Preface

Over the past decade, it has become clearer and clearer to me that more attention and research is needed globally at the intersection of population ageing and oral health, and indeed, awareness of the importance of this issue is now higher than ever. At both the national and international level, oral health throughout the life course is now seen as a fundamental and essential component of socioeconomic development. In 2015, I helped organize the 2015 World Congress on Oral Health and Ageing, which was held jointly by the Japan Dental Association and the World Health Organization in Tokyo, Japan, where the “Tokyo Declaration on Dental Care and Oral Health for Healthy Longevity” was issued. I then began serving as chair of the World Dental Federation’s (FDI) Oral Health for an Ageing Population (OHAP) task team, a role that has continued to this day. It was at the 2017 FDI World Congress in Madrid, Spain that the idea for this book was hatched.

The purpose of the OHAP task team was to build on the success of the 2015 Tokyo Declaration, engaging in further discussions and collaboration with colleagues around the world to put the goals of the declaration into practice. Phase I of the project concluded in 2020 and Phase II began in 2021, leading to the development and provision of education and policy recommendations to dental associations, government officials and dental professionals in Europe, North America and South America. Phase III started in 2024, with the goal of promoting the implementation of oral health campaigns and projects in all regions of the world, regardless of development level. I have also personally visited a number of Asian countries, as part of Japanese government assistance efforts, to discuss the topic of “Dental and Oral Health Care in Ageing Societies” with government officials and dental professionals, and to make recommendations based on Japan’s experiences. Furthermore, I have visited Nepal for two weeks nearly every year for the past three decades as part of an NGO to implement community health programs for schools, mothers and children, and older persons, and to conduct community health worker training. Throughout all of these activities and roles, I have noticed that population ageing and oral health have become more and more important as economies develop and population ageing progresses. Even in low‐ and middle‐income countries, there is a growing understanding that they will soon face the same ageing‐related public health challenges that high‐income countries are facing now.

In 2019, at the UN High‐Level Meeting (HLM), it was determined that oral health would be included in the definition of Universal Health Coverage (UHC), which had already been established as one of the common global Sustainable Development Goals (SDGs). In a further sign of global attention on oral health issues, the 2021 WHO General Assembly adopted a resolution on oral health for the first time in 17 years.

Ageing has already been progressing rapidly in high‐income nations, and it will soon begin to affect low‐ and middle‐income nations as well. Meanwhile, the global burden of oral disease remains heavy, and health inequality remains an urgent global issue. The need for new, creative, and economically efficient solutions for achieving healthy longevity is therefore universal, but the health care system of each country and community must be uniquely tailored to its own circumstances. Evidence is accumulating that oral health plays an important role in general health, but this knowledge has not been effectively translated into policy and practice on a global scale. As researchers, health professionals, and policymakers in each country strive to move forward in this process, the lessons Japan has learned as a frontrunner in the field of public policy for an ageing society can provide insight and inspiration for other countries.

Japan was one of the first countries to implement a UHC system, and the system has been functioning successfully for more than 60 years. Japan was also the first country to be confronted with the challenges of a super‐ageing society. For these reasons, Japan is currently engaged in an intensive process of making its healthcare system even more efficient, economical and prevention‐oriented, with an eye to creating an ageing‐friendly society. To achieve this, we are also trying to achieve more efficient and effective communication and collaboration among healthcare professionals in different fields.

There are many other examples of how countries around the world are dealing with these issues, with varying degrees of success. In the end, each country will need to find locally relevant and sustainable solutions to the problem of UHC. But in order to do so, we need to learn from each other’s successes and failures, and above all we need to have access to the most current and applicable evidence.

The processes of assessing national and regional oral healthcare policies and sharing outcomes globally, addressing issues at both the global and national level, and identifying solutions for the future can only proceed efficiently if it is based on collaboration between professionals in all related fields and around the world. This book is, therefore, intended to help raise the awareness of not only dental clinicians but also a wide array of health professionals and policymakers regarding oral health for an ageing population. It will provide them with the evidence as well as the practical solutions they need to implement effective policies and practices. But perhaps even more important than current policymakers and practitioners, my sincere hope is that the information in this book will be taught in healthcare and health policy‐related courses at the graduate and even undergraduate level. The people who will change the world 30 years from now (when people age 60 and over will account for 40% of the world’s population) must begin, as early as possible in their education, to develop a vision for the type of evidence‐based health policy that will lead to achieving healthy longevity globally. Evidence, public health policy, healthcare practices, and evaluation of the effectiveness of those practices are often studied as separate subjects and in abstract ways, but this book attempts to present them as elements of a connected and unified cycle that takes place in real‐world situations in each country, where limited resources require hard choices.

Population ageing is by no means unique to high‐income countries; it is an unavoidable fact for all humans that the risk of disease and disability increases with age. However, establishing and funding systems to maintain the health of older persons, including preventing oral diseases and oral function decline, is no easy task. It requires long‐term, sustained effort and investment to resolve the significant and unique challenges faced by each country, which often include the financial burden, lack of an existing healthcare system on which to build, and lack of trained professionals. No matter the current political or economic situation, however, every nation should begin taking practical and strategic steps to provide access to oral health care services for all residents. Oral health must be seen as a basic human right for people of all ages, including older persons. After all, everyone has the right to speak, eat and laugh.

The process of researching and writing this book took longer than expected due to the COVID‐19 pandemic, an unprecedented global public health crisis which began in January 2020. During this pandemic, older people were identified as a vulnerable population at higher risk of contracting the disease due to both ageing itself and the underlying respiratory and cardiovascular diseases that are associated with ageing. Indeed, elderly people experienced severe illness and death due to COVID‐19 at a much higher rate than the general population during this period. On the other hand, recent research has reported that the maintenance of healthy oral status, including the prevention of periodontal disease, is associated with reduced severity of COVID‐19 symptoms. The accumulation of oral health throughout the life course is reflected in the oral health and general health of older people. Provision of sufficient oral health services for the elderly population will also be key to dealing with future unexpected health crises similar to COVID‐19.

The six chapters in this publication discuss the policy, practice and evaluation of oral health for an ageing population. This section provides a summary of each chapter.

Chapter 1. Global ageing and health

The unavoidable reality of population ageing is affecting our society on a global scale. Biological ageing makes older adults susceptible to disease and leads to a decline in the bodily functions needed for daily living. Dental and oral health are essential for the lifelong maintenance of quality of life (QOL), and research has also shown that they contribute to the maintenance and improvement of general health. As a matter of basic human rights, the goal of every society should be to provide high‐quality dental care and oral health services to all residents and at all stages of life, especially for its most vulnerable populations, such as older adults and those with disabilities.

Life expectancy trends from 1950 to the end of the 21st century reveal an expected narrowing of the gap between the region with the lowest life expectancy (Africa) and the regions with the highest life expectancy (North America, Europe, Oceania). This gap will narrow...