In collaboration with the American Dental Association,WORLDColgate-Palmolive Company and Henry ScheinThe Economic Rationalefor a Global Commitmentto Invest in Oral HealthWHITE PAPERMAY 2024Images:Getty ImagesContentsForeword3Executive summaryIntroduction61 Oral health:Critical for overall health and well-being72 Better oral health lowers overall healthcare costs93 Oral health is a key driver of economic well-being104 The global burden of oral disease is growing125 When it comes to unmet healthcare needs,oral health stands out136 The cost of oral disease to the global economy is substantial157 The high level of unmet oral healthcare needs is rooted in health16policy choices8 Moving forward:The need for a global commitment to investing in19oral healthConclusion21Contributors22Endnotes24营动DisclaimerWorld Economic Forum as a contributionto a project,insight area or interaction.The findings,interpretations andendorsed by the World Economic Forumrepresent the views of the World EconomicForum,nor the entirety of its Members,reserved.No part of this publication maystorage and retrievel system.The Economic Rationale for a Global Commitment to Invest in Oral Health2ForewordAllison NealeVice-President,PubicMaria RyanPolicy,Henry Schein;Managing Director,HenrySchein Cares FoundationColgate-Pamoive CompanyMarko VujicicShyam BishenHead,Centre for HealthInsftute,American DentalAssociationWorld Eoonomic ForumMore than 80 years ago,the World HealthDespite heightened global recognition of its criticalOrganization (WHO)asserted that "the enjoymentimportance,access to oral care continues to beof the highest attainable standard of health is oneof the fundamental rights of every human being.as well as community-level lack of sufficientAt that time,and even today,too few cliniciansresources to invest in dental care infrastructure.outside of the dental profession would include oralThis is further compounded by shortage of dentalhealth in any definition of a"standard of health."workforce,which plagues many countries andreflecting an age-old separation of oral health fromcommunities.Addressing these gaps in globalmedicine and general health that has compromisedoral health will,therefore,require innovative policy,efforts to stem the tide of oral disease and keepinvestment and delivery solutions from all sectors,people healthy.and for stakeholders to work in tandem via public-private partnerships.As this white paper reports,almost half the world'spopulation is impacted by oral diseases thatinterfere with daily function and put them at higherWorld Economic Forum launched the Oral Healthrisk of and from other systemic illnesses such asAffinity Group (OHAG)in 2023 under its Globaldiabetes,stroke,heart and respiratory diseases,Health Equity Network,which is a group of moreand even some cancers.The cost of oral diseasesthan 50 companies committed to advancing healthis staggering,with estimates putting the directequity to create stronger and more productivetreatment costs plus productivity losses at moresocieties.Within this network,OHAG,which isthan $710 billion each year.Investing in oral healthcomposed of committed leaders from acrosspays dividends in the fomm of better oral health andsectors and industries,is shining a bright light onwell-being,improved overall health and economicthe impact of poor oral health on health outcomesgrowth.Yet oral health has remained a neglectedand on the global economy,and,most importantly,global health challenge-until now.on the actions that governments and private sectorcompanies can take to advance global oral health.A global consensus is gaining ground that oralhealth is integral to overall health,and critical to ourIn this white paper,the first in a planned series,ability to live healthy and productive lives.A tippingwe present the economic rationale for a globalpoint came in 2022 with the adoption of the WHO'scommitment to invest in oral health and explorelandmark global strategy on oral health,with thethe role of various sectors in improving oral health.nations of the world formally recognizing that:"TheThrough this and future white papers that will divepersonal consequences of untreated oral diseasesdeeper into other dimensions of this issue,we hopeand conditions-including physical symptoms,to inspire international health leaders,policy-makersfunctional limitations,stigmatization and detrimentaland private sector partners to reconnect the mouthimpacts on emotional,economic and socialto the body in pursuit of a healthier future for all.well-being-are severe and can affect familiescommunities and the wider healthcare system."The Economic Rationale for a Global Commitment to Invest in Oral HealthExecutive summaryOral health is critical for overall health and well-Governments should pursue policies that promotebeing.It is tied to many health conditions,includingaffordability of dental care services,ensure sufficientdiabetes,stroke,dementia,heart disease andoral health workforce capacity,integrate oral healthmental health,and affects pregnancy outcomes.within health systems and engage in public servicecampaigns to improve oral health literacy.A rangeYet,billions of people worldwide suffer fromof policy options can promote these goals:the negative effects of untreated oral diseases.According to the latest data from the WorldImplement the provisions of the WHO GlobalHealth Organization (WHO),the estimated numberOral Health Action Plan to improve oral healthof cases of oral diseases globally is about 1equity,contributing to the health-relatedbillion higher than cases of mental disorders,Sustainable Development Goals.cardiovascular disease,diabetes,chronicrespiratory diseases and all cancers combined.Integrate oral health within public healthOral diseases affect an estimated 3.5 billion peopleinsurance programmes and benefit packages aseach year,with the number of cases growing fasterpart of universal health coverage policies.than the population.Even after adjusting for therelative impact of various diseases on mortality andRegulate private health insurance markets inmorbidity,oral health conditions still rank within theways that promote comprehensive inclusiontop 10 of all diseases globally.and coverage of oral health in equitable andaffordable ways.Poor oral health has a negative impact on the globaleconomy.The economic burden of oral diseasesStrengthen primary healthcare through fullacross 194 countries was $710 billion in 2019.integration of essential oral healthcare.This includes $387 billion in expenditure for treatingoral diseases and $323 billion in productivityAlign incentives,including provider paymentlosses.Poor oral health leads to missed schoolmodels,to promote upstream prevention ratherdays,limited academic achievement and hinderedthan downstream treatment of disease.employment prospects.For context,productivitylosses stemming from dental diseases exceedAdopt evidence-based guidelines on oralthose of hypertensive heart disease,asthmahygiene practices,fluoride use,as well asand certain cancers,and fall within the range foradvertising,labelling and taxation of sugarydiseases that account for the top 10 global causesfoods and beverages.of death.Simply put,unmet oral health needs exacta substantial economic penalty across the globe.Pursue strategic partnerships with academicMost importantly,the most vulnerable populationsinstitutions,foundations,professionalorganizations,corporations and advocacygroups to strengthen oral health.Unmet oral health needs stem,in part,from policychoices.Health policy often does not treat dentalIn several areas of oral health policy,there is a needcare as an essential healthcare service.As a result.to generate and synthesize evidence on variousdental care ranks at the top when it comes topolicy approaches in ways that are understandableand actionable for policy-makers.healthcare,especially for vulnerable populations.Within most healthcare systems,including thoseThe private sector plays a critical role in thewhere healthcare is mainly publicly funded,dental"commercial determinants of oral health"-care is seen more as a discretionary,privatelycorporate activities that affect people's oral health,financed healthcare service.It is often delivered inboth positively and negatively.These include theseparate,stand-alone facilities rather than as partmanufacture and promotion of products that areof integrated primary care settings.This createsfurther challenges to leveraging the mouth-bodyvapes,and foods and drinks that are high in sugarconnection in driving overall health and well-being.content)as well as those that are beneficial.Theprivate sector plays a key role in ensuring affordableThere is a strong economic rationale to improve oralaccess to fluoride toothpaste,oral hygiene productshealth globally.To achieve this requires bold actionand other products beneficial to oral health.among key stakeholders.The Economic Rationale for a Global Commitment to Invest in Oral HealthThe private sector should:Civil society has numerous roles in advancing oralhealth globally.The research community-agenciesPromote research and development in productsthat fund research and organizations that carry outthat promote oral health and work to createresearch-and private foundations that support thehealthy alternatives to help phase out productsstrengthening of health systems should:that cause oral diseases.Improve the evidence base for oral healthAccelerate efforts to provide affordable self-policy.This includes synthesizing best practicesoral care solutions that are universally availableon oral health financing and delivery basedand affordable,particularly for people livingon comprehensive,data-driven and cross-in deprived socio-economic contexts.Forcountry comparisons.Research on oral healthexample,toothpaste containing fluoride is oftensystems in low-and middle-income countries isunaffordable,especially in lower-middle-incomeparticularly needed.and low-income countries.Fund research exploring the return onExpand coverage for oral healthcare services ininvestment for employers for investing in oralemployer-provided health insurance programmeshealth for their employees.and promote oral health as a core element ofworkplace health and wellness programmesInvest in oral health activities as part ofphilanthropic support for health-systemsSupport and align with the private sectorstrengthening in partner countriesactions outlined in the WHO Global Oral HealthAction Plan.Support and align with civil society actionsoutlined in the WHO Global Oral HealthMultilateral organizations,such as the WorldAction Plan,such as fostering communityHealth Organization,the World Economic Forum.involvement and co-creation of appropriatethe World Bank and the Global Fund,should:policies and services,improving impact andaccountability of programmes and policies,andInclude oral health in policy dialogues forsupporting advocacy for better prioritization ofcommunities'oral health needsoral health will help advance broader healthoutcomes and help achieve the SustainableAddressing the global oral health crisis will requireDevelopment Goalsbold action.The World Economic Forum is ideallyplaced to facilitate the partnerships needed acrossInclude oral diseases within the WHO's non-various stakeholder groups.Going forward,thecommunicable diseases framework.This isnewly established Oral Health Affinity Group,especially relevant as health systems rapidlylaunched in 2023 under the Forum's Global Healthtransition to address the growing non-Equity Network,will be an ideal platfomm to facilitatecommunicable disease burden.this continued dialogue -and action.Support and align with the international partnerand multilateral organization actions outlined inthe WHO Global Oral Health Action Plan.The Economic Rationale for a Global Commitment to Invest in Oral Health5IntroductionOral health is critical for overall health and well-being.Not only does oral health promote people'shealth an essential health service.'The WHOability to eat,speak,breathe,express emotionrecently developed guiding principles for countryand live a full life.it is also linked with healthaction,targeted at various stakeholders,withspecific goals and metrics.2 The United Nations'example,oral diseases are linked with diabetes,political declarations on universal health coveragestroke,dementia,heart disease and mental health,and affect pregnancy outcomes.Oral health alsooral health.shares common risk factors with many non-communicable diseases.Being healthy entailsfrom the French Federation Dentaire Internationale).which represents dental care providers aroundImproved oral health has important economicthe world,recently adopted a new vision that callsbenefits.Better oral health leads to healthcarefor dental care to be included in universal healthcost savings among populations with variouscoverage policies,promoting integration of oralnon-communicable diseases as well as lowerhealth into primary care and building a resilientemergency-room spending.However,thedental workforce that is responsive to populationeconomic impact of oral health extends wellneeds.5beyond the healthcare system.Poor oralhealth leads to lost school days for children,While momentum is building,key stakeholders mustmissed workdays and diminished job prospectstake bold action to advance oral health globally.for working-age adults and reduced labourThis paper summarizes the actions that have theproductivity.In essence,neglecting oral healthmost potential.While presenting a compelling caseexacts an economic penalty.This economic penaltyfor just how vital oral health is to overall health andis most pronounced for low-income,vulnerablewell-being,it summarizes the economic benefitspopulations.Thus,prioritizing oral health canassociated with improved oral health.It goes on tohelp close gaps in global health equity and,moreshow the significant unmet oral health needs acrossbroadly,can narrow economic disparitiesthe globe,with excessive equity gaps stemminglargely from how oral health is currently addressedThankfully,some important developments in recentwithin health policy.The paper concludes with a setyears have recognized the importance of oralof proposed actions for governments,the privatehealth.In 2021,the World Health Organizationsector,multilateral organizations and civil society(WHO)World Health Assembly called for oralthat will advance oral health globally.health's inclusion in universal health coverage in66Oral health has long been neglected in the global health agenda.Ourbiggest challenge now is ensuring that all people,wherever they liveand whatever their income,have the knowledge and tools neededto look after their teeth and mouths,and access prevention and carewhen they need it.sTedros Adhanom Ghebreyesus,Director-General,World Health OrganizationThe Economic Rationale for a Global Commitment to Invest in Oral Healthfor overall health andwell-beingGood oral health-having healthy and pain-freeoral cancer,influence a host of health outcomesteeth and gums-is a critical part of one's overallbeyond the mouth.'In particular,better oral healthhealth and physical,emotional and social well-has been associated with improved outcomes forbeing.A healthy mouth is necessary for eating,people living with heart disease,respiratory disease,smiling,speaking and self-expression.Dentaldiabetes,dementia,arthritis,as well as for pregnantdiseases,including tooth decay,gum disease andpeople,to name a few.BOX 1What is oral health?Oral health is the state of the mouth and teeth.It enables individuals toperform essential functions,such as eating,breathing and speaking,andencompasses psychosocial dimensions,such as self-confidence,well-being and the ability to socialize and work without pain,discomfort andembarrassment.Oral health varies over the life course from early life to oldage,is integral to general health,and supports individuals in participatingin society and achieving their potential.World Health OrganizationGum disease increases the risk of a first heart attackOral health is also a key driver of social andby 28%.10 The risk of stroke is twice as high amongemotional well-being,15 healthy ageing'6 andpeople suffering from poor oral health.11 Tooth lossbroader mental health.17 In short,one cannot behas been shown to be a risk factor for dementiahealthy without a healthy mouth.and heart disease.13 Research shows that peopleliving with diabetes have improved health outcomeswhen their gum disease is managed.#The Economic Rationale for a Global Commitment to Invein Oral HealthFIGURE 1The impact of oral health extends beyond the mouth西Growing evidence connects a healthy mouth with a healthy bodyHere are some examples showing why oral health is about much more than a smile:High blood pressureDementiaPutting off dental care during early adulthood is linked toan increased risk of high blood pressure.associated with a higher risk of developing Alzheimer's diseasePatients with gum disease are less likely to keep theirblood pressure under control with medication than arecould trigger or exacerbate"the neuroinflammatory phenomenonthose with good oral health.seen in Alzheimer's diseaseDiabetesRespiratory healthdiabetes to manage their blood glucose levels.Diabetes raises the risk of developing gum disease by 86%aspiration pneumonia.Patients with ventilator-associated pneumonia (VAP)whoObesityon mechanical ventilation than other VAP patients.Brushing teeth no more than once per day was linked with theImproving veterans'oral hygiene is shown to have reducedFrequent consumption of sugar-sweetened drinks raises the riskpreventing about 136 HAP cases and saving 24 lives.of both obesity and tooth decay among children and adults.AAdverse birth outcomesGum disease among pregnant women is associated with pretemSource:CareQuest Institute for Oral Healthbirths,low birth weight babies and pre-edampsia,a pregnancycomplication that can cause organ damage and can be fatal.The Economic Rationale for a Global Commitment to Invest in Oral Health82Better oral healthlowers overallhealthcare costsIn addition to the health and wellness benefits.states,the Medicaid programme also providesimproved oral health helps reduce costs in thedental care coverage for adults,an optional benefit.health system.19 Medical care costs for conditionsMedicaid expansion has enhanced access to oralsuch as diabetes,heart disease and pregnancy arehealth services for millions of low-income adults.lower when oral health issues are addressed.leading to increased visits to the dentist andIn the United States (US).individuals with heartalso helped reduce medical care spending.Fordisease saved $548 to $675 per year of healthcareexample,states that have provided comprehensivespending when they went for routine preventivedental coverage to adults and have expandedoral healthcare.Among people with diabetes,Medicaid eligibility have seen a 14%reduction inthe savings ranged from $900 to $2,840,21 andemergency-room visits for oral health issues.patients with multiple chronic conditions savedeven more.Further,improved oral health reducedIn one state that expanded Medicaid eligibility,medical costs associated with pregnancy by $1,500Kentucky,individuals who visited a dentist were atto $2,400 per pregnancy.lower risk of being diagnosed with diabetes andheart disease,which reduced healthcare costs forIn the US,41 states have expanded Medicaidthe Medicaid programme.24 In another state,Neweligibility as part of the Affordable Care Act.TheYork,increased utilization of oral health servicesMedicaid programme provides health insurancethanks to Medicaid expansion reduced bothcoverage for low-income Americans,includingemergency-room spending and inpatient healthcaremandatory dental coverage for children.In severacosts.25The Economic Rationale for a Global Commitment to Invest in Oral Health93Oral health is a keydriver of economicwell-beingImproved oral health and employment outcomesImproving oral health can help narow genderare linked,particularly for low-income adults.Forexample,more than one in three low-income adultsin the US report that the condition of their mouthInvesting in oral health is thus vital to promoteand teeth affects their ability to interview for a job.economic well-being among low-income,vulnerableThis is significantly above the rate reported amonggroups.Improved oral health reduces the numberof low-income adults on government socialassistance programmes.2 By enabling better jobThe link between oral health and employmentprospects,investment in oral health promoteseconomic independence for the most vulnerablefrom the US found that improved oral health translatesand disadvantaged segments of society.3 As ato a4%increase in lifetime earnings for women.27result,oral health can play a key role in narrowingdisparities in economic well-being by gender,racein job prospects with better oral health than men.and income.BOX 2Better oral health improves job prospectsIn the US,29%of low-income adults reported thatIn Denmark,a campaign focusing on oral healthamong unemployed and socially disadvantagedfor a job.31 Another study estimated that 3%ofadults,including regular visits to the dentist,job-seekers in the US labour market are unable toincreased job opportunities for recipients.Mostfind employment directly as a result of poor oralimportantly,the effects of the campaign were seerhealth.This translates to over 200,000 peoplevery quickly,within one year,demonstrating thebeing kept out of viable employment due to dentaldisease.32 There is also compelling researchwell-being stemming from better oral health.showing that low-income adults are most proneto the negative employment effects stemmingTaken together,the evidence shows clearlythat improving the oral health of the populationwomen are much more negatively impacted bycontributes to enhanced employment and helpspoor oral health compared to men's.to narrow income,race and gender inequality inearnings.34The relationship between employment and oraloral health.35 This bidirectionality poses an evenhealth can be bidirectional.Just as poor oral healthhas a negative effect on employability and jobbeing,as poor oral health and low employabilityprospects,being unemployed can lead to worsereinforce each other.The Economic Rationale fora Global Commitment to Invest in Oral HealthFIGURE 2How oral health affects job prospectsAppearance of mouth and teeth affects"The appearanceability to interview for a jobof my mouth and100%teeth affects myability to interview80%for a job."71%80%72%84%5%18%84%92%40%29%28%82%20%%16%15%20%low-incomeyoung0%8%adultsadults18-3435-4950-6465+AgeincomeNote:Data are for adults.Oral health issues negatively impact educationless likely to complete all required homework.outcomes,through missed school days andResearch from across the world shows that poorreduced learning capacity,with long-lasting effectsoral health among adolescent children negativelyinto adulthood.The largest effects are seen amonglow-income children.For example,children withother psychosocial outcomes that affect academicpoor oral health are more likely to have lowerachievement and lifelong success.grades,suffer from self-esteem issues,and areBOX 3Poor oral health contributes to impoverishment in low-and middle-income countriesOral health services are costly and beyond mostPolicy-makers should explore healthcare financingpeople's means in low-and middle-incomemodalities that provide adequate financialcountries.Using World Health Survey dataprotection for oral health-related spending.Asfrom households in 40 low-and middle-incomemost oral diseases are preventable,an investmentcountries (LMICs),researchers analysed thein preventive strategies,coupled with healthcareimpact of out-of-pocket spending on oral health onfinancing modalities that provide adequatehousehold finances.Households with recent out-financial protection for oral health-relatedof-pocket spending were more likely to have used aspending,could significantly lessen the financiallarge portion of their disposable household incomeburden of oral diseases in LMICs.and,as a result,fall below the poverty line.Taken together,there is strong evidence linkingThe linkage is particularly strong for certain sub-oral health,education,employment and earnings.can help narrow disparities-of race and sex-individend in the form of better job prospects,employment and earnings.higher earnings and economic independence.The Economic Rationale for a Global Commitment to Invest in Oral Health 11The global burden oforal disease is growingDespite the important role oral health plays in overallOral diseases have remained the most dominanthealth and economic well-being,and despite theconditions globally since data have been availablepreventable nature of most oral diseases,billions ofwith an estimated 3.5 billion people affected eachpeople worldwide suffer from the negative effectsyear.Over the past 30 years,the number of cases ofof untreated oral diseases.In fact,according to theoral diseases worldwide has grown faster than thelatest data compiled by the WHO,the estimatedpopulation,with low-income countries seeing thenumber of cases of oral diseases globally is aboutlargest relative increase.Cases of oral disease are1 billion higher than cases of mental disorders.rising,and even after adjusting for the relative impactcardiovascular disease,diabetes,chronicof various diseases on mortality and morbidity,theyrespiratory diseases and all cancers combined.still rank within the top 10 of all diseases globally.FIGURE 3Estimated number of cases globally for select non-communicable diseasesOral diseasesCardiovascularChronic respiratory3474Mdiseases522M453MMental disordersDiabetes mellitusCancer (all malignant967M(type 1 and type 2)neoplasms)Source:World Health Organization.458M86MThe change in the prevalence oforal diseases as wellto a roughly 50%increase in the number of cases inas the number of cases differs by geographic regionhigh-income countries.as well as by country income level.For example,forboth tooth decay and perbodontal disease,the numberTurning to caries in permanent teeth,between 1990of cases is growing fastest in low-income countries.and 2019,the number of cases worldwide increasedby 46%,or about 640 million cases.This is mainlyGum disease-affecting roughly one in five peopledue to population growth in low-and lower-middle-around the world-has important links to non-communicable diseases beyond the mouth.Thenumber of cases of periodontal disease in low-globally over the same period.The WHO Africanincome and lower-middle-income countries moreRegion showed the highest increase in the numberthan doubled between 1990 and 2019,comparedof cases over this period,at 120%.FIGURE4Estimated prevalence and number of cases of severe periodontal diseaseWorld Bank income groupPrevalence (2019)Percentage change inPercentage change inPercentage change inprevalence(1990-2019)cas8s(1990-2019Low income19.71%80.008,0790.73%129.75%11798%Lower-middle income19.80%436,69733617.24%124.66%6325%Upper-middle income18.19%386,443,13834.98%96.83%27.97%High income17.65%17625193718.71%51.43%20.63%Global18.82%1079927,02523.96%99.18%44.79%Source:World Health Organization.The Economic Rationale for a Global Commitment to Invest in Oral Health 125When it comes to unmethealthcare needs,oralhealth stands outAccess to dental care is an important factor in oralThe health equity issues that health systems arehealth.However,in healthcare systems acrossgrappling with globally are extremely relevant inthe world,dental care is often the healthcarethe oral health arena,particularly when it comes toservice with the most limited access.2 Thisaffordability of care.Even in high-income countries,is true in both high-income and low-incomestudies in Norway and the US,for example,showcountries and is especially true among low-incomethat cost and affordability challenges are muchpopulations within countries.For example,ananalysis combining data for 18 countries fromtrouble finding a provider.the Organisation for Economic Co-operation andDevelopment(OECD)shows that the likelihood ofData from a large number of OECD countrieshaving unmet dental care needs is,on average,shows stark differences in the level of unmetthree times higher than for other medical caredental care needs according to household incomeservices.43in most countries.47 But there is also variationacross countries,with notable outliers.CountriesA similar study across 31 European countriesshowed that dental care is often the most frequentlyNetherlands,Finland and Slovenia show relativelyreported unmet healthcare need.44 Similarly,in thenarrow inequality in access to dental care.AUS,the population reports much more difficultlycomparative analysis of dental care financingin affording dental care services compared to anyand delivery arrangements in these countries,forother type of healthcare service,including medicaexample,might be a helpful next step to identifycare,hospital care and even prescription drugs.promising practices for promoting equity in oralThis is true for all age and income groups.health.FIGURE 5Percent of population reporting unmet dental care needs by household income level25●Low income●High incomeSource:Authors'analysis of OECD/European Union data.The Economic Rationale for a Global Commitment to Invest in Oral Health 13Evidence also suggests a need to improve oralNew,innovative tools are emerging that helphealth literacy globally.For example,in the US,measure oral health literacy and pinpoint actiona recent study found a paucity of understandingareas.Investing in oral health literacy throughamong the public and healthcare providers on thestrategic cooperation among governments,risks,prevention and treatment of oral disease.corporations,academic institutions,foundationsPolicy-makers responded by passing legislationprofessional organizations and advocacy groupsto develop an oral health literacy strategy to reachis important for addressing the global oral healthunderserved communities.49crisis.The Economic Rationale for a Global Commitment to Invest in Oral Health 146The cost of oraldisease to the globaleconomy is substantialProductivity losses dueGlobally,the economic burden of oral diseases,The global productivity losses from oral diseasesto poor oral health costbased on an analysis of 194 countries,wasfall within the range of productivity losses of the topthe global economyestimated at $710 billion in 2019.Of this,the10 diseases that account for all causes of deathtotal direct expenditure for treating oral diseasesworldwide.The productivity losses stemming from$323 billionamounted to $387 billion.On a per capita basis.poor oral health are similar,for example,to thosethis translates to a global average of $50 andfor Alzheimer's disease and other dementias.Theeach year.This is closerepresents around 5%of global direct healthrelatively high prevalence of oral diseases across theto the productivityglobe is clearly translating into a relatively high globallosses from the top 10economic burden of poor oral health in comparisondiseases accountingDirect expenditure for treating oral diseases ranksto other health conditions.This strengthens thefor all deathshigh compared to other health conditions andeconomic argument for prioritizing interventions toworldwideis estimated at,for example,about 50%of theaddress oral diseases and gives persuasive reasonsglobal diabetes-related health expenditures.51 Forthat may resonate among various stakeholdersexample,an analysis focused on countries withinwithin the global health community.the European Union shows that total treatmentcosts for oral diseases ranks third,just behind thoseThe inequalities in the global economic impact offor diabetes and heart disease.5oral diseases are striking.The average per capitadental expenditure in low-income countries isIn addition,productivity losses stemming from oral$0.52,while high-income countries spend andiseases were estimated at $323 billion globally.Itaverage of $260 per capita-a 500-fold difference.is important to note that the economic cost fromSimilarly,estimates for annual productivity lossesproductivity losses is nearly as large as the costper capita stemming from poor oral health areassociated with treating oral diseases.On a global$1.49 in low-income countries compared to $185per capita basis,annual productivity losses averagein high-income countries-more than a 100-foldout to $42.difference.FIGURE 6Estimates of the global economic cost of dental diseases,2019Treatment costsProductivity lossesTotalTotalPer capitaPer capitaAfrican region3.102.844.584.19Eastern Mediterranean region6.979.789.5913.47European region112.51120.96104.48112.32Region of the Americas156.76155.21105.57104.53South-east Asian region0.760.3813.356.67Western Pacific region107.0054.7485.1243.55World Bank low-income countries0.360.521.041.49World Bank lower-middle-income countries2.270.7219.006.05World Bank upper-midde-income countries80.7629.9986.8832.26World Bank high-income countries303.70259.96215.76184.69Source:Heidelberg Open Research Data (heiDATA),2022.The Economic Rationale for a Global Commitment to Invest in Oral Health 15