About 72.6 percent of the rural population in India do not have access to basic oral health. Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success. Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease. The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes.

When we think of innovation in healthcare, most of us tend to look for the ‘Eureka’ moments. The wonder drug that can cure cancer, the surgical procedure that can revive a brain-dead patient, the hi-tech diagnostic tool that can predict cardiac adversities. But these innovations – no matter how spectacular – are of little value without the right healthcare delivery processes.

A very interesting article that appeared in the November 2013 issue of Harvard Business Review looked at how some Indian hospitals are able to provide world-class healthcare at as much as 95 percent lower costs than those at US hospitals. The answers, the authors argue, don’t always lie in grand designs, but in smart delivery systems.

Addressing the Issue

In a recent interview, US-based surgeon and bestselling author Atul Gawande called India’s public health system one of the “most complex things” in the world. And that’s true, given the sheer magnitude of the burden of infectious diseases as well as non-communicable diseases that the country has to tackle.

Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success. According to the WHO, the risk factors for oral diseases include an unhealthy diet, tobacco use and harmful alcohol use. These risk factors are the same for the major chronic diseases – cardiovascular ailments, cancer, respiratory diseases and diabetes.

Studies have shown that periodontal diseases (also known as gum diseases) pose a risk to general health, especially for patients with other chronic diseases. Among patients with diabetes, periodontal disease can accelerate the chances of pancreatic failure, stroke, myocardial infarction and renal failure.

Similarly, maternal periodontal disease during pregnancy is sometimes associated with increased risk of pre-term delivery and low birth weight. Yet only 50 percent of pregnant women with a dental problem visit a dentist during their pregnancy. Despite studies affirming that most dental care procedures are safe during pregnancy, myths of perceived risks still prevail even within the medical fraternity.

Integrative Approach

The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes. Say a patient is seeking treatment for HIV, it’s significant to examine his oral health condition too. Research has shown that inadequate oral healthcare can undermine the success of HIV treatment regimens.

World Health Assembly in 2005 included Oral Health with other non-communicable diseases for health promotion and disease prevention strategies. However, most of our policymakers as well as medical practitioners are still in the dark about the burden of oral diseases in the country and their impact on our overall health and wellbeing. Although there has been no nation-wide study to determine the burden of oral health conditions in India, individual studies indicate that the average prevalence of dental caries is 40-45 percent in all age-groups; periodontal diseases is 90 percent; malocclusion is 30 percent.

In 2000, the US Surgeon General identified oral disease as a “silent epidemic”, wherein a significant amount of money is spent on expensive, invasive treatments that could have been either avoided with simple preventive measures or at least treated at a lower cost and lower risk if identified earlier.

Reality Check

The biggest challenge in implementing an integrative approach vis-a-vis oral health and other diseases is the dismal dentist: population ratio (1:8,000 in urban areas and 1:50,000 in rural areas). About 72.6 percent of the rural population, says the data from Dental Council of India, do not have access to basic oral health.

Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease, states a white paper on Oral Health commissioned by the National Interprofessional Initiative (Oral Health: An Essential Component of Primary Care). Sometimes, we just need to go back to the basics. Prevention is still better than cure. Primary care providers, such as general physicians, nurses and midwives, need to be trained to expand the disease prevention workforce. Children, pregnant women, diabetes and other patients who visit the hospital regularly are ideal candidates for preventive healthcare.

There are several examples of promising healthcare delivery innovations. The challenge is to ensure that they are successfully and widely adopted. And this calls for a change in the attitudes of medical practices, healthcare organisations and policymakers. We need to move away from the traditional doctor-centric healthcare setup and make it patient-centric. Thanks to the advances in information technology, it’s now possible to deliver medical care to patients at a time and place of their convenience. Telemedicine makes the remote delivery of healthcare over the phone a reality, while electronic health records facilitate easier access to expert medical opinions.

Innovations in diagnostic technology, pharmaceuticals, surgical procedures and medical devices are undoubtedly important. But what’s more important is inventive methods to deliver these services in a timely, safe and effective manner to patients. Obviously, this can’t happen overnight. But as Bill Gates so succinctly put it, “We overestimate what we can accomplish in two years, but we underestimate what we can accomplish in 10.”

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