Climate change and environmental pollution are among the greatest health threats affecting the planet, humanity and biodiversity. This is recognised in the 2030 United Nations Agenda for Sustainable Development, which includes an urgent call for action from all sectors. The entire oral healthcare community, including clinical professionals and industry, recognises that we have a responsibility to deliver products and interventions that improve oral health in a sustainable manner. We also recognise the need to address this environmental challenge within the context of huge oral health inequalities across the world. The actions taken to address sustainability goals need to be balanced with the need to manage these avoidable inequalities and the associated preventable diseases.
Towards this objective, the FDI World Dental Federation convened an expert group to produce this Consensus Statement on Environmentally Sustainable Oral Healthcare. This brings together a coalition of stakeholders that includes leading figures from industry, health professionals, academic experts, legislative authorities and dental associations, with the clear intent to identify an impactful and robust strategic action framework that crosses boundaries and takes a truly collaborative, evidence-based approach. In doing so, the work of this panel represents an important continuum of the pioneering statement adopted by the FDI General Assembly (August 2017, Madrid, Spain) [5].
Through this document, we identify the collective views across the whole supply chain, where all are equally committed to further improving sustainability without compromising healthcare benefits. This work is in close alignment with the UN Sustainable Development Goals, and recognises that both excellent oral healthcare and the development of a circular economy are two key pillars in delivering sustainability. We further recognise that there are opportunities to collaborate across the sector and throughout supply chains, to develop and promote sustainable practices that achieve meaningful and measurable environmental benefits.
This joint stakeholder statement recognises the major challenges facing oral healthcare, the complex drivers that underpin current behaviours and practices, and the best opportunities to improve and deliver sustainable oral healthcare for people and the planet. The statement further emphasises the routes to sustainability in oral healthcare, drawing on evidence from the published literature [6, 7]: reduce, reuse, recycle and rethink; legislation, policy and guidelines; waste management (including SUPs); procurement and logistics; research and education; and materials for clinical use.
Each of these routes is considered in a three-step process that sequentially informs future strategy, including positive actions that should be implemented across the sector:
Awareness and challenges. This step recognises the current degree of awareness of the environmental impacts from oral healthcare products, services and consumer behaviours. It also identifies the challenges that all stakeholders face to improve better understanding of these impacts, behaviours and the dissemination of this knowledge.
Drivers and opportunities. There are numerous drivers now operating that promote the development of – and engagement with – sustainable practice. This presents a major opportunity to make improvements across the sector.
Strategic action framework. This consensus statement makes specific recommendations and identifies potential best practices to deliver environmental benefits with a focus on the improvement of global oral health.
Knowledge of the impact of oral healthcare on the environment is not uniform, with significant awareness among manufacturers but relatively little insight from end-users including oral healthcare professionals, patients and consumers. CO2 emissions and plastic waste, packaging and end-user single-use plastics (SUP) are recognised to be among the main contributors to unsustainable practice. Companies across the supply chain have identified that impactful solutions will only come about through unbiased and open inter- and intra-stakeholder collaboration and communication within the supply chain. Companies recognise that they will have to work differently and often together to address key issues. The dental industry seeks to do this through engagement with policymakers, healthcare professionals, manufacturers, distributors and the public as a major stakeholder and end-user of these services. There is a further opportunity for all stakeholders to identify and embrace every element of sustainable practice and in this way, through multiple individual activities, achieve significant cumulative positive benefits.
This consensus statement recognises the importance of legislation to ensure products are fit for purpose while driving sustainable practice. Designing and working with the duality of this legislation is challenging at all levels, but especially so for end-user/oral healthcare providers that have to work within the constraints of stringent regulations that promote patient and workforce safety. There are undoubtedly opportunities to work with legislative authorities at all levels to seek effective remediation strategies.
The greatest opportunities for sustainable practice are through reduction, reuse and recycling:
Reduction – by the patient and consumer end-user, through the promotion of preventive care and provision of good oral healthcare, in this way reducing the demand for restorative products and associated plastic packaging [
8].
Reuse – throughout the supply chain, with a focus on clinical end-users when safe to do so. Reuse is more environmentally favourable to the use of disposable single-use items (e.g. single-use wipes).
Recycling – at the manufacturer and distribution level, with a focus on energy-efficient manufacturing, the design of recyclable end-user products, reducing unnecessary packaging and optimising distribution logistics.
There is broad agreement that stakeholders in the dental sector could potentially make significant reductions in the volume of waste generated, most notably from manufacturing processes, packaging, and the high prevalence of single-use products (mostly plastic). Most of the contaminated biomedical waste impact lies downstream of the supply chain, with the oral healthcare professionals, patients and end-user consumers. This waste problem is further compounded by the increased use of personal protective equipment (PPE).
Recycling remains a challenge at the patient end-user level, but less so with packaging and uncontaminated SUPs. For both scenarios, there is an opportunity to engage in robust research that will drive the required knowhow and supporting technologies.
Education is considered the fundamental component of any action strategy, with a focus on increasing awareness and identifying solutions for each sector and for the supply chain as a whole. Any strategic educational framework should be based on strong and robust research that provides an objective and unbiased representation of the facts that contribute to environmental sustainability in the oral healthcare industry. The oral healthcare industry has a responsibility to promote innovation and high-quality research and to harness best operational models to identify and support sustainable activities within the supply chain.
In conclusion, this statement establishes a consensus opinion on the most promising approaches to reduce the environmental impact of oral healthcare without compromising patient welfare. This is in response to a recognition of the value of implementing sustainable practices, in alignment with the United Nations agenda. While recognising that our sector makes a significant contribution to oral health, which improves the quality of life for millions of people worldwide, this statement also acknowledges that there is an opportunity to further improve sustainability. Specifically, this consensus statement demonstrates clearly the potential for far greater future impact as a direct result of improved coordination and collaboration between diverse stakeholders. Implementation of the approaches presented here will deliver the twin benefits of a sustainable, circular economy with improved global oral health.
How to cite this book chapter:
Martin, N., Mulligan, S., Shellard, I.J. and Hatton, P.V., 2022. Consensus on Environmentally Sustainable Oral Healthcare: A Joint Stakeholder Statement. Pp. 3–5. York: White Rose University Press. DOI: https://doi.org/10.22599/OralHealth.b. CC BY 4.0
