Title: NIHR Global Health Group on Oral Health
Funder: Department of Health and Social Care

Abstract: Oral diseases are a significant but largely neglected global public health problem. In many low and middle-income countries (LMICs) the burden of oral diseases is increasing and very stark oral health inequalities exist as oral conditions disproportionally affect disadvantaged populations. Oral diseases are caused by a range of common risks shared with other NCDs including sugar consumption, tobacco use, alcohol consumption and poor hygiene, and the underlying social, commercial and political determinants of health. In many LMICs dental services are often isolated from primary health care and are inaccessible and unaffordable to large segments of the population but particularly disadvantaged groups. As a consequence, very high levels of unmet oral health needs are often found in these populations leading to significant impacts on quality of life, psychosocial well-being, health and educational/employment opportunities This research programme will address the neglect of oral diseases in four lower-middle and middle-income countries – Kenya, Colombia, India and Brazil. In these countries oral diseases are a major public health problem and there is a pressing need for high quality public health research on oral diseases and the development of oral health research capacity._x000D_ _x000D_ The strategic aim of this programme is to establish an equitable and effective research partnership across the four LMICs, UK academic institutions and selected collaborators to share expertise, experience and local knowledge. The specific programme aims are: i To assess the pattern, mechanisms and impact of oral health inequalities; ii To determine the influence of commercial determinants on oral health and in particular the role of the sugar and tobacco industries; iii To assess the economic burden of oral diseases and opportunities for oral health system reforms; iv To co-produce and test public health interventions and system reforms to reduce oral health inequalities and promote population oral health. In addition, the programme will aim to develop local research capacity through an extensive range of training and short courses. Community engagement and involvement activities will fully inform and support the planned research. _x000D_ _x000D_ This research programme will adopt a mixed methods approach using both qualitative and quantitative methods. Based upon MRC guidelines on complex interventions, exploratory and developmental research will be undertaken to inform future definitive evaluation research plans. The programme will comprise of three distinct but interconnected work packages: WP1 Oral health inequalities; WP2 Commercial determinants; WP3 Oral health system reform and innovation. In broad terms in each WP a situation analysis will initially be conducted involving the collection of empirical data and/or secondary analysis of existing survey data. The analysed data will then be used to inform policy analysis and simulation modelling of different intervention strategies. Finally, the development and feasibility testing of interventions and system reforms will be undertaken in each country to inform the design of future definitive evaluation studies._x000D_ _x000D_ The anticipated impact of this programme includes raising understanding and awareness of the public health importance of oral diseases and inequalities, developing the evidence base for population interventions and system reforms, and ultimately developing public health policies to promote better oral health in LMICs

Lay abstract: Oral diseases are very common conditions affecting over 3.5 billion people globally. Oral conditions have a major impact causing pain, infection, reduced quality of life, time off school or work, and social isolation. In many low- and middle-income countries (LMICs) oral diseases are becoming much more common. Despite their prevalence and impact, oral diseases have been woefully neglected within global health research. This research programme on oral health will begin to address the neglect in four middle-income countries – Colombia, India, Brazil, and Kenya. _x000D_ _x000D_ Oral diseases disproportionally affect poorer and marginalised groups, being very closely linked to levels of education and income. Oral conditions share common risks with other chronic diseases including sugar consumption, poor hygiene, tobacco use and harmful alcohol consumption, and the broader underlying social determinants (the conditions in which people are born, grow, live, work and age). Increasing attention is also now being placed on the role of multinational corporations who market, promote and sell products which are detrimental to health. In many LMICs dental services are often inaccessible and unaffordable to large segments of the population but particularly disadvantaged groups. _x000D_ _x000D_ Our programme has six broad aims: Aim 1: Develop meaningful communication, dialogue and partnership with local communities to better understand their experiences of oral diseases and the best ways ahead of promoting sustainable community engagement in oral health research. Aim 2: Investigate the pattern and impact of oral health inequalities in each country. Aim 3: Explore the influence of the sugar and tobacco industries in promoting their products in each country and their ability to shape national policy, research and professional agendas. Aim 4: Identify opportunities to reform dental care systems to improve their integration with the broader health system and their accessibility and affordability. Aim 5: Build research capacity in the evaluation of public health interventions and health system reforms through postgraduate training and short courses. Aim 6: Engage key stakeholders and partners, including policy makers, clinicians, public health professionals and related agencies on the importance of oral diseases and the need for policy and system reform. _x000D_ _x000D_ This programme will use different research methods to collect and analyse various types of data. Existing national oral health survey data from each country will be analysed to assess oral health inequalities. Individual semi-structured interviews will be undertaken with people from disadvantaged backgrounds to explore their views of the impact of oral diseases on their lives. Policy analysis will be conducted to compare and contrast policies across the four countries and finally pilot studies will be undertaken to assess the potential for future research evaluating policy and system reform. _x000D_ _x000D_ Community engagement activities in this programme will take place to ensure that local communities, and in particular disadvantaged groups are fully consulted and given an opportunity to express their views and co-produce all aspects of the research programme from planning to dissemination of results. The results from our programme of research will be shared and disseminated across policy, professional, and community networks in each of the participating countries but also more widely across existing international networks.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: ORAL AND GASTROINTESTINAL