while morality better explained the actions of city residents. We discussed future theoretical development and a policy roadmap based on these findings.

Transforming Intractable Policy Conflicts: A Qualitative Study Examining the Novel Application of Facilitated Discourse (Track Two Diplomacy) to Community Water Fluoridation in Calgary, Canada.

Governments face challenges in resolving complex health and social policy conflicts, such as the community water fluoridation (CWF) impasse in Calgary. Track Two diplomacy, informal dialogues facilitated by an impartial third party, is proposed to address these issues amid epistemic conflict and declining public trust in fellow citizens, science, and government. This study examined Track Two diplomacy's application in Calgary's CWF policy conflict. Collaborating with policymakers and community partners, the research team explored a Track Two-CWF process and conducted 21 semi-structured interviews with policymakers, scholars, practitioners, observers, and civil society representatives. Data interpretation explored contextual factors, conflict transformation potential, and design features for a Track Two process. A conflict map revealed factors contributing to impasse: the polarizing nature of a binary policy question on fluoridation; disciplinary silos; failed public engagement; societal populism; societal lack of disposition to dialogue; individual factors (adverse impact of conflict on stakeholders, adherence to extreme positions, issue fatigue, apathy, and lack of humility); together with policy-making factors (perceived lack of leadership, lack of forum to dialogue, polarization and silos). Participants suggested reframing the issue as nonbinary, involving a skilled facilitator, convening academics, and considering multiple dialogue tracks for a Track Two process. The first theory of change would focus on personal attitudes, relationships, and culture. Participants expressed cautious optimism about Track Two diplomacy's potential. Track Two diplomacy offers a promising approach to reframe intractable public health policy conflicts by moving stakeholders from adversarial positions to jointly assessing and solving problems. Further empirical evidence is needed to test the suggested process.

From micro to macro: Structural determinants and oral health.

The structural determinants of health include social, economic and political mechanisms which generate social stratification and the socioeconomic positions of individuals within society. Despite their importance, these 'causes of the causes' are still relatively under-studied within oral health research. Yet it is important to assess the effects of these 'upstream' determinants, given that most individuals cannot influence or change them. It is also important to move beyond focusing primarily on downstream determinants and approaches at the individual or household level. This review will offer a brief overview of what is currently known about structural determinants and upstream interventions in relation to oral health. The review starts by briefly summarizing oral health focused studies of structural determinants, including welfare regimes, governance and macroeconomic, social and public policies. Current knowledge on upstream interventions associated with oral health such as community water fluoridation, sugar sweetened beverage taxes and dental payment structures will also be covered. The article will then assess gaps in the research base, including current limitations and barriers-as well as opportunities-in analysing the effects of structural determinants and upstream interventions. The review finishes by suggesting next steps for better understanding and addressing these determinants and interventions-including considerations around theory, data and approaches from other fields such as systems science-with the hope that these can help make contributions to future policy decision making processes.

Public Policies for Fluoride Use in Colombia and Brazil before and during the Adoption of the Right to Health.

The use of fluorides is essential in the prevention of dental caries, considered to be the main dental public health problem. The formulation and implementation of public health policies can vary from country to country, depending on multiple factors. This study aims to analyze the interaction model between the knowledge produced about the use of fluorides and its implementation through public policies in two South American countries until the period of constitutional reform in each country. A narrative review was conducted with a systematic search of scientific articles and normative devices regarding the use of fluorides in public health in each country during the period prior to the implementation of the right to health in the Constitution. In both countries, there was an intense interaction among governmental organizations, researchers, academic and professional leaders, and companies involved in sanitation and salt production. Fluoride use strategies in Brazil and Colombia after an initial stage of similar characteristics began to differ in terms of public policy options for systemic fluoride use. In Brazil, the option was to adjust the concentration of fluoride in the water, while in Colombia, the addition of fluoride to table salt was consolidated as a public policy.

Trend over time on knowledge of the health effects of cigarette smoking and smokeless tobacco use in Bangladesh: Findings from the International Tobacco Control Policy Evaluation Bangladesh Surveys.

INTRODUCTION: Cigarette smoking and smokeless tobacco (ST) use are prevalent in Bangladesh. This longitudinal study examined how knowledge of the health effects of smoking and ST use in Bangladesh has changed overtime with the country's acceleration of tobacco control efforts. METHODS: Data were analysed from the International Tobacco Control Survey, a nationally representative longitudinal study of users and non-users of tobacco (aged 15 and older) in Bangladesh, across four waves conducted in 2009 (n = 4378), 2010 (n = 4359), 2012 (n = 4223) and 2015 (n = 4242). Generalised estimating equations assessed the level of knowledge about harms of tobacco use across four waves. Multivariable logistic regressions assessed whether knowledge of health effects from cigarette smoking and ST use in 2015 differed by user group. RESULTS: In 2015 survey, most tobacco users were aware that cigarette smoking causes stroke (92%), lung cancer (97%), pulmonary tuberculosis (97%) and ST use causes mouth cancer (97%) and difficulty in opening mouth (80%). There were significant increases in the total knowledge score of smoking related health harm from 2010 to 2012 (mean difference = 0.640; 95% confidence interval [CI] 0.537, 0.742) and 2012 to 2015 (mean difference = 0.555; 95% CI 0.465, 0.645). Participants had greater odds of awareness for ST health effects from 2010 to 2015. DISCUSSION AND CONCLUSIONS: The results suggest that increasing efforts of awareness policy interventions is having a positive effect on tobacco-related knowledge in Bangladesh. These policy initiatives should be continued to identify optimal methods to facilitate behaviour change and improve cessation of smoking and ST use.

Age assessment of young asylum seekers.

UNLABELLED: During 2009, 15,100 unaccompanied children sought asylum in Europe. Many of them came from 'failed states' like Somalia and Afghanistan where official documents with exact birth dates are rarely issued. This has led to requests to health care professionals in many countries to assist migration authorities in determining whether a young asylum seeker is a child or an adult. Many different methods are currently employed in Europe for this purpose by dentists, paediatricians, radiographers and social workers, but no currently available method has been demonstrated to have the accuracy needed to be of real use in this decision. Unclear guidelines and arbitrary practices may lead to alarming shortcomings in the protection of this high-risk group of children and adolescents in Europe. Medical participation, as well as non-participation, in these dubious decisions raises a number of ethical questions. CONCLUSION: To improve care for young asylum seekers with undetermined age, we suggest better legal procedures for the determination of age and a more flexible approach to chronological age.

Improved science-based transformation pathways for the development of safe and sustainable plastics.

Projected plastic production volumes are rising, as is societal and political attention to plastic pollution and possible health impacts. In line with ambitions for climate mitigation and the circular economy, various national and international policies and action plans address the reduction of impacts of plastics. Quantitative scenario analyses show that even if current ambitious targets to reduce plastics are achieved, plastics will remain a source of millions of tons of environmental pollution annually. To achieve a sustainable transformation of the global plastics economy, 'extraordinary effort' and 'coordinated global action' beyond current ambitions are needed. While mapping knowledge gaps for the effects of micro and nano plastics (MNP) is crucial, mapping alone is not enough to achieve the needed transition. In this communication, we propose a scope for the exploration of societal transformation pathways to safe and sustainable plastics. To see which efforts are needed globally we need to advance in the following three areas: (i) embedding risk assessment methodologies in wider cost-benefit and life cycle analyses; (ii) using safe-and-sustainable design strategies that include alternative solutions and look at multiple life cycles, and (iii) reflecting on the societal transformation pathways with stakeholders by using co-created quantitative models. We believe that these practices are crucial in the coming decade to realise the extraordinary effort of defining safe and sustainable plastics.