‘There is an important connection between oral health and law’

What applies to general health, also applies to oral health: prevention is better than curing disease. Legislation and regulations can help in this regard, says University of Groningen researcher Dominique Mollet. On Thursday, she will defend her PhD thesis on the role of law in the prevention of non-communicable diseases (NCDs), such as dental caries (tooth decay).

Text: Jelle Posthuma

Non-communicable diseases currently pose the greatest challenge to public health, explains Mollet. Alongside cancer, diabetes and cardiovascular disease, oral diseases such as caries  also fall into this category. ‘Genetic and biological factors play a role in these diseases, but behaviour is at least as important. Various risk factors, such as an unhealthy diet, increase the likelihood of oral diseases.’

Legislation shapes society

Two billion people have dental caries and around 500 million children have caries in their milk teeth. Eating and drinking large amounts of sugar is the main cause of cavities. This unhealthy behaviour is often learnt at a young age, explains Mollet. Parents who are accustomed to unhealthy dietary patterns often pass on that diet to their children. Oral health is like a canary in a coal mine: problems in the mouth can be a warning sign of poorer general health related to behavioral factors.

In her thesis, Mollet investigates how the law can help to reduce risk factors for NCDs, including oral diseases. ‘The law shapes our society. Legislation determines, for example, where fast-food chains can be opened, what food is available in the supermarket and what advertising we encounter on the street and online. When it comes to oral health, the link with regulation is also clear: sugar and caries are directly linked. This is more complicated for other diseases, because other factors also play a role there.’

International approach

Mollet’s PhD programme is a collaboration between the European Commission’s Joint Research Centre (JRC) and the Faculty of Law at the University of Groningen (RUG). The PhD candidate is examining what legislation and regulations are intended to achieve and how they play out in practice. ‘In the Netherlands, for example, measures to protect oral health include a sugar tax, a ban on advertising or a ban on the establishment of certain businesses.’

Mollet argues that Dutch legislation alone is not sufficient to ensure a healthy food environment. In her dissertation, she therefore examines the right to oral health in an international context. ‘Dutch measures may, for example, conflict with European law or international trade law. It is therefore important to have an understanding of the various levels of law and how they interrelate. Public health does not stop at national borders or disciplinary boundaries. This calls for cooperation and the exchange of knowledge.’

In the international context, human rights treaties are of great importance. Mollet cites the Convention on the Rights of the Child (CRC), which has been signed by 196 States. ‘The right to health forms part of this convention. The CRC offers ways to urge States to take action, but also to hold them accountable for their obligations under the Convention. States can take measures at population level, for example by promoting access to fluoride, but also by discouraging sugar consumption as much as possible.’

Prevention is key

Promoting healthy behaviour and a healthy environment does not have to rely solely on legislation and regulations, she continues. ‘It may sound strange coming from a lawyer, but we shouldn’t try to regulate everything through the law. We need to take as broad an approach as possible. You can also promote healthy behaviour in other ways, for example through a healthy school lunch. This can positively influence children’s dietary intake without having to ban anything. So, the solutions are not to be found solely in the law.’

Ultimately, according to Mollet, it’s all about prevention. ‘We still too often assume that the healthcare system can “fix” things, including in oral healthcare. Fortunately, prevention is receiving increasing attention in the public health debate. I’m certainly not saying that dentists should be done away with – access to care remains crucial – but we need to focus much more on preventing diseases.’

Source of inspiration

During her PhD research, Mollet also focused explicitly on public health. She regularly collaborated with the Aletta Jacobs School of Public Health, for example for presentations, round-table discussions and working groups. The PhD candidate was encouraged in this by Brigit Toebes, former scientific director of the School and her promotor.

Toebes, as a professor of health law, was a pioneer in her field, Mollet explains. ‘Brigit had carved out a place for herself amongst doctors, who traditionally preferred to speak with other doctors, but took her very seriously as a lawyer. At the same time, she transformed health law, which until then had focused primarily on medical law. Brigit brought those two worlds together. I am incredibly fortunate to be able to stand on her shoulders and build on that foundation together with others. She has been a tremendous source of inspiration to me.’