Faculty of Dental Sciences

Department of Public Health Dentistry

Report on
Module Global Oral Health

Submitted By -

1. Megnel Leona Menezes

2. Mohammed Zuhair Belgami

3. Mohammed Bilal

4. Neelanshi Kulshreshta

5. Neha Sirohi

6. Paavna Srivatsava
Index
Sl.No Contents Pg. no.
1. Webinars
1.1 Session 1- Introduction to Sustainable Development Goals
(26th March 2021)
1.2 Session 2- Planetary health and one health. Integrating
oral health with Sustainable Development Goals (3rd April
2021)
1.3 Session 3- Social determinants of health. How sugar and
other social determinants can be related to oral health (8 th
April 2021)
1.4 Session 4- Social determinants of health and their relation
to oral health (16th April 2021)
2. Activities:

2.1 Exercise 1a- Rearranging 17 Sustainable Development

Goals according to local/national scenario with short text
explaining their rationale. (Performed in individual
groups)
2.2 Exercise 1b- overall rearrangement of 17 Sustainable
Development Goals according to local/national scenario
with short text explaining their rationale.
2.3 Exercise 2- Integrating oral health with Sustainable
Development Goals
3 Photographs

4 Learning experience

5 References

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FACULTY OF DENTAL SCIENCES

Certificate
This is to certify that Megnel Leona Menezes, Mohammed Zuhair Belgami,

Mohammed Bilal, Neelanshi Kulshreshta, Neha Sirohi, Paavna Srivatsava

bearing,Reg.no:18DSDS011032,18DSDS011033,18DSDS011034,18DSDS011

035, 18DSDS011036, 18DSDS011037 has attended course on Global Oral

Health during the year 2021 in partial fulfilment of requirements for the

award of B.D.S. Degree of M. S. Ramaiah University of Applied Sciences.

May – 2021

Dr. Pushpanjali K.
Head of Department

Dr Anitha R Sagarkar
Reader

Dr. Shwetha K.M.

Reader

2
Session 1 – Introduction to Sustainable Developmental Goals (26th March 2021)
The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked
global goals designed to be the blueprint to achieve a better and more sustainable future for all.
They address the global challenges we face, including poverty, inequality, climate change,
environmental degradation, peace and justice. 
The SDGs are a bold commitment to tackle some of the more pressing challenges faced by
the world today. All 17 Goals interconnect, meaning success in one affect success for
others. The SDGs are unique in that they cover issues that affect us all. They involve us all to
build a more sustainable, safer, more prosperous planet for all humanity. The SDGs aim to
be relevant to all countries – poor, rich and middle-income to promote prosperity while
protecting the environment and tackling climate change. They have a strong focus on improving
equity to meet the needs of women, children and disadvantaged populations making sure no
one is left behind.
Each goal typically has 8–12 targets, and each target has between 1 and 4 indicators used to
measure progress toward reaching the targets. The targets are either "outcome" targets or
"means of implementation" targets.
The Millennium Development Goals were eight international development goals for the year
2015 that had been established following the Millennium Summit of the United Nations in
2000. MDGs had a focus on developing countries with funding came from rich countries.
MDGs and SDGs are different in various ways:

 A global focus.  Unlike the MDGs, which focused primarily on lower- and middle-
income countries, the SDGs include every country - which means also reaching
those who are not benefitting from the economic prosperity of wealthier
countries.
 A holistic approach. The SDGs cover a range of topics. They are interconnected
and should be tackled simultaneously rather than individually.  
 A greater focus on inclusion. The MDGs and other development policies have
failed to address systematic patterns of discrimination – the SDGs aim to change
this. Seven SDG targets focus on people with disabilities, for example, and six
refer to people in vulnerable situations.
 An emphasis on three dimensions of sustainability. The SDGs define
sustainability as having three components – social, economic and environmental.
These are interlinked, with one leading to the others, and should be addressed
simultaneously.
 The incorporation of both systems and lifestyles. Successfully achieving targets
on climate change, for example, does not only include policies at the

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 international, regional or national levels; it also requires that our lifestyles,
thought processes and behaviour changes.
The 17 Sustainable Developmental Goals as given by WHO:
 NO POVERTY: Eradicating poverty in all its forms remains one of the greatest
challenges facing humanity. While the number of people living in extreme
poverty has dropped by half between 1990 and 2015, the progress has slowed
down. Too many people are still struggling for the most basic needs. We must
ensure significant mobilization of resources from a variety of sources, including
through enhanced development cooperation, in order to provide adequate and
predictable means for developing countries, in particular least developed
countries, to implement programmes and policies to end poverty in all its
dimension.

 ZERO HUNGER: Unfortunately, hunger is rising globally, with millions affected.

There is a desperate need for further investment in the technology and
infrastructure required to achieve the goal, which aims to allow food security
and end hunger. We must ensure sustainable food production systems and
implement resilient agricultural practices that increase productivity and
production, that help maintain ecosystems, that strengthen capacity for
adaptation to climate change, extreme weather, drought, flooding and other
disasters that progressively improve land and soil quality.

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 GOOD HEALTH AND WELLBEING: Good health is essential for sustainable
development. It takes into account widening social and economic inequalities.
Universal health coverage will be integral to achieving this goal.

 QUALITY EDUCATION: The fourth SDG addresses access to quality lifelong

learning to all groups. We have made positive movement in the right direction,
however, there is still a lack of access for marginalized groups, women, and girls.
Developing countries are still missing vital infrastructures to provide learning.
Improving the quality of education helps us all, from providing better
opportunities for young people, to making sure that the world has the essential
expertise and knowledge required to navigate future challenges. We must build
and upgrade education facilities that are child, disability and gender
sensitive and provide safe, nonviolent, inclusive and effective learning
environments for all.

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 GENDER EQUALITY: The heart of the goal - empowering women and girls. Even
though gender equality has seen a strong movement toward positive outcomes
(such as the decrease of practicing child marriage, genital mutilation, and
improved gender equality laws), much work is left to do.
Ensuring that women across the globe are protected with essential laws and
rights is a key part of achieving full gender equality. Addressing discriminating
social norms, low-level political involvement, and other structural issues at play
will be needed to reach this goal. Ending all kinds of gender discrimination is
crucial for a sustainable future.

 CLEAN WATER AND SANITATION: Water scarcity affects about 40% of people,
which is an alarming rate that is projected to rise as temperatures do. Targeting
sanitation, sustainable management of water, and its availability to all, this goal
is proving difficult to achieve, with the latest data suggesting that we would need
to double the annual efforts. Billions are still lacking safe water, both in terms of
sanitation and drinking water. Sustainably ensuring that all have access to clean,
safe, water is key to building a sustainable future for our world. Currently, the
projections show that 700 million people may be displaced due to water scarcity
by 2030. Drastic action is needed to make sure our global water supply is safe,
secure, and clean for all. Safe and affordable drinking water for all, requires us to
invest in adequate infrastructure, provide sanitation facilities and encourage
hygiene. Protecting and restoring water related ecosystems is essential.

 AFFORDABLE AND CLEAN ENERGY: Between 2000 and 2018, the number of
people with electricity increased from 78 to 90% and the numbers without
electricity dipped to 789 million. Yet, as the population continues to grow, so will
the demand for cheap energy and an economy reliant on fossil fuels is creating
drastic changes in our climate. The effects of a lack of affordable and clean

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 energy cannot be understated. Expanding infrastructure and upgrading
technology to provide clean and more efficient energy will help ensure a
sustainable future for us all.

 DECENT WORK AND ECONOMIC GROWTH: Over the last 25 years, the number
of workers living in extreme poverty has declined drastically. However, as the
global economy continues to recover, we are seeing slower growth, widened
inequalities and not enough jobs to keep up with a growing labour force. This
goal exists to underpin the efforts and progress toward achieving the other
goals, emphasising sustainable and inclusive economic growth and employment.
More importantly, the goal aims to ensure decent work, with safe environments,
as well as eradicating gender pay gaps and increasing employment
opportunities.

 INDUSTRY, INNOVATION AND INFRASTRUCTURE: Investment in infrastructure

and innovation are crucial drivers of economic growth and development.
technological process is also key to finding lasting solutions to economic and
environmental challenges, such as providing new jobs and promoting energy
efficiency. The ninth SDG targets building solid infrastructures which encourage
innovation and are sustainable and inclusive of key drivers like transport and
communication play a vital role here with the aim to support economic
development through innovative solutions. More than 4 billion people still do
not have access to the internet. Bridging this digital divide is crucial to ensure
equal access to information and knowledge, as well as foster innovation and
entrepreneurship. Nonetheless, investment in this sector remains below the
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 global average requiring further support to embrace true sustainable
development. Manufacturing growth has declined due to tariffs and global trade
tensions, with additional challenges caused by a need to invest more in research
and development.

 REDUCED INEQUALITIES: Income inequality is on the rise. These widening

disparities require sound policies to empower lower income earners and
promote economic inclusion of all. It involves regulation and monitoring of
financial markets and institutions encouraging developmental assistance. The
target of this sustainable development goal is to reduce inequality, with a
particular focus on the disproportion of opportunities, income, and power.

 SUSTAINABLE CITIES AND COMMUNITIES: Sustainable development cannot be

achieved without significantly transforming the way we build and manage our
urban spaces. The rapid growth of cities is a result of rising population and
increasing migration has led to a boom in mega cities. Making cities sustainable
means creating careers and business opportunities, safe and affordable housing
and building resilient societies and economies. This goal addresses living
situations such as slums, access to transport, clean air and waste collection to
name just a few topics. It involves investment in public transport, creating green
public spaces and improving urban planning and management.

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 RESPONSIBLE CONSUMPTION AND PRODUCTION: Achieving economic growth
and sustainable development requires that we urgently reduce our ecological
footprint by changing the way we produce and consume goods and resources.
Encouraging industries, businesses and consumers to recycle and reduce waste is
equally important as is supporting developing countries to move towards more
sustainable patterns of consumption. A large population is still consuming far too
little to meet even their basic needs. Halving the per capita of global food waste
at the retailer and consumer levels is also important for creating more efficient
production and supply chain. This can help with food security and shift us
towards a more resource efficient economy.

 CLIMATE ACTION: The goal that often gets the most airtime, climate action, puts
the spotlight on the increasing greenhouse emissions, climate change, and the
associated impact. Despite the media coverage, the situation is not rosy. There is
no country that is not experiencing the drastic effects of climate change. Global
warming is causing long lasting changes to our climate system which threatens
irreversible consequences if we do not act.

 LIFE BELOW WATER: The world’s oceans- its temperature, chemistry, currents
and life drive global systems that make the earth habitable to humankind. How
we manage this vital resource is essential for humanity as a whole, and to
counterbalance the effects of climate change. This goal is focused on conserving
and sustainably utilising our oceans, seas, and marine resources. Our oceans are
a finite resource despite their vast size and must be treated with respect and
care if they are to continue to be a sustainable resource in the future. As it
stands there are inadequate measures in place to do so, thus, overfishing,
acidification from climate change, and coastal eutrophication (the loading of
unneeded ‘nutrients’ into the water by upstream activities, namely agriculture
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 and other industries) continue to move us further away from this
goal. Enhancing conservation and the sustainable use of ocean-based resources
through international law will help mitigate the challenges.

 LIFE ON LAND: Human life depends on the earth as much as the ocean for our
sustenance and livelihoods. Plant life provides 80% of the human diet and we
rely on agriculture as an important economic resource. While 15% of the land is
protected, biodiversity is still at risk. Nearly, 7000 species of plants and animals
have been illegally traded. Wildlife trafficking not only erodes biodiversity, but
creates insecurity, fuels conflict and feeds corruption.

 PEACE, JUSTICE AND STRONG INSTITUTIONS: This SDG focuses on building

institutions that are inclusive, promoting peaceful societies which are able to be
sustainably developed. Global peace, security, and justice for all through
inclusive institutions at all levels remains the UN’s target with this sustainable
development goal. We cannot hope for sustainable development without peace,
stability, human rights and effective governance. Yet, our world is increasingly
divided. Some regions enjoy peace, security and prosperity, while others fall into
seemingly endless cycles of conflict and violence. The main aim is to significantly
reduce all forms of violence and work with governments and communities to
end conflict and insecurity. Promoting the rule of law and human rights are the
key to this process.
 PARTNERSHIP TO ACHIEVE THE GOAL: The world is more interconnected than
ever. Improving access to technology and knowledge is an important way to
share ideas and foster innovation. Coordinating policies to help developing
countries manage their debt, as well as promoting investment for the least
developed is vital for sustainable growth ad development. This SDG is all about

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how the goals will be achieved through partnerships, funding and initiatives. The
world isn’t just the reserve of a few, the issues targeted by the SDGs affect every
single person on the planet, from rich to poor, from privileged to deprived. By
building effective partnerships that span the globe, the goal is to make us all
invested in building a sustainable and fair future for the world and our
environment.

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 SESSION 2
Planetary health and one health. Integrating oral health with Sustainable
Development Goals (3rd April 2021)

Planetary health can be defined as the health of human civilization and the state of the natural
systems on which it depends. It involves the achievement of highest attainable standard of
health, wellbeing, and equity worldwide through judicious attention to the human systems –
political, economic, and social, that shape the future of humanity and the Earth's natural
systems and determine safe environmental limits within which humanity can flourish.

The Planetary Health Alliance has facilitated the first attempt to create a set of principles for
planetary health education that intersect education at all levels, across all scales, and in all
regions of the world—ie, a set of cross-cutting principles. There are 12 cross-cutting principles
and are envisioned to be a set of core messages teaching planetary health.
The principles are as follows –
1. A planetary health lens
Many global challenges come into sharper focus when they are viewed with the idea of
planetary health in mind. Through a planetary health lens, we can recognise how human
stewardship of the Earth is a primary determinant of future population health.
2. Urgency and scale
The field of planetary health is driven by the scale of environmental change, its effects on
human health, and the urgency with which the global population must respond.
3. Policy

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Planetary health is intrinsically policy oriented. By quantifying the effect on human health
effects of anthropogenic environmental changes and communicating them to stakeholders at
many levels, collaborative work can be done across sectors to identify policies and practices,
both local and global, to protect and improve the health of global populations.
4. Organising and movement building
There should be an understanding that organising in the community and movement building
has a role in the political process both locally and globally. The capacity to mobilise and manage
resources and people power is key when considering solutions to challenges in planetary
health.
5. Communication
Challenges in planetary health are complex, spanning different disciplines, sectors, geographical
regions, cultures, and scales; therefore, effective and meaningful communication across these
arenas is needed, with a focus on translating planetary health science.
6. Systems thinking and transdisciplinary collaborations
An understanding of planetary health necessitates engaging with many disciplines and
stakeholders to understand and propose solutions to complex challenges.
7. Inequality and inequity
Understanding the differences between equality and equity in theory and practice, and
concepts of marginalization, vulnerability, resilience, and who benefits and is harmed in a given
scenario, is a core objective of planetary health teaching. The effects of environmental change
on human health are heterogeneous and mediated by factors such as geographical scale,
temporal scale, socioeconomic factors, and political and cultural context.
8. Bias
People and students should understand potential biases in planetary health research and be
aware of the vested interests of different stakeholders both in support of and against the
factors that affect the connection between environmental change and human health.
9. Governance
Governance is the high-level strategy used by a leader or leadership team in their processes of
decision making and implementation. It is the ability to turn capacity into action and generating
the capacity when it does not exist.
10. Unintended consequences
There can be surprising and unexpected consequences of environmental change, both positive
and negative, which are inevitable. This systemic uncertainty requires a shift in government,

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corporate, and community mindsets to allow for increased adaptive capacity, and an emphasis
on programmes that increase socioecological competence, community resilience, and
sustainability.
11. Global citizenship and cultural identity
A global citizen is someone who sees themselves as part of the international community and
whose actions help define the community’s values and practices. Inherent membership in both
their local and global communities need to be recognized.
12. Historical and current global values
An understanding of the past is necessary to solve the problems of the present. Hence, a
knowledge of this history is crucial.

Planetary health and health-care delivery are inseparable from one another. The Rockefeller
Foundation-Lancet Commission on Planetary Health recognizes that human health and the
health of our planet are inextricably linked, and that our civilization depends on human health,
flourishing natural systems, and the wise stewardship of natural resources. Constant efforts are
being made to construct health care systems in the interest of the environment and planetary
health. A framework has been presented to create sustainable health systems. This includes the
following principles –
The first principle –
To reduce the demand for health services. The combination of population growth and ageing,
increasing global burden of disease, and increasingly complicated methods of diagnosis and
treatment has resulted in a growing demand for health services. This increase in demand has
offset reductions in the carbon intensity of care and slowed progress towards mitigating the
health-care footprint.

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The second principle –
To match the supply of health services to demand, ensuring appropriate care and avoiding
unnecessary investigations and treatment. It includes the avoidance of excess and inadequate
capacity. Excess capacity leads to inefficient use of resources like medical imaging devices
spending the majority of their lifecycle in stand-by mode. A sustainable health care system
should match the type and intensity of care provided to the problem. A patient-centred care
that prioritises health and wellbeing over diagnosis and cure is required.
The third principle –
To reduce emissions from the supply of health services, optimising the efficiency and
environmental performance of care delivery. Few important strategies to be adopted are
optimising building environmental performance, decarbonising hospital energy supplies, and
electrifying transport fleets. Existing emissions targets are not sufficient to avert catastrophic
climate change and are going to diminish the quality of life of the next generation. The health
sector needs to chart an entirely new course requiring transformational change to ensure
sustainable intergenerational health equity. The goal is to achieve net zero emission.
Oral health is an integral part of sustainable development goals. Achieving goals of planetary
health will directly or indirectly be dependent on and impact oral health.

 Oral health is an essential component of primary comprehensive care.

 Proper maintenance of oral health helps in prevention of multiple diseases.
 Defining quality of oral healthcare and consenting quality measures
 The United Nations Environment Programme’s (UNEP) Minamata Convention on
Mercury requires a phase down in the use of amalgam and best practice management
of amalgam waste and mercury.
 Include best practices for the profession in reducing disposable items within dental
clinics and proper disposal of waste generated from clinical practice
 Emphasis on tobacco control and prevention.
 The global burden of untreated oral disease remains unacceptably high and is
accompanied by marked inequalities both within and between countries
 Every country to have a sugar consumption policy in line with WHO guidelines.
 Inclusion of comprehensive oral health information in all medical data management
systems
Major developments in the healthcare debate, such as the Sustainable Development Goals
(SDGs), Universal Health Coverage (UHC), social and commercial determinants of health,
common risk factors, person-centred care, intra- and inter-professional integration and trans-
sectoral collaboration, create major challenges and opportunities for the dental profession.

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Session 3- Social determinants of health. How sugar and other social
determinants can be related to oral health (8th April 2021)
The World Health Organization defines Social determinants of health (SDoH) as the conditions under
which people are born, grow, live, work, and age, and include factors such as socioeconomic status,
education, employment, social support networks, and neighborhood characteristics.  These have a
greater impact on population health than factors like biology, behavior, and health care. SDoH,
especially poverty, structural racism, and discrimination, are the primary drivers of health inequities. 
Access to health care is essential for equitable health, and it argued that health care should be a
common good rather than a market commodity. However, there is substantial variation in health care
systems and coverage from country to country.

Social determinants of health that have gained wide usage include:

 Income and income distribution: Income is perhaps the most important social health

determinant. Level of income shapes overall living conditions, affects psychological functioning
and influences health-related behaviors such as quality of diet, extent of physical activity,
smoking and excessive alcohol use. Physical well-being and economic well-being are always
interrelated. It is believed that higher income level lowers the level of premature death and
critical diseases. This is dependent on the accumulated wealth of a person than the yearly
income.

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  Education: Studies indicate that education has a close association with health: More educated
people have better health outcomes. Every additional year of schooling is associated with better
health and healthier behaviors. More educated people smoke less, drink less, weigh less, have
lower mortality rates, and have lower obesity and heart disease prevalence. Not only is
educational attainment itself important for good health, but the learning environment is as
well. As adolescents spend most of their waking hours in school, learning environments have a
unique opportunity to promote health within the curricula as well as through the social and
built environment.

 Unemployment and job security: is identified as a social determinant of health as it can often

cause material and social deprivation. Unemployment is a direct cause of poverty, which
frequently leads to psychological stress, anxiety, and poor self-esteem. This can further lead to
unhealthy behaviors such as substance abuse.

 Employment and working conditions: On average working adults spend over half their waking
hours in the workplace, which provides an important setting to impact health. Workplace
conditions vary greatly across disciplines, resulting in differential health outcomes. Employee
compensation—through the provision of wages and benefits—can have a significant impact on
one’s health and the health of the workforce. Employee benefits which are likely to positively
contribute to one’s health—either during their working years or in old age—or the health of
their dependents include health insurance, retirement benefits, and, particularly important for
lower income employees, paid family and medical leave.

 Early childhood development: Children's health and development outcomes follow a social
gradient: the further up the socioeconomic spectrum, the better the outcomes. 

 Food insecurity: As with many other social determinants of health, food insecurity is a multi-

faceted issue with multiple causes. Food insecurity in households is caused not only by poverty,
but also by other overlapping issues such as affordable housing, social isolation, location and
chronic health issues.

  Housing: One social determinant is the living environment, which stretches beyond housing to
the economic, regulatory, social, and physical (both natural and man-made) environment of a
community. Where someone lives directly impacts access to health-promoting goods and
services, including nutritious food options, medical care services, and fitness centers or other
places suitable for exercising. High levels of crime and violence, community segregation, and a
high concentration of fast food outlets, liquor stores, and tobacco advertisements correlate
strongly with poor health outcomes.

 Social exclusion/inclusion: The Social Exclusion Knowledge Network of the Commission on

Social Determinants of Health defines social exclusion as consisting of dynamic,

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 multidimensional processes driven by unequal power relationships interacting across four main
dimensions – economic, political, social and cultural – and at different levels including
individual, household, group, community, country and global.It results in a continuum of
inclusion/exclusion characterized by unequal access to resources, capabilities and rights, which
leads to health inequities.

 Social safety network: The social safety net refers to the various government benefits,
programs and supports that protect people from extreme poverty during various changes in
their lives.

 Health services: Health-care services (primary, secondary, tertiary care) have not until recently
been considered an SDH. Inequities in access to health care are changing this view. These
inequities include barriers faced by certain population groups at point of care, such as the lack
of cultural competence of health-care providers.

 Aboriginal status: Aboriginal people are poor in their economic status that leads to transport
barrier to get education at high level. Low education increase the poverty and poor decision
making that leads to unsecure setting of social environment and associated health problems like
stress, mental health problems etc.

 Race: Although an unfortunate reality, people do experience different health outcomes and
health behaviors depending on their race, and African Americans and Hispanic Americans are
often the social groups burdened with worse health outcomes. While some diseases affect
races differently because of their genetic predisposition, such as sickle cell and Tay-Sachs
disease, most of the difference in morbidity can be attributed to the social determinants.

  Disability: People with disabilities need health care and health programs for the same reasons
anyone else does—to stay well, active, and a part of the community. It is very important to
improve the conditions in communities by providing accommodations that decrease or
eliminate activity limitations and participation restrictions for people with disabilities, so they
can participate in the roles and activities of everyday life.

  Gender: The World Health Organization (WHO, 2010) recognizes that gender is an

important determinant of health in two dimensions: 1) gender inequality leads to health risks
for women and girls globally; and 2) addressing gender norms and roles leads to a better
understanding of how the social construction of identity and unbalanced power relations
between men and women affect the risks, health-seeking behavior and health outcomes of men
and women in different age and social groups.

The distributions of social determinants are often shaped by public policies that
reflect prevailing political ideologies of the area. The WHO says, "This unequal distribution of health-

18
damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic
combination of poor social policies, unfair economic arrangements where the already well-off and
healthy become even richer and the poor who are already more likely to be ill become even poorer, and
bad politics."

Reducing health inequities is important because they are widespread, unfair and unjust; individuals
affected have little control over the contributing circumstances; affect everyone; and can be avoided
using existing policy solutions. This necessitates that governments build systems that allow a healthy
standard of living for every resident.

Role of sugar and relation to oral health

Sugar has a long history of generating strongly held views regarding its value as part of the human diet.
Sugar consumption and poor oral health go hand-in-hand. Dietary sugar plays a pivotal role in the
development of dental caries and is also an important risk factor for obesity and other chronic, non-
communicable diseases such as diabetes and cardiovascular disease. These conditions contribute
significantly to healthcare costs as well as to health inequity between individuals of different socio-
economic status.

Dental caries (also known as tooth decay) is the most common noncommunicable disease
worldwide. Free sugars are the essential dietary factor in the development of dental caries. Dental caries
develops when bacteria in the mouth metabolize sugars to produce acid that demineralizes the hard
tissues of the teeth. Dental caries is an expensive disease to treat, consuming 5–10% of healthcare
budgets in industrialized countries, and is among the main reasons for hospitalization of children in
some high-income countries.

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 In many countries, sugars-sweetened beverages, including fruit-based and milk-based sweetened
drinks and 100% fruit juices, are a primary source of free sugars, as well as confectionery, cakes, biscuits,
sweetened cereals, sweet desserts, sucrose, honey, syrups and preserves. Severe dental caries is a
frequent cause of absenteeism at school or work. An association between dental caries and under
nutrition in children has been reported in some low- and middle-income countries; however, whether
this is cause or effect, or both, remains to be determined.

Sugar is cheap and widely available – in most high- and middle-income countries, sugar
consumption far exceeds the levels recommended by health organizations such as the WHO.

The sugar industry is a powerful global player that increasingly targets new markets in low- and middle-
income countries, where consumption is currently rising, with serious implications for oral and general
health.

Polices for sugar consumption are thereby enforced to keep oral and overall health in check:

 Enforcement of higher taxation on sugar-rich food and sugar-sweetened beverages.

 Ensuring transparent food labeling for informed consumer choices.
 Strongly regulating sugar in baby foods and sugar-sweetened beverages.
 Limitation of marketing and availability of sugar-rich foods and sugar-sweetened beverages to
children and adolescents.
 Providing simplified nutrition guidelines, including sugar intake, to promote healthy eating and
drinking.

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Session4 -Social determinants of health and their relation to oral
health
There are many factors that affect our oral health. Not just our habits but our changing lifestyle has
spread it influence on one’s oral health. Experiences in the early years, education, working life, social
habits, income, and environmental conditions, lie outside the immediate reach of the health system.
Health professionals, however, have an important role to play in tackling health disparities amongst
their own patients and more widely in the community and promoting health equity. Current
understanding of the social determinants indicates that significant improvements in health could be
achieved if medical, dental, and public health professionals address these broader influences on health
outcomes while maintaining excellence in traditional disease control approaches.

 Oral diseases like dental caries, periodontal disease and oral cancer, issues such as poor access to
dental care, and low oral health literacy levels are social, political, behavioral, and medical in nature.
These conditions will only be controlled by the promotion of initiatives that prioritize the improvement
in the SDH as a backbone structure for the development of healthy enabling environments. Unless these
determinants are addressed, improving access to dental care, will only alleviate but never substantially
reduce, the burden of dental diseases.

Addressing these determinants is key in reducing health disparities and improving the health in people.

What are these determinants?

 Economic political and environmental condition

 Social and community
 Oral health related behaviors
 Individual influence
 Use of services

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 Behaviors

Behavioral and social cultural condition.

 Lifestyle denotes the way people live reflecting a whole range of social values attitudes and
activities.  
 It is composed of cultural and behavioral patterns and lifelong personal habits.
 Lifestyle are learned through social interactions with parents and peer, groups, friends, siblings
and through schools and mass media.
 Coronary Heart disease, obesity. lung cancers, drug addictions are all associated with lifestyle.
 Tobacco consumption is a developing health issue associated with one’s lifestyle and this has led
to a raising concern in a large group of people.

Environment
 Environment is classified as internal and external.
 Internal environment offer man pertains to each and every component part every tissue organ
and organ system and their harmonious function with the system.
 External or macro environment consists of those things to which man is exposed after
conception.

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 It can be divided into physical biological and social psychosocial components any or all of which
affected and can affect the health of men and is susceptible to illness.
 Other types of environments include occupational environment social economic environment
moral environment.

Social economic conditions

 The health of a person is primarily dependent upon the level of socio economic development.
 Examples per capita income, GNP, education, nutrition, employment housing and political
systems of the country has affected the lifestyle of many people which in turn affects health of
an individual.

Health services
 Health services are seen as essential for social and economic development
 There is a strong relation between GNP and expectations of life at birth and the overall health
status of the given problem.
 There are various programmes such as immunization programmes, programmes for malaria,
midday meal programmes, family welfare programmes another non communicable disease
programmes that aim at prevention promotion and maintenance of the health status of the
population.

Other factors that determine full health could be

 Gender
 The ageing population
 Systems outside the formal healthcare system, health related sectors, Food and Agriculture,
education, industries, social welfare rule development, adoption of policies, employment
opportunities, increasing wages.

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Understanding the social determinants of health and structural inequality is a key competency for all
dental students to develop so they can provide socially competent care, especially for patients from
groups who shoulder the greatest burden of disease due to their socioeconomic status and vulnerability
within society. To ensure that the dental profession remains ‘fit-for-purpose’ into the 21st Century,
having an immutable voice in advocating for global reductions in oral health disparities, dental curricula
need to correct their focus; incorporating the social determinants of health as a theme running through
every learning activity. Dental schools must ensure that students not only understand how the social
determinants of health impact the mouth and oral wellbeing, but also develop a deep sense of social
responsibility and capacity to act towards their amelioration and management.

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Exercise 1a- Rearranging 17 Sustainable Development Goals according to
local/national scenario with short text explaining their rationale. (Performed in
individual groups)

1. POVERTY To eradicate poverty and provide better living conditions to

every individual.
2. ZERO HUNGER To let no stomach sleep empty at night.
3. CLEAN WATER AND To provide clean water and sanitation facility to people who
SANITATION has no access over it.

4. GOOD HEALTH AND To decrease the high mortality rates.

WELL-BEING
5. QUALITY EDUCATION To provide education to everyone as it will bring best to the
society and also put a haul to child labor.
6. CLIMATE ACTION To make people aware about global warming and educate
them on how can we combat this.
7. REDUCED INEQUALITY To get rid of racism and sexism.
8. GENDER EQUALITY To do away with job inequalities and to stop female foeticide
9. DECENT WORK AND To increase the production rate of the country.
ECONOMIC GROWTH
10. INDUSTRY, To increase job opportunities.
INNOVATION AND
INFRASTRUCTURE
11. SUSTAINABLE CITIES Establishment of smart cities and reduce exploitation of
AND COMMUNITIES nature.

12. PEACE, JUSTICE AND Proper crime punishment and social justice.
STRONG JUSTICE
13. RESPONSIBLE No misuse of resources and increased production of products
CONSUMPTION AND that are reusable and biofriendly.
PRODUCTION
14. AFFORDABLE AND Installation of Solar panels at every household and production
CLEAN ENERGY of energy that can be renewed

15. LIFE ON LAND Keep check on biodiversity, reforestation

16. LIFE BELOW WATER To stop sewage disposal in water beds and preserve coral
biodiversity.
17. PARTNERSHIP FOR Enhance communication and teamwork.
THE GOALS

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Exercise 1b – overall rearrangement of 17 Sustainable Development Goals
according to local/national scenario with short text explaining their rationale.

1. NO POVERTY Poverty should be addressed because it decides the overall

well-being of a person and it is directly related to the
individual development of a person and increased economic
status.
2. ZERO HUNGER  Food is the basic need of everyone.
 There are many programs to eradicate hunger but still
we are not able to achieve complete eradication.
3. CLEAN WATER AND Important for public health, improved water supply and
sanitation can boost countries economic growth and
SANITATION
contribute to poverty reduction
4. GOOD HEALTH AND  Good health and well-being ensure complete
commitment towards work decreasing financial
WELL-BEING
burden.
(MENSTRUAL HEALTH  Promote menstrual health and hygiene as it is a major
AND HYGIENE) problem in India. Every woman should be able to get
access of menstrual products.
5. REDUCED  Inequalities create gaps in the society.
 Income inequality has increased to 11% in developing
INEQUALITIES
countries.
 Equal opportunities for every individual is important
for the country’s development.
6. QUALITY EDUCATION It facilitates the progress of the society as out of 100% girls
enrolled for primary education only 25.4% turns up for higher
education.
7. GENDER EQUALITY  It is important for economic growth and development
of the country.
 Child sex ratio is 919 for 1000 boys in India.
 In India the population of women is 48.5% but only
27.4% women are in work force.
8. CLIMATE ACTION  The earth’s climate is changing with severe
consequences and is increasing due to resilience of
our countries.
 India is the 3rd largest greenhouse gas emitter,
responsible for 6.9 of global emissions.
9. LIFE ON LAND  Land and forests are the foundation of sustainable
development.
 Preserving life on land requires concerted action not
only to protect terrestrial ecosystems but also to

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 restore them and promote their sustainable use for
the future.
10. LIFE BELOW WATER  Oceans cover close to 3/4the of Earth’s surface,
contains 97% of Earth’s water and represent 99% of
the living space on the planet.
With their temperature, chemistry and currents it
makes the Earth a habitable place for humankind.
11. PEACE, JUSTICE AND Peace is a way to brighter future as it does not involve
STRONG INSTITUTIONS violence and destruction.
12. DECENT WORK AND Economic growth is inextricably linked to all our other
priorities however unemployment rate in our country is quite
ECONOMIC GROWTH
high.
13. INDUSTRY,  Investment in useful commodities have been crucial
to driving economic growth and empowering
INNOVATION AND
communities in many countries.
INFRASTRUCTURE  Technological progress enhances the well-being of the
country and its people through increased resources
and energy production.
14. AFFORDABLE AND  Energy is the golden thread that connects economic
growth, social equality and environmental
CLEAN ENERGY
sustainability.
 With access to affordable energy, people can make
great use of it in their development.
15. RESPONSIBLE  Ensuring responsible consumption and production
patterns.
CONSUMPTION AND
 With a great population, India is likely to face
PRODUCTION significant resource constraints in the coming
(WASTE decades.
MANAGEMENT)  A better and smarter way of waste management
should be in practice.
 Education about proper utilization of resources and
waste management to every individual.
16. SUSTAINABLE CITIES Achieve sustainable cities and communities by promoting
urban agriculture, encouraging healthy lifestyles, reducing and
AND COMMUNITIES
managing food wastes and reconnecting cities with
surrounding rural areas.
17. PARTNERSHIP FOR Unity of governments, private sectors and civil society will
help in achieving the goals at a faster rate than expected.
THE GOALS
18. CULTURAL  Preserve the rich culture of India and pass it on to the
future generations.
PRESERVATION AND
 Keep the basis of our core values fresh.

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 ADVANCEMENT
19. DIGITAL  Digital transformation is now changing the landscape
DEVELOPMENT AND of development.

CYBER SECURITY  It has begun to change the structural transformation

and economic growth of the country.
 Cybersecurity is important because it encompasses
everything that pertains to protecting our privacy,
intellectual property, data, etc. from damage
attempted by criminals.

Exercise 2- Integrating oral health with Sustainable Development Goals

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 SUSTAINABLE INTEGRATING ORAL HEALTH WITH
DEVELOPMENTAL THE FOLLOWING SDGs
GOALS
1. NO POVERTY  Dental professionals can come together and form an
association or organization offering dental services for
lesser payment values so that it is affordable to all the
sections of the people.
 Government of India should make schemes for free
dental check-ups in rural part of the country.
2. ZERO HUNGER Oral health professionals can play a major role by educating
communities to retain and maintain healthy teeth with the
target groups being children under 5 years of age, adolescent
girls, pregnant and lactating women and older persons.
3. CLEAN WATER AND Dental professionals while operating on patients can educate
the people on turning off the faucets while performing oral
SANITATION cleaning procedures can contribute to this target.
4. GOOD HEALTH AND  Oral diseases affect 3.9 billion people worldwide, with
untreated tooth decay impacting almost half of the
SANITATION world's population i.e., 44%.
 Dentists can educate their patients regarding good oral
health.
 It is also mandatory to have proper sanitation in the
clinics.
5. REDUCED Dental insurance helps the people with low economic status to
get dental treatment and improve their oral health.
INEQUALITIES
6. QUALITY EDUCATION It is important to have equal distribution of dental colleges and
hospitals in India especially in the rural areas where people
have no access and there should be a greater number of
government dental colleges so that the students of the poorer
sections of the society can study BDS.
7. GENDER EQUALITY  End all forms of discrimination, especially job related,
against all women and girls.
 Creating equal opportunities for both the genders to be
part of the decision-making process in oral health
contribute to this target.
8. CLIMATE ACTION  Mercury used in dental amalgam is a global pollutant
 Use of alternate restorative materials other than
amalgam.
 Contribute in research to develop newer restorative
materials that are affordable and safer to environment.
 Advocacy efforts to reduce or eliminate use of
amalgam during training of dental professionals
essentially emphasizing on curricular reforms.
9. LIFE ON LAND Use and proper disposal of restorative materials like amalgam
which are harmful, proper disposal of materials used in
everyday practice like gloves, rubber, plastics etc., increased
use of recyclable instruments and materials. Contribute in
research to develop newer restorative materials that are

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 affordable and safer to environment.
10. LIFE BELOW WATER  Contribute in research to develop newer restorative
materials that are affordable and safer to environment.
 Protecting the marine life by controlled and safer
disposal of dental wastes.

11. PEACE, JUSTICE AND Dentist and healthcare professionals have to follow principles
of ethics, under which they have an obligation to "primum non
STRONG nocere". The legal cases filed against the dentists are
INSTITUTIONS increasing due to which the dentists should be aware of
medicolegal matters. During RCT, iatrogenic root perforation
can lead to tooth extraction, which can result in legal action
against the dentist.

12. DECENT WORK AND  According to National Health Profile 2018, out of over
2.7 lakh dentists registered with DCI, the government
ECONOMIC GROWTH employs only 7,239 dentists.
 It is important for Government of India to take action
and create more job opportunities for dentists. If the
government creates more dental health centers in rural
areas, then people can get dental treatment at a lower
cost.

13. INDUSTRY, Dentist and healthcare professionals need to skill up for the
upcoming technologies which will make treating diseases
INNOVATION AND easier than the traditional methods did.
INFRASTRUCTURE
14. AFFORDABLE AND  Dental professionals can help by educating patients on
water and energy conservation and stick to scientific
CLEAN ENERGY management of dental waste that are generated in the
process of oral care delivery (mercury, lead, gypsum,
plastics etc.).
 Reduce the mercury used in dental amalgam or use of
an alternate restorative material, contribute in research
to develop newer restorative materials that are
affordable and safer to environment, advocacy efforts
to reduce or eliminate use of amalgam during training
of dental professionals.

15. RESPONSIBLE To strengthen systems and methods for oral health

surveillance, both processes and outcomes.
CONSUMPTION AND
PRODUCTION
16. SUSTAINABLE CITIES  To integrate oral health promotion and care with other
sectors that influence health, using the common risk
AND COMMUNITIES factor approach.
 To develop oral health programs that will empower
people to control determinants of health.

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17. PARTNERSHIPS FOR Provision on fully funded scholarships by the Government of
India to deserving dental students can be key in establishing
THE GOALS firm partnerships. Procuring and equipping Indian dentists with
state of the art and the latest instruments from around the world
for utilization. Preparation of various dental clinics with
subsidized or free of cost treatment for the needy in remote
areas and also educating them on oral health awareness and
wellbeing. Establishment of a contingency, consisting of the
best dentists from across the nation to form a panel and discuss
and address the issues and worries from different dental
professionals and institutions all over India.

Photographs

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Learning experience

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 References

–https://www.researchgate.net/publication/349428276_AMEE_Consensus_Statement_Planetary_health
_and_education_for_sustainable_healthcare
–https://www.tandfonline.com/doi/full/10.1080/0142159X.2020.1796949
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