Universal health coverage, oral health, equity and personal responsibility

Wang, Tim T.; Mathur, Manu Raj; Schmidt, Harald

doi:10.2471/blt.19.247288

Cited by 48 publications

(61 citation statements)

References 6 publications

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“…However, UHC does not imply access to oral health care as not all countries that provide UHC coverages include oral health care in the health packages [19]. Among those countries that have integrated oral health care elements into UHC, many exclude preventive oral health care as this is considered a non-essential service [20]. Other reasons for its exclusion are low prioritization of oral health in many countries, the belief that oral health is an individual responsibility rather than social responsibility, and the high cost of dental services [21].…”

Section: Introductionmentioning

confidence: 99%

“…Among those countries that have integrated oral health care elements into UHC, many exclude preventive oral health care as this is considered a non-essential service [20]. Other reasons for its exclusion are low prioritization of oral health in many countries, the belief that oral health is an individual responsibility rather than social responsibility, and the high cost of dental services [21]. It is, therefore, important to assess not only how UHC may affect the risk of ECC but also to determine if countries' health expenditure is associated with ECC.…”

Section: Introductionmentioning

confidence: 99%

“…We postulate that health expenditures may be associated with family income as the lower a government's health expenditures, the higher the out-of-pocket expenditures on health by families. When the costs of oral health care are high, families with limited financial means face additional financial stress because they cannot afford care [20]. Conversely, when government health expenditure is high, it is believed that children's health and wellbeing improve, and children are protected against diseases that otherwise increase the risk of ECC [22].…”

Section: Introductionmentioning

confidence: 99%

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An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

et al. 2021

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Background Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC. Methods Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated. Results Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05). Conclusions Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

et al. 2021

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“…Decision makers and health planners do not automatically include oral health care when defining and designing essential health care services at a macro level. Instead, dental care is oftentimes seen as a separate, private responsibility with partial or full private financing ( Wang et al 2020 ). This occurs despite the major burden of oral diseases worldwide, their significant impact on health, well-being, and economies at large.…”

Section: What Is Essential (Oral) Health Care?mentioning

confidence: 99%

“…We argue that on a macro health care system level, oral health care should be an integral part of essential health care services. In fact, in many countries around the world, health systems cover oral health care and make no distinction between oral and general health care ( Wang et al 2020 ). However, which interventions are part of essential oral health care, prioritized or excluded varies greatly and is determined by national authorities, ideally with local needs and resources in mind.…”

Section: What Is Essential (Oral) Health Care?mentioning

confidence: 99%

Pandemic Considerations on Essential Oral Health Care

et al. 2020

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The coronavirus disease 2019 (COVID-19) pandemic revealed a lack of consensus on the concept of essential oral health care. We propose a definition of essential oral health care that includes urgent and basic oral health care to initiate a broader debate and stakeholder alignment. We argue that oral health care must be part of essential health care provided by any health system. Essential oral health care covers the most prevalent oral health problems through an agreed-on set of safe, quality, and cost-effective interventions at the individual and community level to promote and protect oral health, as well as prevent and treat common oral diseases, including appropriate rehabilitative services, thereby maintaining health, productivity, and quality of life. By default, essential oral health care does not include the full spectrum of possible interventions that contemporary dentistry can provide. On the basis of this definition, we conceptualize a layered model of essential oral health care that integrates urgent and basic oral health care, as well as advanced/specialist oral health care. Finally, we present 3 key reflections on the essentiality of oral health care. First, oral health care must be an integral component of a health care system’s essential services, and by implication, oral health care personnel are part of the essential health care workforce. Second, not all dental care is essential oral health care, and not all essential care is also urgent, particularly under the specific risk conditions of the pandemic. Third, there is a need for criteria, evidence, and consensus-building processes to define which dental interventions are to be included in which category of essential oral health care. All stakeholders, including the research, academic, and clinical communities, as well as professional organizations and civil society, need to tackle this aspect in a concerted effort. Such consensus will be crucial for dentistry in view of the Sustainable Development Goal’s push for universal health coverage, which must cover essential oral health care.

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The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories

Cunha

Compton

et al. 2023

JAMA Oncol

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ImportanceLip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.ObjectiveTo analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence ReviewThe incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.FindingsIn 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and RelevanceIn this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

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Universal health coverage, oral health, equity and personal responsibility

Cited by 48 publications

References 6 publications

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

Pandemic Considerations on Essential Oral Health Care

The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories

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