CONVOCATION SPEECH
INTERNATIONAL COLLEGE OF DENTISTS
SAN FRANCISCO HILTON HOTEL
OCTOBER 19TH 2012
Harold Slavkin, Professor of Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California
It is a special honor to be with you at this convocation of the International College of Dentists here in San Francisco. I am grateful for this opportunity to congratulate each of you onyour outstanding contributions to our profession - - -Congratulations!
As you heard in the very kind introduction by President Michael Kenney, I served as the sixth Director of the National Institute for Dental Research (NIDR) at the National Institutes of Health in Bethesda, Maryland. I served from July 1995 thru June 2000. At a reception hosted by Secretary Donna Shalala at Constitution Hall late in 1995, I met the legendary Walter Cronkite. After introductions, I began to talk fast and described to Mr. Cronkite his enormous attributes and how our nation reveres all that he stands for. I rapidly highlighted his role when President John Kennedy was assassinated and how he broke the news to the nation. At this point, I needed to pause and take a breath. He graciously leaned forward and slowly asked, “And what do you do, Dr. Slavkin?”
“I’m a dentist from Los Angeles, and…” Before I could finish my sentence, he placed both of his hands on either side of my face, leaned forward, and quietly spoke. “I wanted to be a dentist more than anything in the world. My grandfather was a dentist and my father was a dentist. Dentistry is a wonderful profession! Unfortunately, we had little money during the Depression and I took a job on our town newspaper.” We then spoke for almost an hour, very unusual at Washington social gatherings of over one-thousand people in a large space. He explored what I would like to achieve while at the NIH. It was magical!
The next morning, Secretary Donna Shalala called me at my office. “So, Hal, Walter called me last night and asked if we have ever had a Surgeons General Report on the oral health of the American people. My staff checked and we have not. So, Hal, would you and your leadership at the NIDR take the lead agency role and produce a comprehensive report, evidence-based, that traces oral health across the lifespan, with an emphasis upon prevention that works?”
“Madam Secretary, I would love to accept your charge.” Four years later, May 2000, Surgeon General David Satcher released the Report, a Report inspired by Walter Cronkite and led and championed by my Deputy Director Dushanka Kleinman and Dr. Casswell Evans who we recruited from Los Angeles.
This afternoon, Iinvite each of us to reflect on three questions: (1) “where did we come from?,” (2) “where are we?” and (3) “where are we going?” It is now “fact” that we parted ways with chimpanzees 6.6 million years ago. At that time and until the beginning of the 20-century, global life expectancy was 30, and in North America, it had reached 47. By 1900, the world population was 1 billion. The most common cause of death was acute microbial infection associated with childbirth, infancy and childhood.
And, in 1900, the majority of health professional schools (medicine, dentistry, nursing, pharmacy and public health) were proprietary (private and for profit) and significantly influenced by commercial factors. From that environment which was replete with conflicts of interests, the Carnegie and Rockefeller Foundations, out of New York, commissioned a series of reports, the exemplars being the Flexner Report for North American medical education in 1910, and the Gies Report for North American dental education of 1926. There were also comparablereports for nursing, pharmacy, and public health professional education. Remember, life expectancy at that time was 47 years of age, dental schools were generally not associated with universities, nor were they “scientific.” Being toothless was considered normal for mature adults.
Within this environment, leaders from our profession came together on December 31st 1927, New Year’s Eve, in Chicago, Illinois, and the International College of Dentists was officially created as a joint concept between an American, Louis Ottofy, and a Japanese, Tsurukich Okumura. There were 250 dental professionals accepted as Fellows from 162 different countries. The stated criteria for Fellowship read as follows: “Please nominate the ablest, most progressive, best educated, ethical practitioner in your country, regardless of his place of domicile, nationality, race, color or religion.” Importantly, 7 years earlier, August 20th 1920, at the Copley Plaza Hotel in Boston, a similar group of dental professionals were also seeking a more ethical and professional health profession. They created the American College of Dentists. The Gies Report was published in 1926 and the “1920s Era” gave birth to the creation ofdentistry as a science-based, evidence-oriented profession,to bealigned with universities and the highest ideals of ethics and academic rigor. Through education, informal meetings, letters, journals (the Journal of Dental Research,the Journal of Dental Education, and Journals of the American and various International Dental Associations), as well as annual national, international and local scientific and technology conferences, meetings, and study clubs, these notions proliferated andspread around the world.Imagine, this took place without iPads, iPhones and the Internet! That’s where we were 110 years ago.
Where are we today? For a moment consider Sweden’s lifespan statistics. Sweden has extraordinary health records spanning 200 years. A Swede born in 1800 could expect to live 32 years. By 1900, the average Swedelived to 52 years. Today, the Swedish lifespan is 82 years - - - an increase of more than 150% in just over 200 years. This remarkable advance was not due to genetic mutations. Rather, this“miracle” is the result of sustained international investments in personal hygiene, water and air quality improvements, nutrition and food safety, prenatal care, early childhood and K-12 education, immunizations, air conditioning, and, yes, fluoridation, all of which collectively improved the human condition, reduced mortality and morbidity, and gave hope for a better tomorrow.
Today, throughout the industrial countries of the world, people increasingly live longer and better than ever before. And, yes, the quality of oral health care has also profoundly advanced, especially during the last half of the 20th century. More people in the industrial nations of the world have more remaining teeth as they reach the 8th decade of life than ever before. The 20th century was transformational!
And despite our justified reasons to celebrate these accomplishments in oral health care, all too many people have been left behind with respect to the prevalence of diseases, including oral health diseases and disorders. Today, we acknowledge that a variety of socioeconomic determinants control morbidity and mortality.
The global population has reached 7 billion people; a 7-fold increase since 1900. Of these 7 billion people, nearly 2 billion are over the age of 65 years. Shockingly, 10% of the population consumes 70% of the health resources of most industrial nations. More than 1.5 billion are without the basic resources of clean water, sanitation, or health care. Almost 2 billion people live in poverty, many living on less than $1 dollar per day.
In the United States, the third largest country in the world, a country of 310 million people, we provide outstanding oral health care for 2/3 of our population, yet 110 million people are without access to needed oral health services. Today, 25% of our nation’s children live in poverty. Tooth decay is the #1 chronic disease of American children - - - “the silent epidemic” resulting in severe pain, loss of learning hours at school, and even death. Today, 1/3 of our nation’s population are obese. Obese children develop hypertension, ironically “adult onset diabetes,” and cardiovascular diseases. Obesity has become epidemic in the industrial nations of the world, along with depression, diabetes, and cardiovascular diseases. Collectively, these preventable “man-made diseases” are beginning to reduce life expectancy for many people in the industrial nations of the world.
Where are we going? I have focused on these health disparities in order to be an advocate, to encourage each of us to engage in solutions. How can we ensure that wellness for all people in each of our countries is in the global self-interest. In too many parts of the world, we have gone “off track” and, once recognized, the emerging global and national demographics offer leadership opportunities. Of course, I’m speaking to you who areleaders,you who have already demonstrated numerous contributions to your communities and nations. My thesis is that we must do more. We need to think about global, national as well as local problems and find innovations that can put the human condition back on track for all people in all nations.
We are assembled in California, in the Bay Area, and, in particular here in San Francisco where innovation is ubiquitous. Following the initiation of the Grand Rapids, Michigan clinical study to test the effectiveness of water fluoridation in 1948, San Francisco was one of the first major US cities to fluoridate its water supply in 1950. The people of San Francisco understood prevention. By the way, fluoridation saves $4 billion dollars each year in dental costs in the United States. This is the region that translated the scientific accomplishments from the digital revolution into industrial and consumer products such as those from Apple, Intel, Hewlett-Packard, Cisco, and Dell. The Bay area gave birth to the biotechnology industry with the creation of Genentech in Emeryville, next to Oakland, just across the Bay in 1977. Genentech created the very first recombinant DNA product, which was human insulin for the treatment of diabetes. Innovation is the methodology to reduce or eliminate the various insults to our human condition.
Finally, as we look forward to the future, where are we going? How can we optimize the human condition? Specifically, through my lens, we need to “put the mouth back into the rest of the body.” From my perspective, this means our universities need to be reconfigured and we need to eliminate silos and create interdisciplinary or trans-professional learning environments. We need to engage in interdisciplinary team approaches was first demonstrated by an orthodontist named Herbert Cooper in Lancaster, Pennsylvania when he created the very first craniofacial teams to address the special needs of infants presenting cleft lip and/or cleft palate in the late 1930s. In Cooper’s model, physicians, dentists, nurses, social workers, psychologists, speech and hearing therapists, and educators and families all worked together for the welfare, health and habilitation of the child - - -team work that often spanned 17-20 years in the life of the child patient and their families.
Can we envision a future when tooth decay is eradicated, when human behaviors and choices result in reducing oral cancers? Can we reduce periodontal diseases? Can we invest, through innovations,in reducingthe tragic consequences of chronic facial pain? Can we design a strategy for all children to gain a healthy smile for a lifetime? Can we work closely with our colleagues in the other health professions to improve diabetes, reduce premature low birth weight babies, reduce osteoporosis, reduce obesity, eliminate tobacco products, and reduce cardiovascular diseases?
In order for patients to receive the best possible care, health professional education and practices must reflect the changing health needs of the population they serve, and the changing environment in which care is provided. In the US, 25% of physicians are foreign educated. Almost 40% of all nuts and cheeses found in the USA are imported. Flowers, food, people, and microbes cross the Pacific and Atlantic oceans everyday. Microbial infections do not recognize boundaries between nations. Health is a global matter! The future demands multinational, multidisciplinary approaches to exploring promising innovations in health professional education and practices. I implore you to connect with your health sciences schools and engage in changes that transform education to strengthen health care in an increasing interdependent world. We need to spark groundbreaking reforms. We need to form coalitions and not tolerate fragmented and often static organizations. We must broaden our horizons. Through your efforts, your work and your motivation, we can and will make a difference! We will leave the world better and healthier than we found it!
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