June 2016

Volume 33, Issue 2

Do ‘poor areas’ get the services they deserve? The role of dental services in structural inequalities in oral health

Authors: R.V. Harris
doi: 10.1922/CDH_3718-Harris04

Abstract

Do ‘poor areas’ get the services they deserve? The role of dental services in structural inequalities in oral health R.V. Harris Abstract: All over the world, we see that communities with the greatest dental need receive the poorest care – a truism first summarised by the Inverse Care Law in 1971. Despite efforts to attract dentists to under-served areas with incentives such as ‘deprivation payments’, the playing field is still uphill because of the fundamental inequalities which exist in society itself. Deep-seated cultural values which are accepting of a power difference between the ‘haves’ and ‘have nots’, and that emphasise individualism over collectivism, are hard to shift. The marketization of health care contributes, by reinforcing these values through the commodification of care, which stresses efficiency and the transactional aspects of service provision. In response, practitioners working in deprived areas develop ‘scripts’ of routines that deliver ‘satisfactory care’, which are in accord with the wishes of patients who place little value on oral health but which also maintain the viability of the practice as a business. A compliance framework contrasting types of organisational (dental practice) power (coercive, utilitarian, normative) with types of patient orientation (alienative, calculative, moral) identifies where certain combinations ‘work’ (e.g. normative power – moral orientation), but where others struggle. Thus institutional structures combine with patients’ and the wider community’s demands, to generate a model of dental care which leaves little scope for ongoing, preventive dental treatment. This means that in poor areas, all too often, not only is less care available, it is of lower quality too - just where it is needed most. Key words: oral health, inequalities, dental services, markets

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Other articles in this issue

Article Pages Access
Editorial - Prevention of dental caries through the use of fluoride – the WHO approach 66-68 Download
Fluoride and Oral Health 69-99 Download
Child oral health in migrant families: A cross-sectional study of caries in 1-4 year old children from migrant backgrounds residing in Melbourne, Australia 100-106 £10 single article
Choosing a measure of Health Related Quality of Life 107-115 £10 single article
Feasibility, utility and impact of a national dental epidemiological survey of three-year-old children in England 2013 116-120 £10 single article
Dental anxiety, concomitant factors and change in prevalence over 50 years 121-126 Download
A bi-level intervention to improve oral hygiene of older and disabled adults in low-income housing: results of a pilot study 127-132 Download
Association between child caries and maternal health-related behaviours 133-137 £10 single article
Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region 138-144 Download
Examiner reliability in fluorosis scoring: a comparison of photographic and clinical methods 145-150 £10 single article
The mouth as a site of structural inequalities; an introduction 151-151 Download
The mouth and dis/ability 152-155 Download
Inequalities in oral health: the role of sociology 156-160 Download
The mouth as a site of structural inequalities; the experience of Aboriginal Australians 161-163 Download
Do ‘poor areas’ get the services they deserve? The role of dental services in structural inequalities in oral health 164-167 Download
Overcoming structural inequalities in oral health: the role of dental curricula 168-172 Download

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