Preface ix
1 Global ageing and health 1
1.1 Introduction 1
1.2 Changes in the world population and longevity 2
1.3 Causes of death and determinants of life expectancy 5
1.4 Ageing and decline in the functions of daily living 11
1.5 Average life expectancy (LE) and healthy life expectancy (HLE) 12
1.5.1 The gap between LE and HLE 12
1.5.2 Prolonging HLE 13
1.5.3 Measuring HLE around the world 14
Japanese indicators of HLE 14
European indicators of HLE 15
US indicators of HLE 15
WHO indicators of HLE 16
1.6 Strategy for healthy ageing: how to achieve healthy ageing? 16
1.7 Ageing society and social security 18
1.8 Oral health and ageing 18
1.8.1 Oral health in an ageing society 18
1.8.2 Oral health and HLE 19
1.9 Challenges of general health and oral health in an ageing society 21
1.10 Conclusion 23
References 23
2 Achieving oral health among older adults: Community and clinical approaches 26
2.1 Introduction 27
2.2 Oral health in older adults 27
2.3 Frailty and level of dependency in older adults 29
2.4 Deterioration of oral health function 29
2.5 Nutrition and oral health for older adults 33
2.6 Assessment of oral health of older adults 35
2.6.1 Nutrition and diet 35
2.6.2 Assessment of residential environment, family, exercise, health literacy, social activity and economic situation 35
2.6.3 Assessment of oral function 36
2.6.4 General health and lifestyle factors 36
2.6.5 Diseases and medications 37
2.6.6 Level of consciousness and cognitive function 37
2.6.7 Vital signs 37
2.6.8 Activities of daily living and posture 38
2.6.9 Muscle strength and paralysis 38
2.6.10 Breathing and vocal capacity 38
2.6.11 Assessment of the oral environment 38
2.6.11.1 Dental plaque and tongue coating 39
2.6.11.2 Dry mouth and saliva flow 39
2.6.11.3 Halitosis 39
2.6.11.4 Level of independence in performance of daily oral cleaning 39
2.6.11.5 Assessment of teeth, dentures, gums, mucous membranes, jawbones and jaw joints 40
2.6.11.6 Comprehensive assessment of the oral environment 40
2.6.11.7 Assessment of integrated oral function 40
2.6.11.8 Assessment of mastication 40
2.6.11.9 Observation of the act of eating 40
2.6.11.10 Assessment of consumable foods 41
2.6.11.11 Chewing and grinding ability 41
2.6.11.12 Food mixing ability 41
2.6.11.13 Ability to form boluses (salivary masses) 41
2.6.11.14 Assessment of swallowing function 41
2.7 Dementia and oral healthcare in dental clinics 43
2.7.1 The effect of dental maintenance on the delay and prevention of dementia onset 43
2.7.2 Does tooth loss prevention and prevention of oral function decline at dental clinics help delay or prevent the onset of dementia? 43
2.7.3 What barriers must be overcome in order to prevent dental disease and decline of oral health function in people with cognitive decline? 44
2.7.4 How should dental treatment and maintenance plans be adjusted for people with different levels of cognitive decline? 44
2.7.4.1 Mild 45
2.7.4.2 Moderate 45
2.7.4.3 Severe 45
2.8 Oral healthcare systems: community-based and clinical-based approach 46
2.9 Conclusion 47
References 48
3 The link between systemic health and oral health 52
3.1 Introduction 53
3.2 Life expectancy and HLE 54
3.2.1 Determinants of average life expectancy and age-specific survival rates 54
3.2.2 Ageing and daily living functions 55
3.3 Scientific evidence and health policy 56
3.4 Evidence linking dental care and oral health to prolonged HLE 57
3.4.1 Conceptual pathway of oral health and HLE 57
3.4.2 The association of tooth loss and chewing function with life expectancy 57
3.4.3 Oral health and the leading causes of death 61
3.4.3.1 Diabetes mellitus 62
3.4.3.2 Cardiovascular disease 62
3.4.3.3 Cancer 63
3.4.3.4 Chronic obstructive pulmonary disease and respiratory disease 63
3.4.3.5 Risk factors of metabolic syndrome and other NCDs 64
3.4.4 Oral health and the leading causes of long-term care dependence 64
3.4.4.1 Oral health and long-term care dependence 64
3.4.4.2 Frailty and oral health 65
3.4.4.3 Cerebrovascular disease and oral health 65
3.4.4.4 Falls and joint disease, and oral health 66
3.4.4.5 Dementia and oral health 66
3.4.5 Oral health and health promoting factors 69
3.4.6 Social determinants of health 71
3.4.7 Effects of dental care and dental management on general health 72
3.4.7.1 Dental prosthesis and longevity 72
3.4.7.2 Dental maintenance and general health 73
3.4.7.3 Dental care and general health promotion 74
3.5 Conclusion 80
References 80
4 Universal health coverage and effective health policy: Lessons from Japan 91
4.1 Introduction 92
4.2 Evidence-based and effective health policy 92
4.2.1 Evidence-based health policy 92
4.2.2 Effective health policy 94
4.2.3 Public health framework for a healthy ageing population 95
4.3 The global challenge of UHC 97
4.3.1 UHC for older persons 97
4.3.1.1 What is UHC? 97
4.3.1.2 The three dimensions and two components of the WHO’s UHC report 97
4.3.2 Access to dental care for older adults 98
4.3.3 How does the WHO monitor progress towards UHC? 98
4.3.3.1 UHC and inequality 98
4.3.3.2 UHC and financial hardship 99
4.3.4 UHC, SDGs and oral health 99
4.3.4.1 The role of dental care in UHC 100
4.3.5 Achieving healthy longevity by implementing UHC 100
4.4 Japan’s public healthcare system 101
4.4.1 Challenges faced by Japan in a super-ageing society 101
4.4.2 Japan’s current health policy framework for a sustainable social security system 103
4.4.3 How oral health and cooperative medical and dental care contribute to healthy longevity 104
4.4.4 Japan’s public health system and UHC system: a brief history 105
4.4.5 The medical care insurance system in Japan 106
4.4.6 Dental care and public health: the role of Japan’s medical/dental care fee schedule 108
4.4.7 Japan’s National Health Insurance system 109
4.4.8 How the medical fee system works 109
4.4.9 Medical fee revisions as the bridge between medical/dental care and public health 110
4.4.10 Long-term care insurance in Japan 111
4.4.11 Establishing a comprehensive community care system for the prevention of long-term care dependence 114
4.4.12 Long-term care prevention 116
4.4.13 Proposal for improving home dental care provision 117
4.4.14 Provision of dental care under the Comprehensive Community Medical and Long-Term Care Fund 118
4.4.15 Dental examination and treatment in Japan 119
4.4.16 Using the Comprehensive Community Medical and Long-Term Care Fund to promote home dental care 120
4.4.17 Health services and dental examinations for the late stage older adults (75 years and older) 122
4.4.18 Dental check-ups to slow oral function decline 122
4.4.19 The role of dental care and oral health in dementia policies and measures in Japan 123
4.4.19.1 Comprehensive plan to promote dementia measures (New Orange Plan) 124
4.4.19.2 The role of dental and oral health in dementia prevention 124
4.4.20 The Metabolic Syndrome Screening System and oral health 125
4.4.21 Public health policy for NCD prevention 125
4.4.22 Japan’s 8020 Campaign 127
4.4.22.1 History of the 8020 Campaign 128
4.4.22.2 Expanding the role of the 8020 Campaign 131
4.4.22.3 Effects of the 8020 Campaign on public health 131
4.5 Conclusion 132
References 133
5 Lessons from the United Kingdom, Europe, North America and Australia 137
5.1 Introduction 138
5.2 Medical health insurance systems 138
5.2.1 Tax revenue model (government-funded) 138
5.2.1.1 UK 138
5.2.1.2 Sweden 146
5.2.1.3 Australia 147
5.2.1.4 Canada 148
5.2.2 Social insurance model (funded via compulsory premiums) 148
5.2.2.1 France 148
5.2.2.2 Germany 149
5.2.3 Mixed model (tax revenue and social insurance model) (government and insurer-funded) 149
5.2.3.1 USA 149
5.2.4 Discussion 151
5.3 Long-term care system 151
5.3.1 Background 151
5.3.2 UK 152
5.3.3 Germany 154
5.3.4 France 154
5.3.5 Sweden 155
5.3.6 USA 156
5.4 Conclusion 157
References 157
6 Health policy in Asia: Overview and vision 161
6.1 Introduction 162
6.2 Rapidly declining birth rate and accelerated ageing in Asia 162
6.3 Funding sources of health insurance systems 163
6.4 Medical health insurance systems in Asian countries 166
6.4.1 China 166
6.4.1.1 Urban employee basic medical insurance system 166
6.4.1.2 (Former) basic medical insurance system for urban residents 166
6.4.1.3 (Former) new rural co-operative medical care system (NRCMCS) 166
6.4.2 India 166
6.4.2.1 Central government health scheme (CGHS) 166
6.4.2.2 Employees’ state insurance scheme (ESIS) 173
6.4.2.3 Rashtriya swasthya bima yojana (RSBY) 173
6.4.3 Indonesia 173
6.4.4 South Korea 173
6.4.5 Malaysia 173
6.4.6 Philippines 174
6.4.7 Singapore 174
6.4.7.1 Medisave 174
6.4.7.2 MediShield 174
6.4.7.3 Medifund 175
6.4.8 Thailand 175
6.4.8.1 Civil servant medical benefit scheme (CSMBS) 175
6.4.8.2 Invalidity benefits of the social security scheme (SSS) 175
6.4.8.3 Universal coverage (UC) 175
6.4.8.4 Vietnam 176
6.5 Long-term care system in Asia 176
6.5.1 What is long-term care? 176
6.5.2 Ageing in the Asia-Pacific region 176
6.5.3 Increased demand for long-term care: older people living alone 176
6.5.4 Long-term care labour supply 177
6.5.5 Provision of long-term care: nursing homes 177
6.5.6 Ageing in place 177
6.5.7 Toward a sustainable long-term care system 178
6.6 Conclusion 178
References 179
7 Conclusion: Deploying oral health policy to reduce health injustice in an ageing world 182
7.1 Global ageing and health 182
7.2 A rights-based and sustainable oral health monitoring system 183
7.3 Evidence-based and effective health policy 184
7.4 Oral health for healthy ageing 185
7.5 Concluding remarks 186
References 186
Index 187
