Objective To examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country ...with high levels of inequality emerging from a long internal armed conflict. Methods Using birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively). Results Among the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits. Conclusion The lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.
Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now ...needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.
Oral diseases: a global public health challenge Peres, Marco A; Macpherson, Lorna M D; Weyant, Robert J ...
The Lancet (British edition),
07/2019, Volume:
394, Issue:
10194
Journal Article
Peer reviewed
Open access
Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential ...oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.
Objectives
To assess whether eligibility for an age‐related universal (pioneer generation PG) subsidy incentivises dental attendance by older Singaporeans.
Methods
Data were collected between 2018 ...and 2021 from in‐person interviews of Singaporean adults aged 60–90 years using a questionnaire and a clinical examination. The questionnaire included details of age, gender, ethnicity, education, residential status, socio‐economic status, marital status, eligibility for subsidy (community health assistance/CHAS, PG or both) and frequency of dental attendance. The clinical examination recorded number of teeth (categorized as edentulous, 1–9 teeth;10–19 teeth; ≥20 teeth). To estimate the effect of the PG subsidy on dental attendance pattern, a regression discontinuity (RD) analysis was applied using age as the assignment variable.
Results
A total of 1172 participants aged 60–90 years (64.2% female) were recruited, with 498 (43%) being eligible for the PG subsidy. For those eligible for PG subsidy, there was a higher proportion of regular attenders than irregular attenders (53.6% vs. 46.4%). In age adjusted RD analysis, those eligible for the PG subsidy were 1.6 (95% CI: 1.0, 2.7) times more likely to report regular attendance than their PG non‐eligible counterparts. The association remained strong (OR 2.1; 95% CI: 1.1–3.7) even after further controlling for demographics, socioeconomic factors, number of teeth and eligibility for the CHAS subsidy.
Conclusions
Being eligible for the PG subsidy substantially increased the odds of regular dental attendance.
Oral conditions are a public health problem globally and stark oral health inequalities exist between and within countries. Yet, oral diseases are rarely considered as a health priority and ...evidence‐informed policy generation is challenging. Science communication and health advocacy are critical in that respect. However, due to time limitations, research workload and other factors, academics are usually hindered from participating in such lengthy endeavours. Here, we make the case that ‘science communication and health advocacy task forces’ should be a priority at academic institutions. The two main duties of these task forces are knowledge transfer about the burden of oral conditions and patterns of inequalities, and their underlying social and commercial determinants, and advocacy and mediation between the stakeholders involved directly or indirectly in policy making. These interdisciplinary task forces, including both academics and non‐academics, should collectively have skills that include (1) knowledge about oral health, dental public health and epidemiology, (2) ability to communicate clearly and coherently and make the case in both lay and scientific language terms, (3) familiarity with digital and social media platforms and ability to create visual aids, videos and documentaries, (4) good negotiation skills and (5) maintaining scientific transparency and avoiding getting involved in confrontation with political parties. In the current context, the role of the academic institutions should not only be the production of knowledge, but also the active transferability and application of this knowledge towards public benefit.
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID‐19 pandemic has magnified previously existing inequalities and created new ...ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory‐driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co‐design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision‐making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
The objective of this study was to assess socioeconomic inequalities in subjective measures of oral health in a national sample of adults in England, Wales and Northern Ireland.
We analysed data from ...the 2009 Adult Dental Health Survey for 8,765 adults aged 21 years and over. We examined inequalities in three oral health measures: self-rated oral health, Oral Health Impact Profile (OHIP-14), and Oral Impacts on Daily Performance (OIDP). Educational attainment, occupational social class and household income were included as socioeconomic position (SEP) indicators. Multivariable logistic regression models were fitted and from the regression coefficients, predictive margins and conditional marginal effects were estimated to compare predicted probabilities of the outcome across different SEP levels. We also assessed the effect of missing data on our results by re-estimating the regression models after imputing missing data.
There were significant differences in predicted probabilities of the outcomes by SEP level among dentate, but not among edentate, participants. For example, persons with no qualifications showed a higher predicted probability of reporting bad oral health (9.1 percentage points higher, 95% CI: 6.54, 11.68) compared to those with a degree or equivalent. Similarly, predicted probabilities of bad oral health and oral impacts were significantly higher for participants in lower income quintiles compared to those in the highest income level (p < 0.001). Marginal effects for all outcomes were weaker for occupational social class compared to education or income. Educational and income-related inequalities were larger among young people and non-significant among 65+ year-olds. Using imputed data confirmed the aforementioned results.
There were clear socio-economic inequalities in subjective oral health among adults in England, Wales and Northern Ireland with stronger gradients for those at younger ages.
Objective
To assess the extent to which behavioural factors, including those related to dental care, account for oral health inequalities in different European welfare state regimes.
Methods
Data ...from the Eurobarometer 2009 survey were analysed. Nationally representative samples of dentate adults aged ≥45 years (n = 9979) from 21 European countries classified into the five welfare regimes (Scandinavian, Anglo‐Saxon, Bismarckian, Southern, Eastern) were considered. Inequalities in no functional dentition (having <20 natural teeth) by education and occupation were identified using the Relative and Slope Indices of Inequality (RII and SII, respectively). The percentage reduction in RII and SII was calculated from regression models before and after adjustment for behaviours, first one at a time and then all together.
Results
Behaviours explained 21.0% (95% CI 8.7, 31.4) and 13.1% (95% CI 7.9, 33.2) of educational inequalities in no functional dentition (RII) in the Scandinavian and Eastern regimes, respectively. For occupational inequalities, the attenuations in RII in these welfare regimes were 19.3% (95% CI 7.1, 24.2) and 10.5% (95% CI 3.4, 22.5), respectively. Attenuations were weaker and nonsignificant in the Bismarckian, Anglo‐Saxon and Southern regimes. Among the behaviours analysed, alcohol consumption was particularly relevant in explaining inequalities in the Scandinavian regime, and this was confirmed in sensitivity analyses through three‐way cross‐level interaction terms in multilevel models. Behaviours related to dental care produced similar, consistent attenuations in the Scandinavian and Eastern regimes for both socioeconomic indicators. SII findings showed a similar picture.
Conclusion
The role of particular behaviours in explaining oral health inequalities could be heterogeneous across European welfare regimes, indicating that their importance might be influenced by the general approach to social policies.
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