Critically engaging vulnerability: Rethinking oral health with vulnerabilized populations

Abstract

This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to ‘othering’ thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the ‘how,’ ‘why,’ and ‘therefore’ that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them ‘at risk,’ and to what are they ‘at risk’? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co‐engagement and co‐production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.

Race in public health dentistry: a critical review of the literature

“…Historical and social specificities have often been overlooked in the interpretation of racial oral health inequities. Since race, color, and ethnicity are socially-and historically-determined analytical categories, they must be problematized within the corresponding socio-historical context to interpret findings without stigmatizing or perpetuating racial oral health inequities 1,7,11 . About 60% (n = 32) of the studies did not specify the main reason for using racial/ethnic variables in the analysis.…”

Conceptualizing inequities and oppression in oral health research

“…This complete lack of investigations is, we argue, indicative of how the oral health field still needs to engage with a range of social science concepts in order to more fully grasp the roots of oral health inequities and identify and advocate for their effective remedies. When it comes to critically analysing research on oral health inequities, it is crucial to ask ourselves how much we have been part of the problem instead of the solution 16,46 . The omission of oppression from our theoretical models, for example, has supported a body of science that better describes disparities than closes gaps to advance equity.…”

“…10,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] All studies have We argue, then, that the persistence of oral health inequities over time and across space has much to do with how we employ these categories in our scientific, clinical and policy endeavours. 30,46 Understanding oppression in its structural forms requires attention to how the social, political, commercial/corporate and behavioural determinants intersect and impact oral health outcomes. 47,48 Of note, these topics are rarely studied in oral health research.…”

“…When it comes to critically analysing research on oral health inequities, it is crucial to ask ourselves how much we have been part of the problem instead of the solution. 16,46 The omission of oppression from our theoretical models, for example, has supported a body of science that better describes disparities than closes gaps to advance equity.…”

How do state‐level racism, sexism, and income inequality shape edentulism‐related racial inequities in contemporary United States? A structural intersectionality approach to population oral health

“…By conceptualizing systems of oppression (e.g., racism, sexism, and classism) as independent risk factors for the unequal distribution of negative dental conditions, oral health scholars have misinterpreted the very notion of social determinants of health (8). Such misconceptions have helped portray racial health inequities as an intractable problem of modern-day societies (9,10). Focusing almost exclusively on individual-level data has, on the other hand, hampered the potential for studies to inform interventions that transcend the confines of individual responsibility for good oral health.…”