Oral health care: a necessary public good--now and into the future; A brief submitted to the house of commons standing committee on finance, August 15, 2007./Soins de sante buccodentaire: un bien collectif necessaire aujourd'hui et dans l'avenir.SOMMAIRE L'Association canadienne des hygienistes dentaires (ACHD ACHD Ada County Highway District (Idaho, USA) ACHD Allegheny County Health Department ACHD Albany County Health Department (Albany, NY) ) tient a attirer l'attention sur la mauvaise sante buccodentaire d'une partie considerable de la population canadienne et demande que le gouvernement federal considere l'offre de programmes de promotion de la sante buccodentaire et de prevention des maladies buccodentaires comme un bien collectif pour des groupes specifiques, soit les enfants, les personnes agees, les personnes ayant un handicap et les personnes a faible revenu. De nombreux facteurs justifient la necessite d'ajouter les soins de sante buccodentaire a la liste des biens collectifs, notamment l'ecart grandissant des revenus au Canada, le taux croissant de la carie chez chez prep. At the home of; at or by. [French, from Old French, from Latin casa, cottage, hut.] chez prep at the home of [French] les jeunes enfants et la reduction de la couverture Noun 1. couverture - chocolate that contains at least 32 percent cocoa butter chocolate - a food made from roasted ground cacao beans de soins dentaires assuree aux personnes retraitees. Dans son memoire, l'ACHD evoque des cas troublants qui sont autant de plaidoyers en faveur de sa demande. Elle mentionne entre autres le drame humain vecu par un jeune homme de 25 ans stigmatise Verb 1. stigmatise - to accuse or condemn or openly or formally or brand as disgraceful; "He denounced the government action"; "She was stigmatized by society because she had a child out of wedlock" stigmatize, brand, denounce, mark et incapable de se trouver du travail TRAVAIL. The act of child-bearing. 2. A woman is said to be in her travail from the time the pains of child-bearing commence until her delivery. 5 Pick. 63; 6 Greenl. R. 460. 3. a cause d'un grave probleme de carie dentaire qui ne lui laissait que deux dents saines; celui d'un autre homme devenu aveugle apres qu'une infection dentaire se soit propagee jusqu'aux yeux parce qu'il n'avait pas les moyens de se payer le traitement approprie; et le cas tragique d'un enfant qui est decede parce qu'une infection a une dent s'etait propagee jusqu'au cerveau. Ce memoire retrace egalement les demarches repetees entreprises aupres du gouvernement pour une prise en charge dans le domaine de la sante buccodentaire. Les premieres demandes ont ete faites des 1964, lors de la Commission royale d'enquete sur les services de sante et, aujourd'hui encore, un nombre croissant de coalitions en sante buccodentaire reclament un systeme de soins de sante qui donne la priorite a la prevention. L'ACHD recommande que le gouvernement federal prenne les mesures suivantes pour garantir que la promotion de la sante buccodentaire et la prevention des maladies buccodentaires deviennent un bien collectif: * Travailler en collaboration avec les provinces et les territoires pour assurer le leadership, les politiques et le financement (36 % des depenses totales en sante buccodentaire, soit 3 579 millions de dollars) necessaires a la mise en place Mise en place (IPA pronunciation: [miz eñ 'plass]), literally translated from French, means "setting in place." Culinary Institute of America describes the term as "Everything in place". de programmes de promotion de la sante buccodentaire et de prevention des maladies buccodentaires a l'intention des Canadiens et des Canadiennes a faible revenu, y compris ceux et celles qui recoivent des prestations d'aide sociale et ceux et celles qui travaillent, les enfants, les personnes ayant un handicap et les personnes agees; * Accorder le statut de programme complet a l'Initiative en sante buccodentaire des enfants, un programme destine des·tine tr.v. des·tined, des·tin·ing, des·tines 1. To determine beforehand; preordain: a foolish scheme destined to fail; a film destined to become a classic. 2. aux Premieres Nations et aux Inuits. EXECUTIVE SUMMARY THE CANADIAN DENTAL HYGIENISTS ASSOCIATION (CDHA CDHA Capital District Health Authority CDHA Canadian Dental Hygienists Association CDHA California Dental Hygienists' Association CDHA Center for Demography of Health and Aging CDHA Connecticut Dental Hygienists' Association ) highlights the poor oral health of a considerable portion of the Canadian population and requests that the federal government consider providing oral-health promotion and disease prevention as a public good for specific groups of citizens, including children, seniors, persons with disabilities and low-income individuals. A widening income gap in Canada, an increasing rate of early childhood caries Early childhood caries, also known as baby bottle caries and baby bottle tooth decay, is a syndrome characterized by severe decay in the teeth of infants or young children. and a reduction in retirees' dental benefits are some of the factors supporting the need for the government to add oral-health care to the list of public goods. Compelling support for this request comes from the stories of individuals. A 25-year-old experienced social stigma and could not find work due to severe dental decay that left him with only two healthy teeth. A man who could not afford dental treatment suffered blindness related to a dental infection that spread to his eyes. There is also a tragic story of a child who died because of a tooth infection that spread to his brain. This brief also documents the history of appeals to the government for responsibility in the area of oral-health care, from the 1964 Royal Commission on Health Services health services Managed care The benefits covered under a health contract to the current, growing number of oral-health coalitions calling for a health-care system that puts prevention first. ESTABLISHING THE NEED FOR ORAL-HEALTH CARE For the most part, oral-health care in Canada is fee-for-service, with a small number of low-cost clinics and a patchwork of municipalities that offer limited public-health programs. The current fee-for-service, private-practice delivery model does not ensure adequate oral health for a sizeable portion of the population, including many low-income families, seniors who have lost their dental benefits and persons with disabilities. A joint Canada-U.S. study confirms that access to oral-health services is associated with access to dental insurance. The 2004 study reports that more than 70% of individuals with dental insurance in Canada visited the dentist in the past 12 months, compared with 47% of those without insurance. (1) Children are a particularly vulnerable group if they are living in low-income families. In 2000, the U.S. Surgeon General's report on the nation's oral health confirms that low-income individuals are the most vulnerable to oral diseases. (2) The widening income gap in Canada means that low-income families are at a considerable disadvantage in their ability to afford oral-health care. In Canada, among the 10% of families with the lowest incomes, average family market income fell by 11% from 1989 to 2004. (3) It is becoming increasingly difficult for low-income families to afford oral-health care. Tooth decay Tooth Decay Definition Tooth decay, which is also called dental cavities or dental caries, is the destruction of the outer surface (enamel) of a tooth. or early-childhood caries caries or tooth decay Localized disease that causes decay and cavities in teeth. It begins at the tooth's surface and may penetrate the dentin and the pulp cavity. (ECC (1) (Error-Correcting Code) A type of memory that corrects errors on the fly. See ECC memory. (2) (Elliptic Curve Cryptography) A public key cryptography method that provides fast decryption and digital signature processing. ) in young children declined for a number of years, but is now on the rise again. Although data on trends in oral-health status are lacking in Canada, they are likely similar to those in the United States. In the U.S., tooth decay is on the rise in pre-school children aged two to five and adults are reporting less access to oral-health care compared to a year earlier. (4) Depending on severity, ECC may affect behaviour, diet, permanent tooth permanent tooth n. Any of the teeth of the secondary dentition. Also called second tooth. formation and overall growth and development. ECC also affects behaviour, as children deal with the associated pain, suffering and facial disfiguration dis·fig·ure tr.v. dis·fig·ured, dis·fig·ur·ing, dis·fig·ures To mar or spoil the appearance or shape of; deform. [Middle English disfiguren, from Old French desfigurer . Oral-disease prevention can reduce compounded costs associated with restorative work for aging dental fillings. A lack of access to oral-health care means more than simply having a painful tooth; there can be serious health consequences. Moses Han, an Oakville, Ontario, convenience-store owner could not afford the cost of a root canal root canal n. 1. The chamber of the dental pulp lying within the root portion of a tooth. Also called pulp canal. 2. to address tooth decay; the oral infection spread through his body, causing blindness. (5) Our society has overlooked oral health as an essential component of overall health and quality of life. Research shows other links exist between oral diseases and systemic diseases, including heart and lung disease lung disease Pulmonary disease Pulmonology Any condition causing or indicating impaired lung function Types of LD Obstructive lung disease–↓ in air flow caused by a narrowing or blockage of airways–eg, asthma, emphysema, chronic bronchitis; , diabetes and pre-term, low-birth-weight babies. (6,7) Jones, a 25-year-old Toronto resident, faced severe pain due to dental decay and, without dental insurance to cover costly restorative work, resorted to the least costly solution of having all but two teeth removed. His toothless grin hampered his ability to find work. The public responded to his plight and after $10,500 worth of dentures with implants, he now has a job with a boilermaker's union. (8) Early assistance was critical in this case, as an absence of teeth means that underlying bone gradually deteriorates, leaving insufficient bone to support implants. A final tragic story describes a Maryland boy, whose abscessed tooth lead to a severe brain infection and eventual death. His mother had no dental insurance and could not afford to pay for oral-health services. (9) These stories may seem to be isolated examples that have come to our attention through the media, but there are similar stories from other low-income Canadians of all ages who cannot afford oral-health care. In Canada, 39% of Canadians report a need for oral-health services, but do not receive care due to the cost. (10) Seniors also experience an inability to access oral-health services. (11) In the past, approximately 50% of Canadian employers--primarily larger, unionized companies--provided post-retirement non-pension benefits. However, recent reports indicate that these employers are increasingly withdrawing these important benefits from their former employees. A survey of 500 company-sponsored retirement plans indicates that over the past three years, 18% of employers have reduced non-pension benefits, including dental benefits, offered to retired employees and nearly 25% plan on doing so in the next three years. (12) In addition, Bell Canada recently announced elimination of dental-care benefits for future retirees, due to high benefit costs. (13) This withdrawal of dental services across a number of businesses, including profitable businesses such as Bell Canada, combined with an aging population, suggests the potential for a significant negative impact on seniors' oral health. ORAL-HEALTH CARE AS A PUBLIC GOOD CDHA's vision for oral health in Canada is about modernizing the health system and addressing pressing oral-health needs. We are not recommending a "sick care" system, which only addresses oral diseases after they occur, but a system that capitalizes on oral-health promotion and disease prevention. This is a cost-effective way to reduce the need for costly restorative work and to avoid the human suffering associated with dental decay and loss of teeth. Investing in promotion and prevention will contribute to a strong economy because good oral health contributes to good physical health and self-esteem, which are required to secure productive employment. This oral-health-care investment can reduce oral-health expenditures to address dental decay in the long term. There also are benefits for the broader health system. The links between oral diseases and systemic diseases suggest that oral-disease prevention could reduce downstream costs associated with costly chronic diseases. The following oral-health expenditures show who pays for what nationally and internationally. In 2006, out of a total of $9,943 million in dental expenditures in Canada, $488.9 million was publicly funded dental care, $3,622 million was out of pocket and $4,883 million was funded by private dental-insurance companies. As a proportion of total oral-health care expenditures, publicly funded oral-health care has decreased from 5.8% in 1999 to a low of 4.9% in 2006. (14) Figures from 2005 indicate Canada has the second-lowest per capita [Latin, By the heads or polls.] A term used in the Descent and Distribution of the estate of one who dies without a will. It means to share and share alike according to the number of individuals. public oral-health expenditures of all OECD OECD: see Organization for Economic Cooperation and Development. countries (Canada 4.6%, Germany 68%, and France 36%). (15) Furthermore, of the 4.6% we do spend on oral public health, the majority is provincial (61%), not federal (39%). In addition, most of federal spending is for First Nations and Inuit oral-health services. A strong commitment to investing in oral health could make Canada an international leader in oral health. New voices are joining the chorus of appeals for federal government investment in oral health. There is now a broad and varied social interest in seeing equitable access to oral-health care. As early as 1964, Mr. Justice Hall's Royal Commission on Health Services recommended the placement of oral-health services within the medicare system. In 2004, the City of Ottawa
The City of Ottawa (French: Ville d'Ottawa) is the corporate entity of municipal government in Ottawa, Ontario, Canada. passed a resolution calling for the federal government to develop universal access to oral-health services. In 2004, the Federation of Canadian Municipalities The Federation of Canadian Municipalities (FCM) is a civic advocacy group representing many Canadian municipalities. It is an organization with no formal power but significant ability to influence debate and policy, as it is main national lobby group of mayors, councillors and passed a motion calling for the Government of Canada The Government of Canada is the federal government of Canada. The powers and structure of the federal government are set out in the Constitution of Canada. In modern Canadian use, the term "government" (or "federal government") refers broadly to the cabinet of the day and to develop a "comprehensive National Oral Health Strategy that would have as its goal, providing universal access of both preventive and treatment services to all Canadians." (16) In August 2005, the federal/provincial/territorial dental directors developed a Canadian Oral Health Strategy, calling for federal-government leadership to deliver oral-health promotion and disease-prevention programs and services. (17) In 2006, the National Anti-Poverty Organization requested a national, basic dental-care program during the government's pre-budget consultations. (18) In 2007, Ontario's Community and Social Services Minister, Madeleine Meilleur, called for a "national dental strategy that provides provinces with money, because Ontario cannot afford to provide the dental equivalent of medicare on its own." (19) Furthermore, the Ontario Oral Health Alliance, which comprises grassroots coalitions representing 13 regions across Ontario, is advocating for an oral-health system that puts prevention first. (20) CDHA commends the federal government for two pilot projects, including the National Paediatric Adj. 1. paediatric - of or relating to the medical care of children; "pediatric dentist" pediatric Surgical Wait Times Pilot for dental treatment requiring anaesthesia anaesthesia anesthesia. and the First Nations Inuit Health Branch, Childrens' Oral Health Initiative (COHI COHI Circle of Health International (women's health group) ). Oral-health promotion and disease prevention should accompany the Surgery Wait Times Pilot, as a cost-effective method to reduce future wait times. COHI's goal is to deliver oral-health promotion and disease prevention to pregnant mothers, children, families and caregivers, in order to curb the high rate of oral disease among First Nations and Inuit people. Extending the reach of this program to a greater number of communities and granting it full program status would allow a greater number of people to experience the benefits of improved oral health. Providing oral-health promotion and disease prevention for children is the right thing to do, as no child should endure the pain and suffering associated with oral diseases. It is also the right thing to do for other vulnerable populations, such as the working poor, seniors and person with disabilities, in order to prevent the tragic diseases, deaths and disfigurements described above. RECOMMENDATIONS CDHA recommends that the federal government take the following action to ensure that oral-health promotion and disease prevention become a public good: * Work together with the provinces/territories to provide leadership, policies and funding (36% of total oral-health spending, or $3,579 million) for national oral-health promotion and disease-prevention programs for low-income Canadians, including those receiving social assistance and those working, children, persons with disabilities and seniors; and * Grant full program status to the Childrens' Oral Health Initiative within the First Nations and Inuit Health Branch. ENDNOTES 1. Joint Canada-US Survey of Health. Findings and public use microdata file [on-line]. Ottawa: Statistics Canada; 2004. www.statcan.ca/english/freepub/82-005-XIE/82-005-XIE200402.htm. Cited August 14, 2007 2. U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS : Oral health in America: A Report of the Surgeon General The U.S. Surgeon General is charged with the protection and advancement of health in the United States. Since the 1960s the surgeon general has become a highly visible federal public health official, speaking out against known health risks such as tobacco use, and promoting disease [on-line]. [Cited August 14, 2007.] Rockville, MD: USDHHS USDHHS, n.pr See United States Department of Health and Human Services. , National Institute of Dental and Craniofacial Research The National Institute of Dental and Craniofacial Research (NIDCR), is part of the U.S. National Institutes of Health, and as such its function is to the promote the general health of the American people, by improving their oral, dental and craniofacial health. , National Institutes of Health, 2000 3. Heisz, A. Income inequality and redistribution in Canada: 1976 to 2004. Statistic Canada. 11F0019MIE2007298, May 11, 2007 http://www.statcan.ca/bsolc/english/bsolc?catno=11F0019MIE2007298. Cited August 15, 2007 4. Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. NCHS is the United States' principal health statistics agency. . Vital Health Stat 11(248). 2007, ISBN ISBN abbr. International Standard Book Number ISBN International Standard Book Number ISBN n abbr (= International Standard Book Number) → ISBN m 0-8406-0615-X, www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf. Cited August 14, 2007 5. Welsh, M. He has a new smile; system still in decay. Toronto Star, June 23, 2007 6. Lux, J. Oral Disease-Systemic Disease Link. Part 1: Heart Disease, Diabetes. Canadian Journal of Dental Hygiene dental hygiene n. The practice of keeping the mouth, teeth, and gums clean and healthy to prevent disease. Also called oral hygiene. , November-December 2006, 40(6):288-342 7. Lux, J. Oral Disease-Systemic Disease Link. Part 2: Preterm preterm /pre·term/ (-term´) before completion of the full term; said of pregnancy or of an infant. pre·term adj. Low Birth Weight Babies, Respiratory Disease. Canadian Journal of Dental Hygiene, January-February 2007, 41(1):8-21 8. Welsh, M. He has a new smile; system still in decay. Toronto Star, June 23, 2007 9. American Dental Education Association. ADEA ADEA Age Discrimination in Employment Act of 1967 ADEA American Dental Education Association (Washington, DC) ADEA Association for the Development of Education in Africa (RSA) Newsletter March 2007, AEDA AEDA Aroma Extract Dilution Analysis AEDA Alberta Economic Development Authority (Canada) AEDA Arvada Economic Development Association AEDA . , 2007 10. K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007, page 19. www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678 Cited August 14, 2007 11. Lux, J. Access Angst: A CDHA position paper on access to oral health services. Probe Journal, November/December 2003, Vol. 37, No. 6, pp. 261-272 12. Mercer Investment Consulting and Mercer Human Resource Consulting Mercer Human Resource Consulting is a human resource consulting firm that publishes the oft-quoted "Worldwide Cost of Living Survey." External links
13. McFarland, J. Bell takes the axe to future retirement benefits. Globe and Mail update, March 27, 2007. Cited August 14, 2007 14. Canadian Institute for Health Information The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization in Canada, primarily funded by the provincial and federal governments of Canada. . National Health Expenditure Trends 1975-2006, CIHI CIHI Canadian Institute for Health Information CIHI Center for International Health Information , 2006. http://secure.cihi.ca/cihiweb/products/national_health_expenditure_trends_1975_2006_e.pdf. Cited August 14, 2007 15. Canadian Institute for Health Information. Exploring the 70/30 split: how Canada's health care system is financed. Ottawa: CIHI; 2005 16. Federation of Canadian Municipalities. Resolution SOC05.2.05 Access to Dental Care: A national Dental Care Strategy. FCM FCM See: Futures commission merchant FCM See futures commission merchant (FCM). , November 90, 2004 17. Federal, Provincial, Territorial Dental Directors. Canadian Oral Health Strategy. August 2005. www.fptdd.ca/Canadian %20Oral%20Health%20Strategy%20-%20Final.pdf. Cited August 14, 2007 18. National Anti-Poverty Organization. Minutes from the House of Commons House of Commons: see Parliament. Standing Committee on Finance--Pre-budget consultation. (location: 1640) http://cmte.parl.gc.ca/cmte/PublicationSearch.aspx?retAdvancedSearch=1&retKeyword=oral+health&retDateFrom=2006%2f04%2f03&retDateTo=2007%2f08%2f14&retParliament=Parl39%7eSes0&retSortBy=Publication&retMaxResults=10&retSourceDebates=False&retSourceCommitteeEvidence=True&retBooleanSearch=False&retCommitteeAcronymList=FINA&Lang=1&Mode=1&Parl=39&Ses=1&SelId=e99_&COM (1) (Computer Output Microfilm) Creating microfilm or microfiche from the computer. A COM machine receives print-image output from the computer either online or via tape or disk and creates a film image of each page. =10479&retPublicationDocumentld=2353001#Para146985. Cited August 14, 2007 19. Rob Ferguson and Robert Benzie, Queen's Park Bureau. Toronto Star, February 11, 2007 20 Ontario Oral Health Alliance meeting minutes from June 8, 2007 By the Canadian Dental Hygienists Association |
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