From victim blaming to upstream action: tackling the social determinants of oral health inequalities

Community Dentistry and Oral Epidemiology - Tập 35 Số 1 - Trang 1-11 - 2007
Richard G. Watt1
1Department of Epidemiology and Public Health, University College London, London, UK

Tóm tắt

Abstract – The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high‐risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural ‘downstream’ approach, to one addressing the ‘upstream’ underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.

Từ khóa


Tài liệu tham khảo

10.1177/109019819402100109

Schou L, 1994, Oral health: a review of the effectiveness of health education and health promotion

10.1111/j.1600-0528.1996.tb00850.x

Sprod A, 1996, Effective oral health promotion. Literature review

Kay L, 1997, A systematic review of the effectiveness of health promotion aimed at promoting oral health

10.1111/j.1600-0757.2004.03796.x

World Health Organization, 1986, The Ottawa charter for health promotion. Health promotion 1, i

Dahlgren G, 1991, Policies and strategies to promote social equity in health

10.4324/9780203421680

Graham H, 2000, Understanding health inequalities

Marmot M, 2006, Social determinants of health

10.1016/S0140-6736(05)71115-6

Chen M‐S, 1995, Disease prevention and oral health promotion: socio‐dental sciences in action, 153

Watt RG, 1998, Inequalities in oral health: a review of the evidence and recommendations for action, Br Dent J, 187, 6, 10.1038/sj.bdj.4800191a

Nutall N, 2003, Prevention of oral disease, 221

10.1034/j.1600-0528.2000.280301.x

10.1111/j.1600-0528.1984.tb01401.x

10.1111/j.1600-0528.1986.tb01494.x

10.1111/j.1600-0528.1996.tb00822.x

10.1111/j.1600-0528.1994.tb01808.x

10.1111/j.1600-0528.1995.tb00248.x

10.1016/0140-6736(91)93068-K

Macintyre S, 1994, Understanding the social patterning of health: the role of the social sciences, J Public Health Med, 16, 53, 10.1093/oxfordjournals.pubmed.a042936

10.1111/j.1749-6632.1999.tb08101.x

10.1016/S0140-6736(03)13917-7

10.1016/S0140-6736(05)71146-6

10.1001/jama.295.17.2037

Whitehead M, 1990, The concepts and principles of equity and health

Morris AJ, 2001, A guide to the UK adult dental health survey 1998, 47

10.1016/S0140-6736(02)11602-3

10.1111/j.1600-0528.2004.00173.x

10.1111/j.1600-0528.2006.00271.x

10.1111/j.1600-0528.2006.00261.x

10.2105/AJPH.86.5.678

10.1093/oxfordjournals.ije.a019905

WHO Task Force on Research Priorities for Equity in Health and WHO Equity Team, 2005, Priorities for research to take forward the health equity policy agenda, Bull World Health Organ, 83, 948

10.1111/j.1600-0528.2004.00159.x

Dahlgren G, 1991, Policies and strategies to promote social equity in health

10.1016/0277-9536(94)90399-9

10.1006/pmed.1999.0540

10.2307/3090192

Jarvis MJ, 2006, Social determinants of health, 1

Kuh D, 1997, A life course approach to chronic disease epidemiology, 10.1093/oso/9780192627827.001.0001

Rose G, 1992, Strategy of preventive medicine

10.1111/j.1600-0528.2005.00231.x

10.1034/j.1600-0722.2001.00022.x

Watt RG, 2004, Promovendo Saude Buccal na Infancia e Adolescencia

Pine CM, 2004, Developing explanatory models of health inequalities in childhood dental caries, Community Dent Health, 21, 86

10.1111/j.1600-0528.2004.00190.x

10.1177/001789690005900408

10.1034/j.1600-0528.2002.300401.x

10.1136/jech.45.4.270

10.4278/0890-1171-15.2.107

Sanders AE, 2005, Clustering of risk behaviours for oral and general health, Community Dent Health, 22, 133

10.1111/j.1600-0757.2005.00115.x

Aleksejeuniene J, 2002, Psychosocial stress, lifestyle and periodontal health. A hypothesised structural equation model, J Clin Periodontol, 29, 1012

10.1034/j.1600-051X.2002.291106.x

Friere M, 2001, Adolescents’ sense of coherence and their adolescent children's oral health status and behaviour, Community Dent Health, 29, 204

Friere M, 2002, Mothers’ sense of coherence and their adolescent children's oral health status and behaviour, Community Dent Health, 19, 24

10.1016/0277-9536(92)90054-T

10.1159/000072162

10.1046/j.0303-6979.2003.00424.x

10.1034/j.1600-0528.2003.t01-1-00019.x

10.1016/S0140-6736(02)11602-3

10.1111/j.1600-0528.2005.00237.x

Basu S, Aids, empire and public health behaviourism. Equinet‐newsletter August 2003

Towner E, 1993, Oral health promotion, 1

10.1016/0277-9536(93)90202-F

Syme L, 1996, Health and social organisation: towards a health policy for the 21st century, 21

10.1001/jama.1982.03330120023025

Blackburn H, 1984, Behavioural health: a handbook of health enhancement and disease prevention, 1171

10.1016/0091-7435(86)90081-2

Farquhar JW, 1990, Effects of community wide education of cardiovascular risk factors: the Stanford Five‐City Project, JAMA, 264, 359, 10.1001/jama.1990.03450030083037

Schou L, 1994, Does dental health education affect inequalities in dental health, Community Dent Health, 11, 97

Sogaard A, 1996, Oral health promotion, 25

10.1111/j.1559-1816.1998.tb01679.x

10.1136/bmj.326.7400.1175

Crombie IK, 2004, Closing the health inequalities gap: an international perspective

Hogstedt H, 2004, The Swedish public health policy and the National Institute of Public Health, Scand J Public Health, 32, 1

Sheiham A, 1992, Risk markers for oral diseases, dental caries: markers of high and low risk groups and individuals, 445

10.1034/j.1600-0528.2002.00057.x

10.1038/sj.bdj.4813724

10.1016/S0140-6736(97)09494-4

10.1034/j.1600-0528.2000.280104.x

10.1046/j..2003.com122.x

Watt RG, 2005, Strategies and approaches in oral disease prevention and health promotion, Bull World Health Organ, 83, 711

World Health Organisation, 1998, Health promotion evaluation: recommendations to policy makers

World Health Organisation, 1980, Risk factors and comprehensive control of chronic diseases

10.1034/j.1600-0528.2000.028006399.x

Joossens L, 2004, Effective tobacco control policies in 28 European countries, European Network for Smoking Prevention

World Health Organisation, 2003, WHO Framework Convention on Tobacco Control

Lang T, 2006, The food industry, diet, physical activity and health: a review of reported commitments and practice of 25 of the world's largest food companies

Caroline Walker Trust, 2006, Nutritional guidelines for under 5’s in child care. Report of an expert working group

World Health Organisation, 1998, Health Promoting Schools: a healthy setting for living, learning and working

10.1093/heapro/dag016

Malikaew P, 2003, Association between school environments and traumatic dental injuries, Oral Health Prev Dent, 4, 255

Department of Health, 2005, Choosing better oral health: an oral health plan for England