Similar to the definition of inequalities, oral health inequalities are disparities in oral health that are unfair and preventable. This is especially true of the dental health conditions we aim to minimise in dental public health and through Childsmile. Oral health inequalities remain a significant challenge. Figure X shows data for the proportion of five-year old children with no obvious decay experience by the Scottish Index of Multiple Deprivation (SIMD) quintiles (NDIP, 2018). Quintile SIMD1 is the most deprived and quintile SIMD5 is the least deprived.
Despite improvement in all groups over recent years, there are clear and persistent inequalities in child dental health over time, indicating that tackling child dental health inequalities should remain the clear focus for the Childsmile programme. Above demonstrates the change from 2012 to 2020 in the percentage of P1 children in Scotland with no obvious decay experience by deprivation quintile.
What kind of interventions are effective for addressing health inequalities?
- legislative and regulatory controls (e.g. influence nutrition guidelines for education)
- fiscal policies (e.g. introduce payment for prevention to work to dental contract)
- structural changes to the environment (e.g. water fluoridation
- target children when they are young (e.g. work with health visitors and nurseries)
- community based action and engagement (e.g. local voluntary sector services)
- improve access to services and support (e.g. support families to attend dental practice)
- prioritise disadvantaged populations (e.g. those with highest needs get most support)
What kind of interventions have the potential to widen health inequalities?
- mass media information campaigns
- written materials (e.g. poster campaigns)
- campaigns reliant on people taking the initiative to opt in
- whole population health education campaigns
Watt, 2007 illustrates how these interventions are considered to be on an upstream/downstream continuum with the upstream and midstream activities having the greatest potential for helping to reduce oral health inequalities. We can overlay Childsmile programme activities onto this concept to understand how Childsmile is structured to address oral health inequality.
Main Childsmile interventions within the upstream/downstream continuum has been adapted from Childsmile after 10 years part 2: programme development, implementation and evaluation Macpherson, Rogers and Conway.