Determinants of Health and their Impact on Community and Clinical Practice

For many years, both of my parents were commercial fishermen who dug clams. They did not graduate from school, but working as “clam-diggers” was a good career when it paid well, though that was not always the case. Income was dependent on the season, and the availability and quality of the clams. Eventually, this field of work became insufficient for income as prices dropped, legal digging openings became limited, and my dad’s back suffered. We did not always have medical or dental insurance for a good portion of my life, but my parents always ensured that my brother and I would see a dentist twice a year, despite not going themselves. The determinants of health have affected access to dental care, and oral health status for my parents. Income, education, work environment, and health practices are all determinants of health, including oral health.(1)

Up until entering university in the dental field, I had never considered why my family did not access dental care regularly. Oral health complications did not occur as frequently as might have been expected, but it seemed as if my parents would only go to our dentist if they were experiencing pain. According to Newman and Gift,(2) regular preventative dental care was accessed by people who had dental insurance, were high school graduated, and had no cost barriers. Without education, insurance, and steady income, paucity of dental visits by my parents confirms these findings. With an increase in education and income there was an increase in the probability of seeking preventative care. This is unfortunate considering that income and education are linked to oral health status with the burden of disease being heaviest on those with low socioeconomic status.(3)

The role of dental hygienists as advocates is something I feel very strongly about because I have personally witnessed how education and money act as barriers to dental care. Advocating for those who suffer poorer oral health based on circumstances outside their control is crucial for removing those barriers to care. If one is to be a competent health care provider who strives to eradicate health disparities, one must not be judgmental of others based on life circumstances. Being judgmental may lead to variance in quality and type of services provided by the practitioner. In a study by Brennan and Spencer,(4) variations in service provision for dental care were found to be associated with factors unrelated to oral health. Their findings suggested that better service is given to those with higher socioeconomic status. If the quality and types of services are being affected by judgments of socioeconomic status, it is important for the dental hygienist to act as an advocate in the clinic and community so that the needs of people of all backgrounds are met.

For both clinical and community practice it is important to be aware of the determinants of health and how they create health differences, and of any stereotypes one may hold so that everyone receives equal and optimal care. Being in university has educated me on socioeconomic status and determinants of health, topics for which I have been developing a passion. Dental hygiene gives me an opportunity to express my passion as an advocate, for having the option to work in the community, and having the ability to offer more accessible oral health care. To be competent in clinical and community practice, I must be prepared to deal with ethical issues based on quality/quantity of care for someone who needs may not be met due to money. Despite having minimal client experience, all of my clients do not have dental insurance and chose UBC as an inexpensive means to oral health. Now is the time to advocate and work toward making the health disparities caused by the determinants of health to disappear.

References

1. Mikkonen J. Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management; 2010.

2. Newman JF, Gift HC. Regular pattern of preventive dental services – A measure of access. Soc Sci Med 1992; 35(8):997-1001.

3. Timis T, Danila I. Socioeconomic status and oral health. J Prev Med 2005; 13(1):116-121.

4. Brennan DS, Spencer AJ. Influence of patient, visit, and oral health factors on dental service provision. J Pub Health Dent 2007; 62(3):148-157.