CORE Launch Event

On October 16, 2024, the official launch of Project CORE took place at the India Habitat Centre in Delhi, organised by the Public Health Foundation of India and hosted by Prof. Manu Raj Mathur and Prof. Abhishek Mehta. The event featured three engaging sessions.

INAUGURAL SESSION

The inaugural session commenced with addresses from our esteemed chief guests, setting a positive tone for the day. This was followed by a technical session that brought together several prominent figures in oral health research. They contributed valuable insights into the overarching themes of oral health care and the research landscape, both globally and in India.

The launch concluded with two thought-provoking panel discussions that delved deeper into the challenges and future potential for improving work in this vital area.

1. WELCOME REMARKS BY PROF. SANJAY ZODPEY; PRESIDENT OF PUBLIC HEALTH FOUNDATION OF INDIA

In his welcome address for the launch of Project CORE, Prof. Sanjay Zodpey, highlighted the global burden of oral diseases, which affect over 50% of the world’s population and are intricately linked to overall health and well-being. He emphasised that India faces a severe oral health crisis, particularly among rural and disadvantaged communities, where access to preventive care is limited. Prof. Zodpey outlined PHFI’s significant contributions to public health through capacity building and policy advocacy, stating that Project CORE aims to address oral health inequities by collaborating with local communities and international experts. He concluded by expressing optimism about the project’s potential to transform oral health into a fundamental right for all, wishing success to everyone involved.

2. OPENING REMARKS BY PROF. KEYA SIRCAR, DEAN, FACULTY OF DENTISTRY, JAMIA MILLIA ISLAMIA

Prof. Keya Sircar emphasised, “There is no health without oral health.” She highlighted the urgent need to address the global burden of oral diseases, which disproportionately affects disadvantaged communities and shows a higher prevalence among these populations. Prof. Sircar noted that this is a pivotal moment for oral surgeons, as the world is increasingly recognizing the critical importance of access to oral health care.

3. KEYNOTE ADDRESS BY PROF. K SRINATH REDDY FOUNDER (PAST) PRESIDENT & DISTINGUISHED PROFESSOR OF PUBLIC HEALTH, PUBLIC HEALTH FOUNDATION OF INDIA

In his keynote address, Prof. Reddy emphasised the critical need to address gaps in knowledge and operational strategies within oral health to enhance its integration into overall healthcare. He highlighted that while the Jan Arogya Yojana was designed to cover high-cost treatments such as cardiac and renal procedures, it has seen the highest utilization for dental and cataract treatments. This trend underscores the significant lack of integration of oral health into general health services.

Prof. Reddy stressed that Universal Health Coverage (UHC) is incomplete without oral health services. He noted the pivotal role of the microbiome, particularly the oral microbiome, in identifying diseases. Unfortunately, oral health is often viewed as a personal responsibility, leading to its long-standing neglect. He further explained that various commercial and economic drivers, rather than individual choices, significantly impact oral health outcomes. Specifically, commercial determinants and the broader health system are essential social determinants of health.

Oral health is frequently perceived as a consequence of personal choices based on dietary intake decisions; however, these choices are influenced by multiple factors, including aggressive marketing, promotion of unhealthy options, and limited access to healthier foods. To achieve progressive universalization, Prof. Reddy advocated for both horizontal equity (providing basic services) and vertical equity (offering additional services) in healthcare. He called for increased promotion of oral health, greater insurance literacy, and improved financing to address these challenges, as he concluded, “Oral health needs a bigger bite of the UHC apple.”

4. SPECIAL REMARKS BY GUEST OF HONOUR, DR. NAVIN VERMA, ASSISTANT DDG, MOHFW, NEW DELHI

In his special remarks, the director emphasised the inclusion of oral health care within the Ayushman Arogya Mandir initiative. He also pointed out that the All India Institute of Medical Sciences (AIIMS) in New Delhi houses the National Referral and Research Institute for Higher Dental Studies (NaRRIDS), which conducts the National Oral Diseases Burden Survey, further contributing to the understanding of oral health challenges in the country.

5. CHIEF GUEST ADDRESS BY PROF. MOHAMMAD SHAKEEL, HONOURABLE VICE CHANCELLOR, JAMIA MILLIA ISLAMIA

During his address, the chief guest emphasised the importance of addressing Sustainable Development Goal 3 (SDG 3) through Project CORE. He outlined the project’s strategic approach to improving access to oral health care and reducing inequalities, particularly highlighting the unequal distribution of the oral disease burden, which disproportionately affects rural areas and populations with lower awareness of oral health, including both rural and educated urban groups. He expressed hope for policy reforms that would enhance oral health outcomes and reiterated the commitment to building capacity at Jamia Millia Islamia (JMI) in alignment with the university’s core values, aiming to create a more equitable oral health landscape for all communities.

TECHNICAL SESSION

1. INTRODUCTION TO PROJECT “CORE” PROF. RICHARD WATT PROFESSOR & CHAIR OF DENTAL PUBLIC HEALTH, UNIVERSITY COLLEGE LONDON

In his remarks, Prof. Richard Watt highlighted that oral health is at a tipping point, marking a seminal moment for the field. He noted that career options in oral health research have expanded for younger generations, especially since 2020, when oral health gained increased recognition as part of the non-communicable diseases (NCD) agenda. Prof. Watt emphasised that oral health is a social collective good, with strong momentum surrounding policy developments. He pointed to the significance of the Bangkok Oral Health Conference and mentioned that the Lancet Commission on Oral Health is set to be published next year, which will underscore the importance of integrating oral health into the broader health agenda.

He outlined Project CORE, which includes qualitative research and various work packages, as well as the Community Engagement and Involvement (CEI) Initiative. Prof. Watt also stressed the need for a community perspective in dentistry, which has traditionally been led by dental professionals.

2. “INITIATIVES TO STRENGTHEN ORAL HEALTH EDUCATION IN INDIA,” BY PROF. MAHESH VERMA VICE CHANCELLOR, GURU GOBIND SINGH INDRAPRASTHA UNIVERSITY

In his remarks, Prof. Mahesh Varma emphasised several key points regarding the current landscape of oral health research, describing this period as a golden age characterised by significant developments. He noted the importance of intense lobbying and advocacy efforts, stating that general health is incomplete without a focus on oral health. The demand for oral health services in secondary care is substantial, often because issues are not addressed early on. He asserted that oral health is now recognised as part of the non-communicable diseases (NCDs) agenda, and it must be approached with actionable strategies, as it is no longer merely a cosmetic concern.

Citing a 2014 survey on fluoride mapping, Prof. Varma highlighted that 90% of the population suffers from oral diseases, reinforcing the need to prioritise equity in research. He stated, “Education is the key to unlocking all opportunities,” emphasizing the importance of education at both professional and community levels. He argued that education can transform and empower individuals and communities through effective information dissemination and communication strategies at national and local levels.

Prof. Varma stressed that research must be pivotal and relevant to the specific needs of the country, advocating for long-term follow-ups facilitated by technology. He noted that global collaboration is essential for informing best practices and achieving better, sustainable advocacy, policy, and governance. He concluded by declaring, “Oral health matters, and it matters all the more today.”

3. PROF. RITU DUGGAL FROM THE CENTRE OF DENTAL EDUCATION AT AIIMS

In her address, Prof Ritu Duggal emphasised the significance of the project for India. She expressed her humility in the presence of the visionaries at the podium and highlighted the need for collaboration among professionals from different fields to reduce the disease burden. Prof. Duggal highlighted a surprising aspect of the current system: while students obtain specialty registrations as dentists, they do not pursue Indian Dental Association (IDA) registration. This calls for a concerted effort to address this gap and emphasises the need for collaboration among the existing pool of professionals, regardless of their specialisations, to effectively tackle oral health challenges in the country.

4. “ROLE OF PARTNERSHIPS TO STRENGTHEN ORAL HEALTH SYSTEMS,” BY PROF. O P KHARBANDA PRO-VICE CHANCELLOR HEALTH SCIENCES RAMAIAH UNIVERSITY

In his address, Prof. O.P. Kharbanda highlighted that the world remains largely unaware of how oral diseases can progress into more serious conditions, underscoring the need for a clear action plan to address inequities in oral health care. He noted that treatments for oral diseases require a life course approach, which is essential as oral cancer becomes more prevalent. There is a significant risk of oral lesions converting into cancers of the oral cavity, pancreas, and liver, making it crucial to invest in preventive measures.

Prof. Kharbanda pointed to E-Dant Seva as one of the most comprehensive applications available for oral health, stressing that rather than duplicating existing resources, there should be enhancements to current systems. He remarked that dentists have struggled to establish a cohesive social or professional identity, often being perceived merely as surgeons, cosmetic dentists, or orthodontists.

Using the analogy of the blind men and the elephant, he illustrated the fragmented understanding of the dental profession and emphasised the need for a collective definition of a dentist. Additionally, he highlighted the strong role of genetics in oral health research and mentioned the creation of a national web-based cephalometric system. Prof. Kharbanda expressed optimism that through collaboration with other disciplines, the vision for the future of oral health could be achieved, including innovative solutions like mini robots in the mouth or automated toothbrushes, indicating a significant scope for collaboration in this field.

5. “ROLE OF NATIONAL DENTAL ASSOCIATION IN ADVANCING ORAL HEALTH RESEARCH IN INDIA,” DR. ASHOK DHOBLE HON. SECRETARY GENERAL INDIAN DENTAL ASSOCIATION

In his address, Dr. Ashok Dhoble from the Indian Dental Association (IDA) emphasised the crucial role that national dental associations play in advancing oral health research. He called for discussions to be taken to the masses, highlighting that over the past 15-20 years, the IDA has been actively working to address the neglect of oral health in the country.

Despite a growing number of dental professionals, Dr. Dhoble noted that job opportunities remain insufficient. He pointed out that research efforts are often sporadic and emphasised the need for a central hub to unite stakeholders in the field. He stressed the importance of collaboration to achieve the collective vision for oral health by 2030.

MODERATED PANEL DISCUSSION 1

HEARING THE UNHEARD VOICES

1. MS. MIRAI CHATTERJEE DIRECTOR, LOK SWASTHYA SEWA TRUST: ROLE OF COMMUNITY ENGAGEMENT IN ORAL HEALTH PROMOTION AND DISEASE PREVENTION

Ms. Mirai Chatterjee emphasised the invaluable role of frontline community workers, describing them as critical assets to the public health system. She highlighted the vast network of 1.4 million Anganwadi centres across the country, supported by dedicated workers and self-help groups. Ms. Chatterjee called for the co-creation of guiding principles to ensure that all public health messages are coordinated and people-centric, reaching the grassroots effectively.

She stressed that simply delivering oral health literacy is not enough; frontline workers must be supported with proper incentives, including fair salaries and manageable workloads, and should not be treated solely as data collectors. Recognising the need to organise informal workers, Ms. Chatterjee underscored that frontline workers are among the best public health advocates, and their contributions should be valued accordingly.

2. PROF. REGINA MUTAVE JAMES ASSOCIATE PROFESSOR, UNIVERSITY OF NAIROBI: “WHAT ARE THE COMMON BARRIERS IN THE RURAL COMMUNITIES IN KENYA?”-

Prof. Regina highlighted the significant challenges facing Kenya’s oral health system, noting that the country, as a typical LMIC, has only a few dental schools and a total of just 1,500 dentists serving a population of over 50 million. This reflects a low capacity to meet the country’s dental health needs. She pointed out that while 78% of Kenya’s population lives in rural areas, the majority of dentists are concentrated in central regions, leaving these vast rural communities with limited access to dental care.

Prof. Regina stressed that this creates a substantial gap in access to dental care for rural communities, compounded by a general lack of oral health awareness across the country. Despite attempts to implement screening and other procedures, the government has not made sufficient investments in oral health. Consequently, there is a high prevalence of dental caries and periodontal diseases, but inadequate access to dental care to address these issues.

3. DR. MICHELLE STENNET CLINICAL RESEARCH FELLOW, UNIVERSITY COLLEGE LONDON: EXPERIENCE WITH QUALITATIVE INTERVIEWS-

Dr. Michelle shared her experience with the qualitative interviews conducted as part of Project CORE’s distinct and interrelated work packages. She emphasised the importance of speaking to individuals who are often overlooked to gain a deeper understanding of their lived experiences. The team conducted interviews in Kenya, Colombia, and deprived communities in Glasgow, revealing significant differences in funding across these regions but strikingly similar challenges within the communities themselves. Despite varying levels of financial support, the experiences of individuals in these areas shared common themes.

The common themes that emerged included difficulties in eating and the social stigma associated with missing teeth, which often led to value judgments. Access to dental services was found to be severely limited in all locations. Dr. Michelle noted that the interviews aimed to explore these challenges not only from a personal perspective but also within their broader cultural contexts.

4. DR. CHANDRASHEKAR JANAKIRAM, HEAD OF DEPARTMENT, DEPARTMENT OF PUBLIC HEALTH DENTISTRY, SCHOOL OF DENTISTRY, KOCHI: “HOW CAN INTERPROFESSIONAL EDUCATION AND COLLABORATION HELP IMPROVE ORAL HEALTH DELIVERY?”-

In response to the question of how interprofessional education and collaboration can improve oral health delivery, Prof. Chandrasekhar provided a thought-provoking perspective. He emphasised that the philosophical foundation for integrating oral health into Universal Health Coverage (UHC) can only be achieved through a multidisciplinary team approach. Prof. Chandrasekhar used a compelling example comparing Kenya, with its 1,500 dentists, and India, which has more than the WHO-recommended ratio of dentists, to demonstrate that despite differing numbers of dental professionals, both countries face similar challenges with oral disease prevalence and inaccessibility to oral care. This highlights that simply increasing the number of dentists doesn’t directly solve the problem. Instead, he emphasised the need to “de-professionalise” oral health care by involving community and frontline workers. Equitable and accountable oral care requires engaging non-dental professionals, especially in underserved areas, to bridge the gap and provide basic services.

Prof. Chandrasekhar also argued for a bottom-up approach, integrating oral health from the grassroots level, rather than solely at the UHC level. He explained that the current separation of oral and general health stems from a flawed assumption that they develop independently. To achieve real progress, he advocated for a model that starts at the community level, ensuring that oral health and general health grow together, rather than apart.

5. MS. LAXMIBEN JASHUBHAI MAKAWANA MEMBER OF THE BOARD, LOK SWASTHYA SEWA TRUST: MOST EFFECTIVE WAY TO APPROACH COMMUNITY ENGAGEMENT-

Ms. Laxmiben shared her experiences working in Gujarat with SEWA for the past 16 years as an agricultural labourer. She highlighted the low awareness levels regarding oral health in her area and the efforts made to improve this situation. The team conducts group discussions, community meetings, and house visits to educate residents about dental care. Exposure visits have proven effective, as many people are unaware of the existence of dental clinics. They utilise educational modules to emphasise the importance of accessing dental services and to discourage reliance on home remedies.

To engage younger generations, they organise dental camps in schools, teaching children about oral health and encouraging them to communicate what they learn to their parents. Children are often more receptive to learning, and their enthusiasm helps to inform their families about dental care.

Additionally, Ms. Laxmiben provided an example of community action where they successfully addressed the issue of polluted water by mobilizing community leadership. Through collective efforts such as hunger strikes, they advocated for a solution. She emphasised that the most effective way to raise awareness and drive change is by mobilising the community and fostering unity among its members.

MODERATED PANEL DISCUSSION 2

EQUITY AND SOCIAL DETERMINANTS OF HEALTH RESEARCH – THE WAY FORWARD

1. DR. CAROL GUARNIZO HERRENO ASSOCIATE PROFESSOR, NATIONAL UNIVERSITY OF COLOMBIA : “WHAT RESEARCH METHODOLOGY IS THE MOST EFFECTIVE IN STUDYING ORAL HEALTH INEQUALITIES?”

Dr. Carol emphasised the importance of ensuring that research ideas align with local contexts, needs, and cultures. Based on her experience, she noted that engaging community members is essential for meaningful research. They conduct quantitative assessments through district surveys, while qualitative research offered valuable insights. She went on to say that utilising a participatory action research framework allows for a better understanding of community responses and the development of illnesses.

Dr. Carol highlighted the principles of listening to community voices and increasing their involvement in the research process. She stressed the need to co-design studies, moving beyond traditional research practices. Research on oral health inequalities should not merely document issues but also challenge the systems that create unfair access. To effectively address these issues, it is crucial to incorporate knowledge from political and other social sciences.

2. PROF. AL ROSS PROFESSOR IN HUMAN FACTORS AT THE UNIVERSITY OF STAFFORDSHIRE : “QUALITATIVE RESEARCH REMAINS LARGELY UNEXPLORED IN THE FIELD OF ORAL HEALTH. HOW CAN WE INTEGRATE QUALITATIVE METHODS INTO ORAL HEALTH RESEARCH TO GAIN A BETTER UNDERSTANDING OF THE INEQUALITIES PRESENT IN THIS AREA?”

Prof. Ross began by asserting that the world is inherently qualitative, emphasising that it is fuzzy and dynamic rather than binary. While we often rely on mathematical models to understand health issues, he noted that these models can be theoretical and may fail to capture the complexities of real-life experiences, sometimes obscuring critical aspects of people’s lives. To truly understand how individuals navigate and respond to their health challenges, we must engage in qualitative research that reflects their lived experiences.

He stressed that implementation necessitates a systems analysis approach. Research must be pragmatic, utilising the appropriate methods to address pressing questions. By combining observational analysis with mathematical models and co-designing research efforts, we can gain deeper insights into health systems. Prof. Ross concluded that evidence-based public health interventions are essential; we cannot impose actions that are irrelevant to the communities we aim to serve.

3. PROF. MONIKA ARORA VICE PRESIDENT (RESEARCH AND HEALTH PROMOTION DIVISION), PUBLIC HEALTH FOUNDATION OF INDIA: “HOW CAN WE DESIGN IMPACTFUL STUDIES TO UNDERSTAND SOCIAL DETERMINANTS OF HEALTH?”

Prof. Arora emphasised the importance of engaging with communities to design effective research. She shared a real-life example from a village in Pune, where she encountered a farmer who was potentially pre-diabetic. His response to the prospect of seeking help at a primary health centre was telling: he feared he would be advised to eliminate sugar from his tea. This illustrates that any changes we propose are destined to fail if we do not involve communities in the conversation.

She noted that in some groups, there is a belief that a tooth can be “poisoned,” leading individuals to seek tooth extraction for pain relief. This highlights the necessity of co-creating solutions while identifying genuine research problems, which include not only social but also structural determinants of health. Factors such as politics, racism, stigma, and violence must all be taken into account to make our research responsive.

Prof. Arora stressed the need to train not only PhD students and postdocs but also community workers. She recounted a learning experience from the National Institute for Health Research (NIHR), where two individuals with lived experiences aspired to become community champions but felt uncertain about their acceptance among health professionals. This emphasises the importance of enhancing the interaction time between patients and health systems. She concluded by mentioning the global framework established by the NCD Alliance, which aims to foster these connections.

4. PROF. PAULO GOES ASSOCIATE PROFESSOR AT FEDERAL UNIVERSITY OF PERNAMBUCO (UFPE) PROFESSOR AT OLINDA MEDICAL SCHOOL (FMO): “FROM YOUR EXPERIENCE, WHAT STRATEGIES CAN BE EMPLOYED TO IMPROVE DATA COLLECTION, THE GRANULARITY OF DATA, AND RECORD-KEEPING?”

Prof. Goes highlighted the necessity of capturing the complexity of work in epidemiology, which fundamentally relies on quantitative methods. He emphasised the need for precision in this field and called for the standardisation of protocols. Utilising digital tools, implementing data mining, and leveraging big data and artificial intelligence are critical steps toward enhancing our precision.

However, he cautioned that while these methods can improve the resolution of our existing data, they may not fundamentally change the underlying picture we are observing. To advance our understanding, he advocated for improving survey methodologies and increasing the reliance on self-reports in conjunction with quantitative epidemiology.

By capturing self-reports and patient-centered measures, we can gain a more nuanced view of health outcomes. Prof. Goes also underscored the importance of considering ethical issues when collecting and utilising this data to ensure that our approaches respect the rights and privacy of individuals involved.

5. PROF. VIKRANT MOHANTY PROFESSOR AND HEAD OF DEPARTMENT OF PUBLIC HEALTH DENTISTRY, MAIDS: “IN THE CONTEXT OF A DEVELOPING COUNTRY, WHAT CHALLENGES ARE FACED WHEN INVOLVING MARGINALISED COMMUNITIES IN RESEARCH?”

Prof. Mohanty addressed the significant challenges of involving marginalised communities in research, emphasising that accessibility remains a critical issue. When we implement our approaches in the community, the realities of different groups, particularly in slums and peri-urban areas, pose substantial barriers to successful execution. He pointed out that strong cultural beliefs can hinder the uptake of oral care services, making it essential to recognise and navigate these cultural sensitivities.

Furthermore, he highlighted the structural challenges that arise from India’s diverse social fabric, where regional differences lead to varying access to clean drinking water and oral health care. There is also a notable lack of training in qualitative research methodologies, resulting in insufficient data in quantitative surveys. Research efforts tend to be sporadic across the country, leading to a lack of cohesion and a missing granularity in data, which complicates replication and duplication efforts.

Prof. Mohanty emphasised that geographic factors and cultural sensitivities must be considered, along with a deeper understanding of community practices. He advocated for the need for community-led researchers to address these challenges effectively. To improve accessibility, his team has established a mobile dental clinic and trained dentists in data collection. However, he noted that patients typically seek treatment and leave without engaging in discussions or sharing their views, which has resulted in fragmented data from over 300,000 individuals. He concluded by stressing the importance of involving non-medical professionals to bridge these gaps in research and community engagement.

CONCLUSION

In conclusion, the event showcased a series of insightful and revelatory discussions that illuminated the future of oral public health research. The host, Prof. Manu Mathur, eloquently encapsulated this vision through the three guiding principles:

1) Focused: Research tailored to address specific needs.

2) Fit for Purpose: Ensuring relevance and applicability of findings.

3) Free for Analysis: Advocating for open access to data and insights.