Strengthening oral health for universal health coverage

Fisher, Julian; Selikowitz, Harry-Sam; Mathur, Manu Raj; Varenne, Benoît

doi:10.1016/s0140-6736(18)31707-0

Cited by 75 publications

(70 citation statements)

References 9 publications

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“…Those interventions should include a wide range of strategies including emphasis on prevention and oral health promotion, integration of oral health into non-communicable diseases programmes, public health actions with a degree and intensity proportionate to the level of disadvantage and, more importantly, actions on the broader structural determinants of health. Our findings particularly highlight the importance of investing in education policies and universal healthcare coverage 52. Focusing only on the most disadvantaged within a society is not enough to comprehensively address health inequalities.…”

Section: Discussionmentioning

confidence: 81%

Health insurance and education: major contributors to oral health inequalities in Colombia

Guarnizo-Herreño

Watt

Garzón‐Orjuela

et al. 2019

J Epidemiol Community Health

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BackgroundHealth inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the relationship between oral health and different dimensions of socioeconomic position (SEP) in Colombia, a very unequal society emerging from a long-lasting internal armed conflict.MethodsUsing data from the last Colombian Oral Health Survey (2014), we analysed inequalities in severe untreated caries (≥3 teeth), edentulousness (total tooth loss) and number of missing teeth. Inequalities by education, income, area-level SEP and health insurance scheme were estimated by the relative index of inequality and slope index of inequality (RII and SII, respectively).ResultsA general pattern of social gradients was observed and significant inequalities for all outcomes and SEP indicators were identified with RII and SII. Relative inequalities were larger for decay by health insurance scheme, with worse decay levels among the uninsured (RII: 2.57; 95% CI 2.11 to 3.13), and in edentulousness (RII: 3.23; 95% CI 1.88 to 5.55) and number of missing teeth (RII: 2.08; 95% CI 1.86 to 2.33) by education, with worse levels of these outcomes among the lower educated groups. Absolute inequalities followed the same pattern. Inequalities were larger in urban areas.ConclusionHealth insurance and education appear to be the main contributors to oral health inequalities in Colombia, posing challenges for designing public health strategies and social policies. Tackling health inequalities is crucial for a fairer society in a Colombian post-conflict era and our findings highlight the importance of investing in education policies and universal health care coverage.

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Section: Discussionmentioning

confidence: 81%

Health insurance and education: major contributors to oral health inequalities in Colombia

Guarnizo-Herreño

Watt

Garzón‐Orjuela

et al. 2019

J Epidemiol Community Health

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“…UHC is defined as ‘all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’ . Although international organizations such as the United Nations, World Bank and World Health Organization have promoted UHC, oral health is often ignored . However, because oral disease is prevalent, expensive and reported all over the world, oral health should be included in UHC …”

Section: Introductionmentioning

confidence: 99%

“…Universal Health Coverage (UHC) has been promoted worldwide, 1 and recently, dental researchers have argued that its oral health aspect requires strengthening. 2 UHC is defined as 'all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship'. 3 Although international organizations such as the United Nations, World Bank and World Health Organization have promoted UHC, 4 oral health is often ignored.…”

Section: Introductionmentioning

confidence: 99%

“…2 However, because oral disease is prevalent, expensive and reported all over the world, 5,6 oral health should be included in UHC. 2 Japan's public healthcare insurance covers a wide range of dental treatments. 7 Japan achieved universal health insurance in 1961, 8 which contributed to population health outcome such as longevity and boosted social stability and equity.…”

Section: Introductionmentioning

confidence: 99%

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Does public transportation reduce inequalities in access to dental care among older adults? Japan Gerontological Evaluation Study

Kiuchi

Aida

Kusama

et al. 2019

Comm Dent Oral Epid

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Objectives Income inequalities in access to dental care have been reported worldwide. While geographical accessibility may affect inequalities, no study has examined whether the use of public transportation reduces income inequalities in access to dental care. Therefore, we examined whether the use of public transportation is associated with reduced income inequalities in access to dental care. Methods This cross‐sectional study used data from the Japan Gerontological Evaluation Study conducted in 2016. Self‐reported questionnaires were distributed to 34 567 community‐dwelling independent older adults aged 65 years or over from 39 municipalities. The dependent variable was dental attendance for any treatment. The independent variables were daily public transportation use and household equivalent income. The covariates were age, years of education, marital status, self‐rated health, number of teeth, car use, having bus stops or railway stations nearby for individual level and density of dental clinics for community level. After multiple imputation, a two‐level linear regression analysis was performed and stratified by sex. Results The mean age of the 19 664 participants (response rate: 69.9%) was 73.8 years (standard deviation = 6.1). Among the participants with dental attendance for treatment in the past six months, daily public transportation users represented 45.5% of men and 56.1% of women. These users had higher levels of dental attendance for treatment (β = .109, 95% confidence interval (CI) = 0.051‐0.166 for men, β = .094, 95% CI = 0.039‐0.149 for women) than nondaily users. Household equivalent income was positively associated with higher dental attendance for treatment (β = .046, 95% CI = 0.029‐0.062 for men, β = .029, 95% CI = 0.013‐0.045 for women). Income inequalities in access to dental care were smaller among the daily public transportation users than in nondaily users, and a statistically significant interaction was observed only in men (P‐value interactions = .025 for men, .188 for women). Conclusion Income inequalities in access to dental care were smaller among older daily users of public transportation than in nondaily users. These results suggest that providing environment in which people can conveniently use public transportation is needed for reducing income inequalities in access to dental care, especially for men.

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“…More people live with chronic oral diseases than any other health condition, with over 3.9 billion individuals affected worldwide 1 . Oral health is increasingly recognized as an essential component of overall health and therefore integral to global health efforts 2‐4 . Preparing the oral health workforce to tackle these challenges begins with education.…”

mentioning

confidence: 99%

Integrating Competency‐Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model

Yu¹,

Lambert²,

Alvarado³

et al. 2020

Journal of Dental Education

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The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency‐based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017‐18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter‐American Center for Global Health, was a five‐day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second‐year dental students completed the didactic course, and three of those students completed the experiential course. A pre‐post survey and a six‐month follow‐up survey on self‐reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty‐two students completed the pre‐post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre‐post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six‐month follow‐up. All three students reported that the experiential learning course was “extremely effective” in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency‐based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.

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Strengthening oral health for universal health coverage

Cited by 75 publications

References 9 publications

Health insurance and education: major contributors to oral health inequalities in Colombia

Health insurance and education: major contributors to oral health inequalities in Colombia

Does public transportation reduce inequalities in access to dental care among older adults? Japan Gerontological Evaluation Study

Integrating Competency‐Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model

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