Well... here is my essay as promised. I might still adjust a couple things but you get the general idea. We all can make a difference. Today I was on the bus coming home, and some sweet lady asked me what I was doing (working on cue cards) and that lead to dental hygiene, which lead to the Social Determinants of Health. She did not realize the scope of dental hygiene and has has a new outlook on the profession. Just wait. She will tell at least 3 people-her husband and a couple friends which in turn tell people... I hope.
Dental hygienists currently focus on providing oral health care within clinical settings that are sustaining substantial oral health inequalities. Statistics show that if British Columbia continues with the individualistic behavioural approach the inequalities gap will remain unchanged. (1) Initially when the dental hygiene profession started, the focus was on promoting preventative oral health to the population as a whole; specifically towards children. Dental hygienists need to return to their social justice roots to focus on oral health promotion towards a population perspective, rather than looking at individual care to minimize the equity gap.
There are two main perspectives to promote oral health, individualistic behavioural point of view and population point of view. The individualistic perspective affirms that “change was viewed as being mainly under the control of the individual and changes in knowledge and attitudes were thought to be primary influences on lifestyle choices.” (2, p405) It is now known that this individualistic approach is not “effective in achieving sustainable oral health improvements across the population.” (1, p1) Currently, the majority of dental hygienists are working in the clinical setting providing upper and middle class education while unable to provide for the needs of lower class society. “The individual (method) fails to make a comprehensive and ecological view of the broader socio-enviromental factors, since many of the socio-economic constraints are beyond the control of individuals, intervention is needed at the community level.” (3, p354) The Center for Disease Control director, James Mason mentioned, “it is my observation that, up until now, most of the behavior changes we have promoted have involved the better-educated, upper-, and middle-class segments of our society, not just that portion which is favorably predisposed.” (2, p405)
The second perspective is the population perspective where it mainly focuses on the “importance of social, environmental and political determinants of health.” (4, p35) This is where the over population of dental hygienists will flourish because they have the absolute newest knowledge of oral health prevention. British Columbia does have excellent health outcomes, however, they are not distributed equally. (5) WHO discovered and developed 12 underlying social determinants of oral health that mirror general health; social status, weak social networks, housing and early childhood experiences are the main areas that are needing the most attention within Canada, specifically British Columbia. (6-5) Underlying these four determinants of health is stress which is proven to make individuals more vulnerable to illness and chronic diseases. (7) The purpose of supporting the population perspective would minimize the inequalities of health and decrease the equity gap once all the underlying social determinants of oral health have been addressed. There is a significant amount of literature globally proving that lower socioeconomic groups have lower oral health, mortality and a higher morbidity than groups that have higher socioeconomic statues. (1,8) “This phenomenon does not only affect the lowest income groups; If you divide society into income divisions, each higher division has better health outcomes.” (5) People at the top of the social scale have a high quality of life, then as you follow the social scale downwards oral health follows the gradient and becomes worse. (1) A study was done in Brittan where they compared toddlers age 1-4 years in a low social class to toddlers in a high social class. There were 40% of toddlers in the low social class had experienced tooth decay, where the high social class only 16% of toddlers experienced tooth decay. (3)
The book, College of Dental Hygienists of British Columbia states, dental hygienists “uphold the principle that the public should have fair and equitable access to dental hygiene care.” (9) Dental hygienists are currently promoting oral health at the lowest end at chair side in a clinical setting. There is currently an abundance of dental hygienists within British Columbia that should be maximizing their services that they provide such as; preventative fissure sealants, mouth guards, tobacco cessation, and education about water fluoridation, prenatal education, elderly care, cancer screening and so much more. It is here and now that we need to have national initiatives and involve communities in their preventative oral care in settings such as a workplace, schools, and wider community. (6)
There have been many improvements in health inequalities during the past century in Canada, however, substantial inequalities still remain. (2) Resolving the inequalities are within reach now that the causation is known. The whole community, including the government, needs to work together to achieve and diminish the equity gap as well as oral health inequalities across the province.
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