This letters was published in the journal Tuith Online in December 1999

Great Expectations - by the Chief Scientist, Professor Graeme Catto

An introduction from the Chief Scientist, Professor Graeme Catto (December 1999)

This initiative from the CSO Dental Health Services Research Unit in Dundee is both welcome and timely. I hope that dental practitioners throughout Scotland will make use of this new online journal to help keep up to date with current evidence and to explore new ways of developing the service for patients.I wish it well.

The contrast was stark. On one side of the page, actuaries were quoting large increases in life expectancy for British men while the leader opposite bemoaned the current state of the NHS. Such apparent inconsistencies are, of course, not unknown in newspapers. They do, however, say something about our approach to health and the NHS in this country - a mixture of admiration and irritation. These feelings are not confined to the UK; indeed, a number of recent reviews indicate that public attitudes towards their own health services have deteriorated in Australia, Canada, New Zealand, and the USA as well as in the UK. Still if the actuaries, not generally known for adopting an optimistic outlook, find that life expectancy has increased substantially over the last five years and now exceeds 84 and 87 years respectively, for men and women currently aged 50 years old, something must be going right.

A number of factors are moving in a helpful direction although we are not always sure which are the most important. The health of the nation, if by that we mean the life expectancy we and our children can expect, is directly related to the economy of the country in which we live. Indeed within any one country the same trends are all too readily apparent with the most deprived citizens having the lowest life expectancy. Their prognosis is poorer even within specific disease categories - cancer, cardiovascular diseases, mental illness, and accidents for example. The reasons are complex, relating as much to overall lifestyle as to deficiencies in the NHS, but the disparities in outcomes are now becoming so manifest that they can no longer be ignored. The challenge for the new public health is to determine what really matters from what is of lesser importance - and ensure that all government departments and agencies co-ordinate their efforts appropriately. The NHS has, paradoxically, a relatively small if important part to play in this process.

It may seem slightly odd to concentrate on life expectancy in an article on dental health. Teeth, their disease or absence seldom present life-threatening conditions. Dental health is, nevertheless, a matter of great importance to the public health and to the NHS. Poor oral hygiene is closely linked to deprivation and data from repeated dental examinations provide useful objective measures of the individual's health and lifestyle. It has become abundantly clear recently, if there were ever any real doubts, that health and illness are not absolutes but must be viewed in relation to the expectations and customs of the society in which we live; the different attitudes to health and healthcare in our multicultural country are increasingly appreciated. Dental health services have an important role in both primary and secondary care not only in documenting oral health but in health promotion -providing lifestyle information and help appropriate for the individual patient.

It is likely that many aspects of our common diseases at the end of the 20th century are linked not only to our genetic make-up, but to our diet and lifestyle -including lack of exercise and consumption of alcohol, drugs, and tobacco. Changing our approach to these basic aspects of life is not a simple process. It is likely to become even more important in the years ahead as the results of the "Human Genome Project" allow us to identify risk factors for the individual patient rather than for a population. Let me give you an example. It may prove possible to identify a subgroup of diabetic patients for whom it is particularly important that blood pressure should be maintained within normal limits if the microvascular complications of the disease are to be reduced. Identifying the risk is one step; persuading the individual to check the blood pressure and take the appropriate medication is a separate and complex task. Those who suggest that patients will modify their behaviour when made aware of the real risks to their own health ignore the evidence we have from drug and alcohol abusers who are well aware of the risks but carry on regardless. Once again, the approaches developed by dental researchers into how the behaviour of children and adolescents can best be modified will be relevant for much of the NHS.

For all these developments to succeed a number of factors is essential. We must base our advice and our strategies for prevention and treatment on the best available evidence -and that, in turn, must be readily available to practising clinicians in a form that is relevant and accessible. As many have observed, practice-based evidence is as important as evidence-based practice. Publishing studies in peer-reviewed journals is essential if we are to ensure research of high quality. That approach, however, if used exclusively is both time-consuming and ineffective in helping to change practice.

This initiative from the CSO Dental Health Services Research Unit in Dundee is y and timely. I hope that dental practitioners throughout Scotland will make use of this new e-journal to help keep up to date with current evidence. The accessibility of the information will be further enhanced if clinicians become involved in stimulating on-line correspondence and in developing further networks of colleagues eager to explore new ways of developing the services for patients. Dental health services will, I believe, become increasingly involved with other components of the NHS in researching and implementing service improvements. That at least is what the public expects -not unreasonably. This journal will help that process -I wish it well.

Graeme Catto