Oral Health Matters

Richard Watt 00:04

Welcome to Oral Health Matters, a podcast that shines a spotlight on oral health and calls for it to be embraced as a key part of the global public health agenda. I'm Richard Watt, Professor of Dental Public Health at University College London. In the second series of our podcast, I'll be in conversation with leading researchers and policy makers from around the world who are working in the fields of global health or public health, and who are interested in issues of equity, community action and the politics of health. In this episode, we're focusing on the United Nations high level meeting on non-communicable diseases, NCDs that took place in New York in September 2025. We'll be exploring the background to the meeting, the likely impact of the declaration that was adopted in December 2025 and considering the way forwards in tackling NCDs at a global level. I'm very excited to be joined by two global health public health leaders, Dr Taskeen Khan, Director of Research at WISH – World Innovation Summit for Health. She is a seasoned global health expert previously based at WHO. My second guest is, Dr Habib Benzian, Professor at the University of Sydney and the University of the Western Cape in South Africa. Habib is a very well-known figure in oral health at a global level, heavily involved in supporting WHO and a range of other international initiatives, including the Lancet Commission on oral health. So, thank you, both of you, for joining us in this conversation. And I'd like to start really by considering and reflecting on the background and preparation that took place in the drafting of the NC Declaration. What was your experience, insight into that background? Perhaps we could start with Taskeen.

Taskeen Khan 02:16

Absolutely Richard, fantastic way to start. So, the thing about the drafting process that I think most people don't understand is that it's not a technical exercise. It's not an exercise of, you know, doing a research article, an academic paper. It's actually pure political diplomacy, and what you've got is 194 countries, or member states, as you call them in the UN. You've got strict word limits and an absolute need for consensus in order to even make the declaration possible. And that means that when you translate this, every single sentence is negotiated, even comma placements are battlegrounds. It's a transactional document where survival matters more than perfection. The text tells us a lot less about what experts want, but more about what governments and countries are willing to tolerate. In summary, I'd like to say it's not written to be right; it's written to be possible.

Richard Watt 03:28

Well, that's a really good start, and it really does get the flavour of that process. Habib, would you agree with that perspective? Would you disagree? Give us your view on the drafting process.

Habib Benzian 03:42

Of course, thank you, Richard. And pleasure to be in this podcast. I agree 100% with this scheme. I think people, when you read a final declaration, people have some ideas on how this document came about, and it's usually a wrong impression. You see the shiny, high-level event, the meeting itself, where everything is highly staged and prepared beforehand. The process for this document goes more than a year back, or took more than a year, and this process has become more and more complex, with consultations, with drafting groups, with public input opportunities, where also civil society is heard, and then these documents go back in closer circles. In this situation, there was also another level of complications that the high-level summit itself was hosted by the United Nations, not by WHO. So, it's a whole other level of diplomacy and complexity, where WHO is only a guest, is one actor at the table. It's all run by the United Nations, and this brings complication. And as Taskeen rightly said, this fight around words, around commas and what matters in the end is what has survived this process, rather than what has been added. It so for oral health, I think we can be very happy that we have a full paragraph that speaks about oral health, but I think we're going to talk about this a bit later.

Richard Watt 05:10

Yes, we'll come back into the content in a minute, but I think yeah really interesting start. I suppose, for me and for perhaps our listeners, really understanding that political process, this is not a scientific endeavour, it's a political process about consensus, agreement. If we now move forwards and then consider the actual meeting in New York in September of last year, and what happened at that meeting. Now again, Taskeen, I don't know if you were present in New York, but certainly, I'm sure you know some of the details of what happened. But from my understanding, the US and Argentina blocked the declaration in September. What's your insight to that point of the actual meeting itself?

Taskeen Khan 05:59

So I was actually in New York, Richard, and what surprised many was the blocking of the declaration, you know, by the US and Argentina, as you point out. But honestly, I can't say that I was, you know, particularly surprised, I think, with the way things were going in the current geopolitical framing, and once you understand how sensitive issues like taxation, regulation and commercial interests in particular are, it's almost predictable what happened. I think NCD policy, and particularly the declaration, what it tries to do is go to the heart of sovereignty and markets - food systems, alcohol, corporate power. Blocking or watering down language has been a consistent pattern in this exercise, rather than an exception. So, in some senses, it wasn't shocking behaviour, it felt like familiar behaviour, especially with these countries also, you know, declaring that they'd like to leave the World Health Organisation, and somehow talk to the multilateral framework that we're all used to.

Richard Watt 07:16

So that really highlights, yet again, the sort of geopolitics and the broader context and Habib, were you surprised? Perhaps you were in New York, because at that point you were working in New York. Were you in New York at that time?

Habib Benzian 07:31

I was not in New York, I followed online, which is a nice feature nowadays, of these UN and WHO meetings there. Most of the public proceedings are available on live stream, so it's a good opportunity for everyone who is interested in how the mechanics of events like this are working, just to follow and listen in and to be bored by how boring these procedures are in the end, all the statements are predetermined, can be read afterwards. So, it's really highly staged. That said, I think the vote of no from Argentina and the US was not really surprising to anyone who has followed how these things unfolded in the past. And as Taskeen said, both countries have been very consistent in the past with resisting binding language on certain of the hot topics, like regulation, taxation, commercial determinants. So that was not a surprise. And on top the overarching geopolitical move of the US and Argentina to withdraw from the WHO compounded all this. I think what was more important, actually, was to observe that even this dissent did not derail the process. The process usually is built on consensus, that's how it was handled in the past. And of course, there was no consensus this time. There was a moment of consternation by the chair and the meeting leadership, but then they decided to pause, go back into consultation, and then it was tabled again in December, and it was very clear that all the other nations are very determined to move on with the health agenda, with the NCD agenda. So, the declaration was then eventually adopted again, only with two countries voting against it. I think this is the more powerful message from the whole process

Richard Watt 09:19

That is incredibly interesting, because I think one point I always observe is, is how professional and impressive some of the diplomats are at being able to respond to challenges, etc. And were there any particular countries that were particular advocates for this declaration? Because, you know, we know in the in the past, whether it's oral health or other policy, sometimes there's one or two countries that will lead to the charge, so to speak. But were there countries that were strongly advocating and supporting this declaration? Any insights on that point?

Taskeen Khan 09:57

What I do think is that particularly lower- and middle-income countries really featured prominently, and I think that was because this is now the lived burden in those contexts. You know, many years ago, we used to think of non-communicable diseases, as diseases of lifestyle and diseases of the affluent. But I think that has significantly changed, and I think that was also quite prominent in the way that the general assembly meeting was handled. For the low- and middle-income countries, it's no longer about policy debates, because they are pushing for equity, for access, for gender. And for me, the most you know striking thing about the declaration was the concrete targets. And I think here, what was very revealing was that leadership came less from power and more from the proximity to the problem. I just wanted to touch on a point that you made earlier, Habib, to say I absolutely agree with you everyone comes with the pre-cook statement, and then it's pretty boring for the rest of us to follow, right? You have all these countries talking about the progress they've made on NCDs, when in fact, there's still such large challenges and gaps, particularly in implementation.

Habib Benzian 11:20

I think, to your point Taskeen, this comes from, also from the idea, or the misconception, that a declaration is a starting point for something, while in fact, I believe it's an end point. It is the testimony of consensus that has been negotiated and debated over months, in diplomatic circles, in health circles, in technical circles, gone back and forth. So, what we see as the shiny declaration is an endpoint and is a document of where consensus ends. What is the ceiling of agreement, and it defines, in this way, the space where action can happen. So, it's not a starting point, per se. It's at first, I think it's a documentation of where we stand at the moment, and from there on, if we see it this way, we can find out what are the pressure points where we need to expand that space, where action is possible in the future. So that's the task that comes from a declaration for the years to come.

Richard Watt 12:22

Well, that's a good opportunity, perhaps, to for us to then focus on the actual declaration that was adopted. So, as we've heard in December, 15th December 2025, the declaration was adopted by the UN. So, we've got a final text now for our listeners, for the for the wider audience, it would be interesting to hear both your views on the relative strengths and weaknesses of that final document. And Habib, I should say is that the end point, or the starting point, another interesting issue. But let's think about the strengths of the document. Taskeen, you're you mentioned the concrete targets you felt that's important, anything else in the document that you think is a real strength.

Taskeen Khan 13:09

So absolutely, the one thing is definitely the clear targets. Because I think for once in the global health NCD space, we got numbers. And for me, numbers are power and speaks to my math’s bias. But I also feel that it strengthened language on gender, air pollution, oral health and digital health. And I thought that for me was particularly good and a step in the right direction. When I think it's bold enough, probably not, but I do think it was the sort of epitome of what was politically achievable at the time. In terms of weaknesses, the biggest weakness was how cautiously the commercial determinants of health were addressed. I think lots of things like taxation and things were framed as something to consider, not necessarily commit to. And I really felt that mental health was named, but that it feels structurally secondary. And I don't think that that's a problem with the declaration per se. I think that's a broader, you know, non-communicable disease definition challenge, industries were acknowledged but not confronted. And it's not that awareness is missing from this, it's political courage.

Richard Watt 14:29

Some interesting points. Habib, how would you respond?

Habib Benzian 14:33

I couldn't agree more with what Taskeen said. I think the declaration is a reflection of the current reality, and this reality shows all these weaknesses that Taskeen mentioned. A lack of recognition for certain risk factors, missing full integration of mental health conditions and of oral health and other NCDs into the mainstream. But what it does, it shows that NCDs are still alive in the Global Health Agenda, and in the context of broader development and all endeavours towards universal health coverage. So, I think in that sense, it shows that the agenda and the actors are willing to maintain NCDs as a topic, and that in itself, in the current situation, global financing situation, is already progress. I know it sounds a bit modest as an achievement, but it's not trivial. When we look at oral health specifically, I think, of course, we see progress. In previous declarations, we only had one word mentioning oral diseases among other non-important NCDs as part of those declarations. This time, we see a full paragraph, an operative paragraph. Of course, we would have liked to see more, and we would have had enough text or content technical matters to be listed there. But again, it's the compromise that was possible. I think I would see it almost not as progress, in terms of success, in terms of advocacy and civil society push that this mention of oral health is now more than it used to be. I would rather see it in a way that it was unavoidable, politically unavoidable to ignore, because we have a strong policy framework that has developed over the last four or five years, with resolutions from the World Health Assembly, with a global action plan, with a global monitoring framework. So oral health is no longer a fringe topic, at least from these who guidance documents. So, it had to be reflected in a different way in this declaration. And when you look at the civil society demands and critics of the declaration that reads like a long laundry list of missed opportunities. Again, I think we need to recognise this is a political document. It's not a checklist of things we need to do tomorrow. It represents the consensus of what is possible at the moment.

Richard Watt 16:57

It's very important where you're both saying is definitely some progress, some strengths, something that we're pleased to see there, and I think what was interesting, Taskeen, do you mentioned air pollution is an important area of global health, and it was certainly highlighted. Do we have any evidence? I don't know if any of you have got insights into this. Do we know if the sort of trans-global corporations, did they lobby heavily to not have mandatory recommendations on taxation.

Habib Benzian 17:30

This is very difficult to obtain evidence, hard evidence, in the sense of an email or a statement of an industry lobbyist in the public forum. Those are things that happen behind closed doors in the black box of health diplomacy, and they often happen not only directly through industry representatives. They also happen through member states who are heavily biased in their position, through corporate actor interests, so it's a complicated mix. What we see nowadays is that the health diplomacy also works a lot through informal WhatsApp groups, but wording is tested in small groups before you speak up and suggest something, or even put a written statement that we would like delegation and would like to see wording changed in this or that way. The nature of health diplomacy has changed, and despite the big efforts of WHO and The United Nations to make the entire process a bit more transparent and to give more opportunities for civil society to participate. I think the large bulk of negotiation work is hidden from public view. We don't know what is happening behind these closed circles. So, uncovering corporate interests is equally complicated and difficult in hindsight,

Taskeen Khan 18:54

I'm so happy Habib went first because he framed that answer perfectly, and very little to add on the point, except to say that if you watch The Diplomat on Netflix, you can imagine that it's something like that, not that we want to make it clandestine or anything, but it's absolutely true that most of these conversations happen behind closed doors and are often, you know, never, sort of substantiated with clear evidence, as Habib put it.

Richard Watt 19:25

So, I suppose that just highlights, yet again, the issues of transparency, about clarity on conflicts of interest, all those different issues that are mitigating the commercial interests on global health. Let's move on, perhaps to your final point to consider is then really looking forwards now. We have this declaration, NCDs are recognised, we've got some global targets, etc. And I'd just be interested to hear from both of you what happens next at both a global and national level. What do you see as the next steps, the next battles really, to move this agenda forward? Taskeen, what's your view, and perhaps thinking particularly about low- and middle-income countries, that would be interesting.

Taskeen Khan 20:13

The first thing, I think, is that we've well established now I think that the declaration won't fix health systems, and really that was never its purpose. But I think that what it does do is give national advocates, and this is particularly relevant for low- and middle-income countries, a sort of permission slip or a tool for accountability and a shared global language. So, if you can imagine that you were a Ministry of Health official, you can now point to a document that, you know, the head of state signed, it's at that level, and say, this is what we committed to. It's not trivial, you know, it's leverage. And so, I think that, for me, is particularly important. In terms of battles, like with everything these days. And I think, you know, again, the geopolitical landscape is really teaching us new things every day. I think for us, the next battles are about money and power. How do we finance NCDs in debt stress countries. You know, the declaration sort of name checks, or organisations like the Global Fund and the Gavi, etc. But the truth is that they are going through their own downsizing, and they're going through their own funding crisis and things. And who is really going to evolve beyond traditional mandates, we don't know. And I think the fight is sort of moving, it's shifting from consensus to contested policy. And for me, the absence of global health at Davos was also, you know, it was quite shocking, and Davos was extremely silent, which I found really, you know the wrong way to go in terms of health. But at the same thing, it's more about confrontation now, and I think that you know the next opportunity really is where we see diseases intersecting with economics, with climate and with development. And where we see things like productivity, security, resilience, that's where the non-communicable diseases will become impossible to ignore. And I think the most important thing for me is that the declaration isn't the win, but it is the tool, and it's about who knows how to use it now.

Richard Watt 22:40

Well, lots to think about that, some really fundamental challenges perhaps you've raised for us, which is great to hear. Habib, anything to add, anything to disagree on?

Habib Benzian 22:53

Yeah, well, no, I don't disagree with Taskeen, she's left hardly anything for me to say, because I agree really. I like power finance as the key issues battlefields. I would add redistribution to that. Redistribution in the sense that NCDs are, despite their burden and the strong evidence of their impact, they are still a terribly underfunded area in global health, and this is reflecting the current power balance. So, redistribution of priorities is absolutely essential. The power of the declaration, as Taskeen, rightly said, is mainly discursive. So, it's it opens the space of what can be said, what can be thought, even, and documents that so we can go back to this document. We can cite it, we can, as Taskeen said, it can be used in argumentation, but it's not a document for structural change. This is the translation process that now needs to happen. And for this, I think there are basically three, levers. One is the the high level, multilateral moments like this highest high level United Nations high level meeting. There is another one coming up in 2027 on universal health coverage, again staged in New York by the United Nations. And there are other multilateral opportunities where this agenda can be renewed, where again there will be an outcome, document or declaration, and it can be renegotiated. The space can be opened and widened. And it should be, we should be pushing the boundaries of this space of possibility. The second tier, I think, is we also need to use these agenda shifting opportunities, like health being included at climate negotiation process, the cop events, where health has now been introduced as a feature, as a topic that is ongoing. You mentioned Tusken, you mentioned the Davos meeting. I was equally disappointed about the way health and NCDs in particular were treated. You may have seen there was a report on. Acting early on NCDs, which completely reframed the NCD agenda by dropping mental health and adding chronic kidney disease. So, there was outside of the mainstream of health, there are events and opportunities to reshape the discourse and the agenda. We need to use these and by having health coming through non-health doors into the public discourse. I think we have opportunities that are sometimes surprising but usually quite impactful. And the third, I think, is a very essential area as well, which is technical guidance. And that's what who and other agencies are for. It's a quiet work, but it's, it's quite consequential if you are providing technical guidance, implementation guidance, technical support to member states on how to improve coverage and care for NCDs, surveillance for NCDs, financing for NCDs, including oral health. Of course, this is where the real work, the real translation work, happens. That's also the space where there's opportunity for research, a different kind of research, as we have repeatedly emphasized implementation research rather than and basic research. These are the three areas I think, where we need to keep working. If we stop at one of these, I think the process and the recognition and the situation of NCDs will not change a lot.

Richard Watt 26:22

Well, look, I think really nice end to our discussion there. And I think it's hard to sort of summarize, because we've covered so much in our last sort of 30 minutes or so. But for me, I think you know, both of you have just beautifully described that political process, that importance of diplomacy, discussion, the challenges that we're facing you, from consensus to a contested world, confrontational, etc. We've heard a lot about the importance of civil society, about a global perspective, the need for low- and middle-income countries to be at the table as equal partners. I think we've also heard beautifully about the conflicts and contested nature of power, economics, money. You know, those are the drivers that we're looking at. So, it's a complex space, but I think we've heard some optimistic points as well, so that's a nice way to end. I would just like to thank both my guests, Dr Taskeen Khan, and Dr Habib Benzian, and to you for listening to this podcast. I hope you find our conversation as interesting and stimulating as I certainly did. Do join us for our next episode, which will be published in two weeks time. You can follow the dental public health group on LinkedIn, blue sky and Instagram. Oral Health Matters is produced by the Dental Public Health Group at UCL, with production support from Research Podcasts and funding from the National Institute for Health and Care. Thank you very much for listening.