Dentists making ends meet for the most vulnerable
In the news clippings that came across my desk this morning, I was particularly interested to see this story from the CBC about the Downtown Eastside Dental Clinic in Vancouver, where volunteer dentists do their best to make sure that no patients get turned away, because of the lack of ability to pay. It is a heroic aspiration to attempt to provide care in such a way for the most vulnerable Vancouverites.
The Downtown Eastside clinic is part of a network of low-cost non-profit clinics in British Columbia providing care to people who find it hard to make ends meet each week. What is disheartening to read in the CBC article is that the clinic itself is finding it difficult to make ends meet and its attempts to meet its ends are considered “unsustainable.” Reading the piece, I am prompted to ask what more can we dentists do, individually and collectively, to improve the oral health of the most vulnerable people across Canada in a sustainable manner?
The following paragraphs indicate what the 2018 CDA Task Force report on the future of the dental profession had to say about the determinants of oral health and the need for dentists, individually and collectively to build coalitions with like-minded individuals and organizations who wish to improve the oral health of Canada’s most vulnerable residents.
“The biggest health problem in Canada is not heart disease or cancer or mental health. Rather, it is the social determinants of health and the resulting inequities which exist in virtually every aspect of population health. Inequalities persist in Canada, and little headway has been made in reducing them when measuring factors influencing health.
The most significant vulnerable groups in Canada are those with low socioeconomic status, the un- or under-insured, the very young (<5 years), the elderly (especially those institutionalized), those with special health care needs, new arrivals to Canada and members of certain racial and ethnic minority groups, including Indigenous populations.
The main challenges for these target populations are competing priorities: food insecurity, housing, settlement challenges, language barriers and very little money. These social determinants of health could systematically explain many of the barriers to care experienced by people in the vulnerable groups.
As income inequality continues to grow, this translates to fewer Canadians being able to afford dental care. Particularly significant, middle-income earners in Canada in 2013 reported the greatest increase in cost barriers and have had the largest rise in out-of-pocket expenditures for dental care since 1978 and the lowest levels of dental insurance coverage. Dental care utilization is associated with relinquishing spending on other goods and services, making it a competing financial demand for many economically constrained adults, or the “working poor.”
Until they experience oral pain, many will choose to spend their limited resources elsewhere. An avenue for reaching out to other stakeholders and message carriers is for the dental profession to get more involved in public policy issues that don’t appear at first glance to be directly relevant to dentistry. If the profession can demonstrate a willingness to engage on broader, societal-level issues, other groups may engage more readily with dentistry’s issues. The dental profession’s involvement in broader societal issues, such as tobacco cessation, sugar reduction, opioid crisis, and antibiotic prescribing practices, are some recent examples.
The profession needs to focus on broader societal issues that impact on vulnerable groups and become engaged in addressing the social determinants of health and poverty reduction, in order to make oral health part of the conversation. This is an effective way to foster public trust in the profession and enhance the perceived value of oral health. It would demonstrate that dentistry understands and is committed to our moral and ethical responsibilities to provide care to all Canadians. Increased trust in the profession could also lead to increased utilization of oral health care services, particularly from those vulnerable populations.
Finding like-minded partners is also important. An example of this approach is the profession’s current discussions with the Assembly of First Nations about Indigenous children’s oral health and finding the best alignment, in terms of priorities, for both organizations. As one informant told us: “It doesn’t resonate with decision-makers if you speak on behalf of a patient group who is not there.”
To finance access to care initiatives for these groups, dentistry should seek partnerships with local community leaders and other organizations that are aligned with these causes and are also looking for support funding such as hospitals, Rotary clubs, the United Way and other non-profit organizations.”
I wonder if you have stories to share about how Canadian dentists are reaching out today and building coalitions with partners of all kinds in order to help improve the oral health of the most marginalized in our society? If you do, I would love to talk to you and seek ways to share those stories across the profession and beyond. Inspiring stories can spur us to new heights in our efforts to promote optimal oral health for all Canadians.
Dear colleagues, I would love to learn how you “do your bit” to reduce barriers to good oral health experienced by the most vulnerable Canadians. Please don’t hesitate to meet me for a friendly, casual conversation at www.zoom.us/j/6136144798 (my video meeting space). I love learning the perspectives of colleagues, especially when I can share them. Sincerely, John