Amid protests over the weakening of the political declaration for the UN High Level Meeting on NCDs, one huge issue was omitted from the start: oral health.
As United Nations (UN) Member States navigate negotiations for the political declaration of the 2025 United Nations (UN) High-Level Meeting (HLM) on Non-communicable Diseases (NCDs), a familiar and troubling omission reappears: oral health is absent from the zero draft.
This exclusion is neither new nor accidental – but it is increasingly indefensible. Oral diseases are the most prevalent NCDs globally, affecting nearly 3.7 billion people. They are preventable, deeply inequitable, and carry significant social and economic costs. Yet they remain excluded from the core political commitments that will shape global NCD and health priorities through 2030 and beyond.
The zero draft, released around the 2025 World Health Assembly, omits oral health entirely—not in the preamble, not in the goals, not even in passing. This silence has raised concern among advocates, stakeholders, and Member States. Since then, at least a dozen countries, including major regional blocs, have called for its inclusion in the next draft.
Previous UN HLM declarations, starting in 2011, offered only token two-word references to oral diseases, usually buried in broader commitments on NCDs or Universal Health Coverage. Given the major policy progress over the past five years, such minimal language no longer reflects the reality. Member states have made clear their collective commitment to act; the Declaration must now do the same.
This is not a bold or unreasonable demand. It is a call for fairness and for recognition of a disease burden that touches half the world’s population and undermines education, livelihoods, and wellbeing.
The burden is vast and rising. Untreated caries, periodontal disease, tooth loss, and oral cancers are among the most common health conditions worldwide. The highest burden is in middle-income countries, where health systems face growing needs but limited capacity.
Annual global spending on oral health exceeds $390 billion, most of it out-of-pocket and concentrated in high-income countries. In many lower-income settings, even basic treatment is unaffordable. With few public services, most systems rely on a privatized, commercialized model that deepens inequality and leaves billions behind.
Adding to this imbalance is a critical advocacy gap. Unlike other major health issues, oral health lacks strong civil society mobilisation. The absence of patient-led organisations and grassroots movements means there is little community pressure to drive policy change. As a result, those most affected by oral diseases remain largely unheard in global health debates.
Fragile moment of transition at WHO
The omission of oral health comes at a precarious time. In recent years, the global oral health community has achieved major milestones: a 2021 World Health Assembly resolution, the Global Oral Health Status Report, a Global Strategy and Action Plan, and the Bangkok Declaration – No Health without Oral Health – endorsed by over 100 countries. Yet these advances remain largely under the radar of the broader global health community.
At the same time, WHO is navigating internal turbulence and leadership gaps, particularly in NCDs. This weakens its presence in critical policy spaces, where influence depends as much on relationships and coordination as on technical input.
The UNHLM is a UN-led process, and WHO’s role is limited. Influence flows through mechanisms like the Interagency Task Force and the Global Coordinating Mechanism, which dilute technical leadership and can shift focus toward political compromise.
Compounding this, resistance to integrating oral health exists within the WHO itself. Traditional departmental silos, rigid program structures, and donor-driven priorities can hinder progress. Despite recent gains, systemic inertia continues to slow fuller inclusion.
NCD Alliance and the limits of ‘5×5’ model
The NCD Alliance’s response to the zero draft has been underwhelming. Despite counting major oral health organisations among its members, it failed to support the inclusion of oral diseases – likely to avoid expanding beyond the traditional “5×5” focus of five diseases and five risk factors.
This narrow, mortality-based framework excludes conditions like oral diseases that cause long-term disability and deepen inequities. But chronic diseases are not defined by lethality alone. They require lifelong care and can often be managed successfully with the right support.
Oral diseases begin early and last a lifetime. They cause pain, stigma, and exclusion—especially among the poor. Any political declaration that claims to advance equity must reflect today’s realities, not yesterday’s frameworks. Ignoring oral health means ignoring the lived experience of billions.
A call for concrete commitments
The inclusion of oral health in the Political Declaration is not about symbolism. It is about creating the conditions for action—national policies, budgets, and accountability frameworks that can translate global commitments into local change. At a minimum, this means:
- Recognizing oral diseases in the Declaration as part of the global NCD burden;
- Reaffirming existing commitments made by Member States through WHO instruments;
- Supporting the integration of essential oral health services into UHC and primary care delivery;
- Addressing the commercial determinants of oral diseases—especially the role of sugar and ultra-processed foods; and
- Ensuring that oral health is included in global monitoring and accountability systems.
Anything less risks undermining the credibility of the declaration and leaving billions of people once again outside the promise of “health for all.”
A quiet crisis, a global test
Oral health affects nearly every household but remains low on political agendas. It lacks visibility, donor attention, and strong public advocacy, despite being a major source of avoidable pain and inequality. Recent progress has been real but remains fragile. Without political recognition, it risks stalling.
The UN HLM is a test of global health priorities and our commitment to equity. Oral diseases are the most common NCDs. Excluding them would be indefensible. Oral health is not optional. This time, the Declaration must get it right.
news/oral-health-left-out-again-why-the-uns-ncd-declaration-must-not-repeat-past-mistakes/screenshot-2025-08-01-at-10-44-42/” data-orig-file=”https://i0.wp.com/healthpolicy-watch.news/wp-content/uploads/2025/08/Screenshot-2025-08-01-at-10.44.42.png?fit=316%2C440&ssl=1″ data-orig-size=”316,440″ data-comments-opened=”0″ data-image-meta=”{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}” data-image-title=”Habib Benzian” data-image-description=”” data-image-caption=”<p>Habib Benzian is Professor of Epidemiology and Global Health at NYU College of Dentistry and a member of the Lancet Commission on Oral Health. He advises governments and international organizations on oral health policy and equity.</p>
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Habib Benzian is Professor of Epidemiology and Global Health at NYU College of Dentistry and a member of the Lancet Commission on Oral Health. He advises governments and international organizations on oral health policy and equity.
Image Credits: Manila Water Foundation, Kurdistan Dental Health Organization.
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