A comparative analysis of policies addressing rural oral health in eight English-speaking OECD countries

Abstract

A comparative analysis of policies addressing rural oral health in eight English-speaking OECD countriesRural and Remote Health 17: 3809. (Online) 2017Available: http://www.rrh.org.au A B S T R A C TIntroduction: Oral health is fundamental to overall health. Poor oral health is largely preventable but unacceptable inequalities exist, particularly for people in rural areas. The issues are complex. Rural populations are characterised by lower rates of health insurance, higher rates of poverty, less water fluoridation, fewer dentists and oral health specialists, and greater distances to access care. These factors inter-relate with educational, attitudinal, and system-level issues. An important area of enquiry is whether and how national oral health policies address causes and solutions for poor rural oral health. The purpose of this study was to examine a series of government policies on oral health to (i) determine the extent to which such policies addressed rural oral health issues, and (ii) identify enabling assumptions in policy language about problems and solutions regarding rural communities. Methods: Eight current oral health policies were identified from Australia, New Zealand, Canada, the USA, England, Scotland, Northern Ireland, and Wales. Validated content and critical discourse analyses were used to document and explore the concepts in these policy documents, with a particular focus on the frequency with which rural oral health was mentioned, and the enabling assumptions in policy language about rural communities.Results: Seventy-three concepts relating to oral health were identified from the textual analysis of the eight policy documents. The rural concept addressing oral health issues occurred in only 2% of all policies and was notably absent from the oral health policies of countries with substantial rural populations. It occurred most frequently in the policy documents from Australia and Scotland, less so in the policy documents from Canada, Wales, and New Zealand, and not at all in the oral health policies from the US, England, and Northern Ireland. Thus, the oral health needs of rural communities were generally not the focus of, nor included in, the oral health policy documents in this study. When the language of concepts related to rural oral health was examined, the qualitative analysis identified four discourse themes related to both causality and solutions. These ranked discourse themes focused on service models, workforce issues, social determinants of health, and prevention. None of the policies addressed the structural economic © LA Crocombe, LR Goldberg, E Bell, B Seidel, 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 determinants of unequal rural oral health, nor did they specifically assert the rights of children in rural communities to equitable oral health care.Conclusions: This study documented the limited focus on rural oral health that existed in national oral health policies from eight different English-speaking countries. ...

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