Tooth decay and gum disease are destroying the health and life chances of millions of people in Kenya, Colombia, India and Brazil, yet these countries lack the research and policies to stop it. This matters because oral diseases are not just about teeth. They share the same root causes as heart disease, diabetes and cancer—sugar, tobacco, alcohol and poverty—yet dental care in these countries is often isolated from mainstream healthcare, unaffordable and inaccessible. The result is untreated pain, lost school days, reduced job opportunities and a severe drain on quality of life. The research gap is stark: there is almost no high-quality public health evidence on how to prevent oral disease or reform dental systems in these settings. If this programme succeeds, it will produce the first robust data on how commercial forces—especially the sugar and tobacco industries—drive oral health inequalities, and what policy reforms and community interventions can actually reduce them. The team will also train local researchers, building lasting capacity. The ultimate change would be national public health policies that integrate oral health into primary care, making prevention and treatment available to the poorest populations, not just those who can pay.
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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. 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. 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. 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
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