Pakpoom Saengkanokkul Part I: perfrormance of oral health system. Part II: AEC and impact on workforce mobility and quality of oral health system. Part III: experiences from EU. WHO defined “ Health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction” Composed with 1. Policy making and implementation bodies. 2. Health information system. 3. Health financing system. 4. Human resource system. 5. Delivery system. 6. Medical products and technologies system. and 7. Other Health related system, ex. food system etc. In 2000, WHO published WHO report health system : improving performance. The latest ranking published in 2000 (Tandon et al. 2000). From 191 countries, Singapore was ranked 6th, Brunei 36 th, Thailand 47th, Malaysia 49th, the Philippines 60th, Indonesia 92th, Vietnam 160th, Laos 165th, Cambodia 174 th, Myanmar 190th. WHO defined health that: “…Health is a state of complete physical, mental and social well-being and no merely the absence of disease and infirmity.” trend of health policies in many countries have been changed from medical treatment to health prevention, health promotion and holistic approach. An important movement was initiated by WHO Alma Ata Declaration in 1977. Source: Dahlgren & whitehead (1991) health prevention and health assurance are based on different risk management system. Health prevention aims on reducing the health risks of population. Purpose of Health assurance is to redistribute the risks between high risk population and low risk population. To attain sustainable health, existence of both systems is necessary. Non-cumunicable diseases, No externalities. the causes of diseases frequently related with individual behaviors. Excluded from benefit of health care package. Expensive. Coincidentally, socioeconomic status has high influence on disparities oforal health distribution. In the past, oral health was not included in physical health. Oral health system seperated from health system. This misconcept spread to all of policy-maker level, oral health professional level, and patient. Fortunately, there is pushing force from topdown. WHO is a major player to drive the concept of oral health, general health integration. According to World Oral Health Report 2003 (Petersen), Oral health is integral and essential to general health. Oral health is a determinant factor for quality of life. Oral health and general health share the same common risks, ex. smoking, alcohol abuse, sugar consumption, etc. Proper oral health reduces mortality rate. Assessment of quality of oral health system is important and necessary. Performace can be measured by Effectiveness, Equity, Efficiency. New concept, Oral health has already integrated in genaral health. Health prevention and health assurance are based on different risk management. To achive sustainable health, preventive system and health assurance are required. ASEAN Economic Community (AEC) is one of three pillars for ASEAN integration. The goal of AEC is economic integration between ASEAN member countries by 2015. This integration envisages creating a single market of products, services and labor, in order to increase competitiveness and equitable economic. integrated products and services market, integrated labor market, integrated currency market, and integrated social security scheme AEC integrated only integrated products and services market. Integrated hi-skill labor market. Source: Dussault et al. 2009. Aging Society. Source: IndexMundi, CIA World Factbook Education. in Thailand, dentist training is monopolized by State. after AEC, it is more difficult for central government to estimate demand and supply correctly. Both supply and demand can come from outside. in 2009, we have a total of 10571 dentists (Dental Council, 2010). The ratio of population/dentist is 6400 per one dentist. 47.4% of dentists work for public sector, and 52.6% work in private sector. The ratio of population/dentist in Bangkok is 1167, while 17563 in North eastern region (Bureau of dental health, 2010). Thailand needs more 4000 dentists to response increasing demand. But there are only 8 public universities plus one private university to train dentist. Capacity to train dentist is around 800 per years. dental practitioners shortage will remain continuously. But, increasing domestic capacity of training requires infrastructure, budget and time that cannot response increasing demand immediately. Immigration & Contracting. Normally, health workforce prefer move from lower income country to higher income country, for better opportunity, or individual satisfaction, or political stability. Then, health workforce from CLMV, Indonesia and the Philippines seem likely to immigrate to Thailand. but there are many remain obstacles in ASEAN member, many of these are non-legal barriers. Difference of culture and language. Political instability in Thailand. All dental practitioners must be approved qualification by Dental Council and pass examination in Thai language. ASEAN Mutual Recognition Arrangement on Dental Practitioners. Emigration. Singapore and Brunei should be main destination for Thai dentist. However, difference of culture and language will retain thai dentist to stay homeland. Only some specialist that Brunei and Singapore prefer to recruit from Thailand. Some private hospital clusters see bright future in emerging neighbor countries that lacks quality of hospital and health services. They have project to open hospitals in city in CLMV to serve hi-society group. Dentist is a high earning and respectful occupation in Thailand. Domestic demand of this occupation is very high and dentists still have bright future in homeland. non-traditional barriers, such as, language and culture, quality control, domestic regulation are still be major obstacles. AEC impacts very little on immigration and emigration for health workforce in Thailand. After AEC, demand will increase dramatically, but there are many conditions limit increasing of supply. Dental practitioner shortage could be a major concern. Medical hub will attract oral health work force from public sector to private center, and rural area to urban area. It could impact negatively on equity of oral health care and oral health and financing. Source: Dussault et al. 2009. Council of European dentists a professional association of european. registered in the joint Transparency Register of the European Parliamenr and European Commission. Financed by memberships fee and partially subventioned by EU. to promote high standards of oral healthcare and effective patient-safety centred professional practice across Europe, including through regular contacts with other European organisations and the EU institutions Activities. monitors EU political and legislative developments which have an impact on the dental profession issues policy statements and drafts amendments to proposed EU legislation so as to ensure that the views of European dentists are reflected in all EU decisions affecting them provides expertise for the EU institutions in the areas of health and consumer protection, training, safety at the work place and internal market legislation provides a platform for the exchange of information between national dental associations, and supports them in understanding the effects and implementation of EU legislation, in particular members from the new Member States and EU accession countries Cooperates with all major European associations of health professionals and other liberal professions on policy issues of common interest Source: CED The Platform for Better oral health in Europe. Initiate by private association, i.e., the Association for Dental Education in Europe (ADEE), the Council of European Chief Dental Officers (CECDO), the European Association of Dental Public Health (EADPH), and the International Dental Health Foundation (IDHF), supported by the European Dental Hygienists Federation (EDHF), the Union Francaise pour la Santé Bucco-Dentaire (UFSBD) and Ivoren Kruis. Sponsored by private company for profit likes GlaxoSmith Kline Consumer healthcare, Company chewing gum Wrigley. Goals Promote oral health and the prevention of oral diseases as one of the fundamental actions for staying healthy Provide sound advice and recommendations to policymakers for action with regard to EU oral health policy developments Develop the knowledge base and strengthen the evidence-based case for EU action on oral health Address oral healthcare inequalities and the major oral health challenges of children and adolescents, of the increasing elderly population, and of the populations with special needs in Europe Mainstream oral health across all EU health policies Activities. Draw up a specific EU Action Plan on Oral Health that will define the EU’s role in promoting dental public health. Make oral health a priority under the Community Health Action Programme to help exchange best practice in oral health prevention, to improve data collection, and to reduce the detrimental effects of common risk factors on dental health. Address existing oral health inequalities as part of the implementation of the EU Strategy for Reducing Health Inequalities in Europe. Provide funding under the Research Framework Programmes in order to investigate the future use of innovative approaches in dental prevention and develop effective strategies for a better inclusion of socially and economically disadvantaged populations in dental care. Source: The Platform for better oral health in Europe EU parliament and EU Commission. On policies of European oral health, European commission Directorate-general for health & Consumers is a major player. Initiatives of EU institutions focuses on data collection, fund projects on oral health indicators and collect data on the self-perceived oral health status of Europeans. the European Parliament send written questions to the European Commission and the Council of the EU to raise oral health inequity as major concern EGOHID I&II project Eurobarometer The state of oral health in Europe 2012 CED annual report Need to establish new supra-national organizations ASEAN oral health information system Council of ASEAN dentist ASEAN oral public health The most important missing jigsaw, i.e., ASEAN parliament and ASEAN executive body for oral health.