Perseverance, politics and health

Being focussed on more earthly concerns, such as the pandemic in particular, it probably escaped the notice of most of us but on 30 July 2020 an Atlas V launch vehicle took off from planet Earth and launched its payload towards Mars. In contrast, the dramatic images of the landing of the mission and of the rover Perseverance on that far away destination probably captured at least the passing interest and arguably the awe of many of us.

The applications of science and technology find their routes into our lives in such seamless and astonishing ways that we might be forgiven for taking so many of them for granted so much of the time. Yet there are also remarkable developments that are giant and significant life-savers, literally. The creation of vaccines against coronavirus is unquestionably one of those closest, current and most pertinent to our daily existence.

Throughout the pandemic we have looked to our political leaders for guidance and they in turn have very publicly declared their reliance on science. Neither discipline can provide the full solutions but the daily references of one to the other have focussed, one hopes, not only the realism of the politicians but also the pragmatism of the researchers. It would be very pleasing to think that the resultant alliance continues to grow and appreciate its strength of purpose. Integral with this and possibly of great long-term benefit is the inevitable attention that has been paid to the importance of public health. This has taken many forms but is immediately manifest in relation to vaccinations.

This rare spotlight shone on the value of public health has implications for oral health too; especially as it relates to general health. It is significant that the first question asked when lockdown stopped all regular dental care was not 'how do I get my prevention now?' but 'what do I do if I get toothache?' Given these recent imperatives it may be that politics can help lead us all to better oral health by following the science and by taking note, at last, of our perseverance over many years and decades to get the topic further up the welfare agenda. Two developments suggest that some good might come from the pandemic and have boosted my hope from a year ago that one outcome could be better collaboration.

Has COVID-19 finally convinced the politicians that in looking out for their citizens' health, prevention really is the best first defence?

Closest to home, the first is the UK government's White Paper on reforms for the NHS and social care.¹ The most striking public dental health element is a change to the implementation of fluoridation of community water supplies. Planned reforms undo the Health and Social Care Act 2012, which devolved control of water fluoridation to local authorities, so that the government would take back this responsibility for funding and implementing the preventive measure, putting it in a position to drive forward and establish schemes. We know so well that this supremely well evidenced and unquestionably successful public health activity, in operation in many countries, has been attempted time and again in the UK but has been met with countless bureaucratic and red tape barriers. Has COVID-19 finally convinced the politicians that in looking out for their citizens' health, prevention really is the best first defence?

Further afield the WHO has also been making strides. Following the publication on their website of an overview report on oral health,² a number of countries agreed a landmark, broad draft Resolution on Oral Health. This was approved by the WHO's Executive Board on 25 January 2021.³ Whilst seemingly a rather dry action distant from our daily concerns, this is the first Resolution on oral health since 2007 and could pave the way to full adoption by the WHO. This would have important and direct consequences for the oral health agenda in all WHO member countries and we will be keeping a close watch on developments. Interestingly, the overview considers oral health in a much wider society context, referencing universal health coverage and noncommunicable disease agendas towards 2030, sustainable development, the Minamata Convention on Mercury, prevalence of oral diseases and their financial impacts worldwide. This truly embeds oral health in a panoramic view which makes it more difficult to ignore or marginalise.

Perhaps, while NASA's Perseverance explores Mars, our more earthly perseverance will at last bring stellar results on oral health improvements that we can celebrate as a plus of the pandemic.