BEING A DENTATE OLDER IN THE LUCKY COUNTRY! OR, how I grew up to live with the bomb, bureaucrats and believers! Clive Wright 5 mins of PHAA Sig Fame Perth, September 2014

ORATION [aw-rey-shuh n, oh-rey-] /ɔˈreɪ ʃən, oʊˈreɪ-/ noun 1. a formal public speech, especially one delivered on a special occasion, as on an anniversary, at a funeral, or at academic exercises. Definitions CHAT /tʃat/ verb 1.talk in a friendly and informal way. noun 1.an informal conversation

The 400 who came to hear Mr Abbott deliver the Sir John Downer Oration, were jeered and abused by the protesters but there was no physical contact. Protesters rally against Prime Minister Tony Abbott’s appearance at Adelaide University by: MILES KEMP From: The Advertiser August 22, :41AM THE ORATION

THE CHAT Professor Matthew Nock (right), Harvard College Dean Evelynn M. Hammonds, and 20 students gathered at Hammonds' home for a fireside chat. The event was the second in a new series meant to connect undergraduates with faculty members in an open, informal, and welcoming atmosphere.

Dr Martin Dooland AM First PHAA Sig Oration/Chat Would I have done things differently? What are the issues currently facing dental public health?

REVOLUTION CERA THEGERIATRICREVOLUTION Q1. Yes - I would have become a marine biologist! Q2. Grumpy older people! Current Speaker’s Answers in 2014

Overview What are the issues – underneath the issues? Values Beliefs Prevention Why are grumpy old people important? More of them Better bite Nothing to lose

Global Context Economic challenges; Displaced refugees; Ageing population Determinants of Health & Disability Social determinants of health – interaction of individual, lifestyle and social environment... “only 40% of the population are highly motivated to adopt healthy lifestyles... 60% have negative and fatalistic attitudes” Future Patterns of Disease & Disability Shift from communicable diseases to non-communicable (number of older people with care needs to rise by 61%) Increase co-morbidity Where in Health is the World going? Medical Advances New hope in neurodegenerative conditions Low-cost genetic sequencing, genome mapping etc leading to personalised treatments Information Technologies “By 2032 everyone should be able to access the internet everywhere”. New opportunities to capture & interpret information in home & other settings. Impact of social media Health Workforce Oversupply of consultants; Undersupply of nurses Public Attitudes & Expectations Respect & Dignity Health & social services will need to play closer attention to relational aspects of care: Respect & Dignity

In the Australian context - what are the current Issues AND Do we have a Road Map?

Australia’s Oral Health Roadmaps DRAFT Foundation Areas Population Groups Consensus across jurisdictions

Or do we need a GPS for the GOP* Crisis? Why is a paradigm shift so difficult? *GOP - Grumpy Older Population

A Simple Navigational Toolkit for the Issues Under the Issues Based on “best” evidence at the time... Applicable across ALL communities... Recognises the complexities of human existence... Integrates oral health into global bio-social systems... Values & beliefs Education Access equality Prevention General heath Beliefs recognition Culture Generation Professional Allied health Community Civil society training Dental professional Dental products

What do we know about Values; Best Practices; & Beliefs?

* Wayne Richards, Dental needs and priorities in dental care. British Journal of Heath Care Management 2004: 10:

Lee JY & Divaris K (2013) The ethical imperative of addressing oral health disparities: a unifying framework. J Dent Res XX (X): 1-7, Online, DOI: /

Why is a paradigm shift so difficult? Is our focus too individualistic & proximal? Proximal factors “Ecosystem factors”

Why is a paradigm shift so difficult?