BY NAVITA SINGH & ANJUM SULTANA
Canadians owe much to Tommy Douglas – a fierce leader who fought to establish a universal health care system in Saskatchewan and later have it spread across the country. Our universal health care system is a source of national pride for many Canadians – yet it is not as comprehensive as we imagine it to be. Unfortunately, the services currently covered in our Medicare are limited to only physician and hospital services. We are only in the first stage of Medicare, which focuses mainly on treating people who are sick and removing financial barriers to care. Many advocates are pushing for this to be expanded to the second stage, with an increased emphasis on keeping people well and reorienting the entire health care delivery model to focus on primary and preventive care, interprofessional practice, democratic governance of health care systems through community boards, and expanding the types of services covered. To elaborate, it would include initiating coverage of services such as, pharmacare, home care and dental care, among others.
Dental care is often forgotten in discussions of health care and its connection to overall health is not widely known, even though several studies have explicated links to diabetes, cardiovascular disease, pneumonia and Alzheimer’s disease1. It has been shown that nations with private dental care systems have poor equity and access to services for marginalized and vulnerable populations, and Canada is no exception. Canada has one of the world’s best dental care delivery systems, yet close to one third of residents do not have public or private coverage for dental care1. Approximately 6 million Canadians avoid going to the dentist altogether due to cost2. This is not surprising since only 5% of the 12.6 billion dollars spent on dental care in the country is publicly financed1, while the rest is paid out of pocket or through a patchwork of private employer-provided insurance that is only available to some. Access to this essential service should not be based on where you work but should be guaranteed as with other human rights.
What has been seen with dental care usage is a great deal of inequity – those who need it the most are the ones that have the greatest barriers in accessing care2. This is precisely what is contributing to overall low levels of oral health in certain populations. These populations are quite vulnerable, often marginalized, and include those with low incomes, young children in low income families, those working without dental insurance, elderly people living in institutions or with low incomes, aboriginal peoples, refugees and immigrants, those with disabilities, and people living in rural and remote region2. In summary, vulnerable groups in Canada are the least likely to have some form of dental insurance, are less likely to visit the dentist due to financial barriers, are more likely to only consult dentists in times of emergencies, have greater likelihood to have untreated dental decay, gum diseases, missing teeth and dental pain and as a result, are more likely to avoid eating healthy foods due to oral health problems, leading to other health conditions2. How is this possible in a nation that purports to have universal healthcare coverage?
Health is a human right, and yet many Canadian residents remain unable to access affordable dental health services. This is in spite of the fact that it has been known how intricately connected oral health is to other aspects of one’s overall health. It is disturbing that oral health is not granted the significance it deserves. Anyone who has ever had the misfortune of experiencing a toothache knows how much oral health matters. More than just having an impact on one’s overall physical health, diseases of the mouth have a profound impact on one’s life. Due to the damaging impact of these diseases on one’s physical appearance, self-confidence, and well-being, there are negative impacts on the ability of an individual to have gainful employment, to be productive, to fulfill family obligations, and to have peace of mind.
It is unfortunate that when it comes to human rights, it is the vulnerable populations who have their rights trampled on the most, though there is data to show a gradient effect of high cost on dental care access. Middle income Canadians, as well as seniors on fixed incomes, also suffer the ill effects of reduced access. Dental health care is treated as a luxury for the privileged who can afford it. We need to stop treating dental health as a luxury, and treat it instead as the basic health necessity that it is. Moreover, we need to place a special emphasis on prevention–not just so that oral diseases do not get out of control, but also so that other bodily diseases do not develop. We find it unacceptable that people should have untreated diabetes or heart disease, and yet it is somehow acceptable for the oral diseases to be left
At the core of public health is a commitment to advancing health equity and ensuring equitable access to dental services for all people in Canada–a commitment that aligns strongly with the central mission of global health. Advocates have demonstrated the impact establishing a universal dental care system will have on saving money, facilitating access and improving health outcomes for all. We have made glacial progress in improving dental care for some but we do not have the luxury of time. We need to demand more from our governments and also from each other.
The federal election campaign period is a good time as any to work collectively to advocate for improving access and equity of dental care in this nation. Earlier this year, the Association for Ontario Health Centres (AOHC) hosted the Oral Health Forum, which was creatively titled – ‘Needed: A Tommy Douglas for Dental Health’. Individuals from varied backgrounds; including dentists, nurses, community members, students, and other officials; converged to discuss how to mobilize a movement for universal dental health coverage. If you are interested in taking immediate action, the Association of Ontario Health Centres has set up a petition to call on the Minister of Health of Ontario to extend public health coverage for oral health services in the province.
Navita Singh is a Masters of Public Health student at the Dalla Lana School of Public Health, the Co-President of the Public Health Students’ Association (PHSA), and the Co-Chair for the Graduate Student Alliance for Global Health (GSAGH), an interdisciplinary student-led global health initiative affiliated with the University of Toronto. Follow her on Twitter at “@nav_ess”!
Anjum Sultana is a Masters of Public Health student at the Dalla Lana School of Public Health and Executive Co-Director for IMAGINE, an student-run clinic and interprofessional health promotion initiative affiliated with the University of Toronto. Follow her on twitter at “@anjumsultana”!
- Canadian Centre for Policy Alternatives. (2011). Putting Our Money Where Our Mouth Is: The Future of Dental Care in Canada. Retrieved from: https://www.policyalternatives.ca/publications/reports/putting-our-money-where-our-mouth
- Canadian Academy of Health Sciences. (2014). Improving access to oral health care for vulnerable people living in Canada. Retrieved from: http://www.cahs-acss.ca/wp-content/uploads/2014/09/Access_to_Oral_Care_Executive_Summary_and_Recommendations_EN.pdf
Image: “Dental Hygiene Area” by José M. Osorio for Chicago Dental Society. CC 2.0.