Inclusion oral health: Advancing a theoretical framework for policy, research and practice

Abstract

In response to headlines about the oral health of persons experiencing social exclusion resonating in highincome countries, and research demonstrating the need for urgent action, a symposium entitled 'International Perspectives on Socially Inclusive Dentistry: A Call to Action' was organized for the IADR International Meeting of 2018. The aim of the symposium was to initiate an international dialogue on barriers to care, multidisciplinary action, and examples of best practice for service delivery for people experiencing social exclusion; in other words, to develop the idea of inclusion oral health. Through our international exchange, what emerged was an awareness of a lack of professional consensus: What exactly is inclusion oral health? A theoretical framework to push forward the policy, research and practice agenda was clearly needed. This paper advances such a framework. Over the decades, dentistry has forged an approach to service delivery mainly through a business, demand-led model. While oral health continues to improve globally, an important consequence of this approach is that it compounds the social exclusion that many people are already experiencing because of a constellation of economic, political, cultural and individual factors. Thus, many people are simply not getting the dental care they need. In contrast, drawing on the theoretical literature on social exclusion, intersectionality and othering, we suggest that dentistry could act as an agent for social inclusion as a more responsive, all-encompassing form of oral health care and delivery. This paper advances a theoretical framework for inclusion oral health and an action plan to show how inclusion oral health may become one solution in an armamentarium to tackle the global phenomena of oral health inequities.

Depression, drugs and dental anxiety in prisons: A mediation model explaining dental decay experience

“…Secondly, it encourages multidisciplinary working between healthcare providers, the prison estate and social care. This is of some importance with regard to the promotion of inclusion oral health and the incorporation of oral health into health and social care policy to ensure that the oral health and psychosocial needs of prison populations are more adequately met …”

Determinants Of Adherence To Dental Treatment Of Socially Vulnerable Adolescents In Primary Health Care: A Cohort Study

“…It is worth noting that the inclusion of socially vulnerable individuals in dental care does not depend exclusively on the organization of services. Even in public dental services, there must be planning coordinated with social care [13].…”

“…Thus, it is important that the health system makes access to treatment of oral diseases that affect the adolescents' health available, especially among those that are socially vulnerable [13]. In Brazil, the Uni ed Health System, by means of Primary Health Care, abides by its principle of tackling inequalities in service provision, providing health care service, including dental care, in more deprived localities [14].…”

Promoting Inclusion Oral Health: Social Interventions to Reduce Oral Health Inequities

“…Returning to the framework of inclusion oral health [5], the papers by Beaton et al [11] and Rodriguez et al [12] on homelessness and Lambert [13] and Yuan [14] on undocumented migrants reflect the very essence of inclusion oral health. The requirement for mixed-methods research to include the voice of experts by experience in the research process is no clearer illustrated than in the papers of Beaton et al [11] and Rodriguez et al [12].…”

“…Inclusion oral health focuses on developing innovative inter-sectoral solutions to tackle the inequities of people enduring extreme oral health". [5] Underpinned by social exclusion, intersectionality, and othering theory, and the proposition that current dental systems acted as drivers for exclusion rather than inclusion, Freeman et al [5] postulated a framework to promote oral health inclusion. This framework called for the following: the integration of health and social care policies to drive social justice and reduce prejudice and stigma; and the co-design and co-production of strategies formulated with and for people experiencing exclusion and the planning of "innovative, inter-sectorial services to promote inclusion" [5].…”