Social Determinants of Health Affecting Access to Dental Care
- Julie Collette, BSc, RDH
- Jun 17, 2022
- 3 min read
According to the Canadian government, there are 12 core determinants of health that can affect or influence the health of an individual or a population (Government of Canada, 2022). These determinants fall under one or more of four different categories: personal, social, economic, or environmental. The core determinants of health are listed as:
Income and social status
Employment and working conditions
Education and literacy
Childhood experiences
Physical environments
Social supports and coping skills
Healthy behaviours
Access to health services
Biology and genetic endowment
Gender
Culture
Race / Racism
In particular, social determinants are the social and economic factors that determine an individual's place in society such as income, education, social status, and employment, and can cause differences in health among individuals and populations (Peterson & Kwan, 2011).
For example, poverty is a social determinant that can create health inequalities for people trying to access different types of health care such as dental care (Watt, 2012). At a national level, the government of Canada has highlighted contact with a dental professional in the past year as an indicator for health inequity (Pan-Canadian Health Inequalities Data Tool, 2017). Those with the lowest incomes are less likely to see a dental professional than those with higher incomes. Using the health inequalities data tool on the government of Canada website, the prevalence of people contacting a dental professional in Alberta ranges from 49.1% to 74.7%, with the lowest prevalence being from those with the lowest income and the higher prevalence being from those with the highest income (Figure 1).
This health inequality trend is similar among provinces, with Ontario having a similar prevalence range from 50.8% to 85.8% (Figure 2).
As dental care costs are largely covered by individuals as out-of-pocket expenses or by private insurance plans, it creates an economic burden on low-income populations that do not have the means or resources to access these health care systems.
Oral health is becoming a more prominent part of general health and, thus, is influenced by the same broad determinants of health such as income, social supports, health services and employment. In 2010, the World Health Organization (Blas et al., 2010) published a report on "Equity, Social Determinants, and Public Health Programmes" that listed oral health as a priority in public health programs and policy creation. This priority was because it represented a large aggregate of the burden of disease and had large disparities across and within populations.
In 2004, a Canadian Oral Health Strategy (COHS) was established by the federal, provincial, and territorial dental directors' group that develops a strategic planning process based on current oral health statuses over different determinants of health and health inequities. Provinces and territories can use the data from the COHS to help guide policy and dental program development to reduce financial, geographic, social, and legislative barriers.
References
Blas, E, Sivasankara Kurup, A & World Health Organization. (2010). Equity, social determinants and public health programmes / editors Erik Blas and Anand Sivasankara Kurup. World Health Organization. https://apps.who.int/iris/handle/10665/44289
Canada, P. H. A. of. (2022, June 14). Government of Canada. Social determinants of health and health inequalities - Canada.ca. Retrieved June 17, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html#
Health Inequalities Data Tool. Public Health Infobase. (n.d.). Retrieved June 17, 2022, from https://health-infobase.canada.ca/health-inequalities/data-tool/index
Pan-Canadian Health Inequalities Data Tool, 2017 Edition. A joint initiative of the Public Health Agency of Canada, the Pan-Canadian Public Health Network, Statistics Canada and the Canadian Institute of Health Information. https://health-infobase.canada.ca/health-inequalities/data-tool/index
Petersen, P. E., & Kwan, S. (2011). Equity, Social Determinants and public health programmes - The case of oral health. Community Dentistry and Oral Epidemiology, 39(6), 481–487. https://doi.org/10.1111/j.1600-0528.2011.00623.x
Reducing dental disease a Canadian oral health framework. (n.d.). Retrieved June 18, 2022, from https://www.caphd.ca/sites/default/files/FrameworkOctober%202014%20-%20FINAL%20English.pdf
Watt, R. G. (2012). Social Determinants of Oral Health Inequalities: Implications for Action. Community Dentistry and Oral Epidemiology, 40, 44–48. https://doi.org/10.1111/j.1600-0528.2012.00719.x
What are the determinants of health? Colleaga. (n.d.). Retrieved June 17, 2022, from https://www.colleaga.org/article/what-are-determinants-health
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