Structural Determinants and Children’s Oral Health: A Cross-National Study

Abstract

Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.

Caries severity and socioeconomic inequalities in a nationwide setting: data from the Italian National pathfinder in 12-years children

“…Both macroeconomic indicators (GNP per capita, Gini Index and Unemployment rate) and individual socioeconomic indicators (nationality, educational level, working status and smoking habits) were significantly correlated to caries presence and severity and to the prevalence of restorations due to caries. Measures of economic resources, such as per capita GDP, have an important role on population health through multiple factors as welfare, higher standard of living or educational provide 19 . Worse macroeconomic indicators such as high Unemployment rate were associated with higher child mortality rates, underlying the harmful effects of the macroeconomic crises on children health 38 .…”

“…The lack of adequate oral hygiene habits, the www.nature.com/scientificreports/ higher consumption of cariogenic foods and the non-regular dental check-ups might be the main reasons associated to the poor oral heath recorded in children living in low income and high inequality areas of the Country. Dental caries and socioeconomic inequalities are under scrutiny several times 2,19,30 in different age and population groups 9,18,47 but the discriminating factors leading and linked to different stages of the disease are still unclear. In toddlers and kindergarten children, socioeconomic factors are found to be associated with the inequalities in caries distribution 48 .…”

Governance, maternal well-being and early childhood caries in 3–5-year-old children

“…There are limited studies on how human rights indicators and public oral health indicators interact to affect oral health. Understanding these interactions might promote global health responses that advocate for democratic governances [30] and respect for human rights.…”

Why UK dental education should take a greater interest in the behavioural and social sciences

“…Consequently, there is a difficulty with all things inherently 'social' or complex: 'the social context [is seen as] as a problem of confounding to be disentangled in order to achieve objectivity'(p. 135). 58 The preference for individual factors alone to explain oral health and inequalities 59 is a shortcoming of dental education because it ignores the inherent complexity of oral health, something that is fundamentally multifactorial and socially determined. 32,58 By aligning itself with an individualist approach to oral health, dental education does not equip dental students with the tools, methods and framework needed for delivering long-term and sustainable change in health outcomes.…”