Overview

Abstract (English)

This report concludes a three-year evaluation by a multi-disciplinary Canadian Academy of Health Sciences (CAHS) panel (from here on referred to as “the Panel”) into the issue of access to oral health care among vulnerable groups in Canada. It presents an innovative analysis of data from the recent Canadian Health Measures Survey (CHMS), which for the first time in approximately 40 years has provided nationally representative, clinical information on the oral health status of Canadians. In addition, targeted literature reviews were completed, with all resulting information reviewed, discussed, and integrated into the report by the Panel. The following major issues have emerged from the CAHS investigation in relation to oral health and oral health care in Canada: * Many low income, and even middle income, Canadians suffer from pain, discomfort, disability, and loss of opportunity because of poor oral health. * Approximately six million Canadians avoid visiting the dentist every year because of the cost. * There are significant income-related inequalities in oral health and inequity in access to oral health care. * Those with the highest levels of oral health problems are also those with the greatest difficulty accessing oral health care. * Income-related inequalities in oral health are greater than income-related inequalities in general health indicators. * Income-related inequalities in oral health are greater in women than men. * Inequalities in access to dental care are contributing to inequalities in oral health. * Oral health is part of general health, with the same social, economic, and behavioural determinants, and with direct links between poor oral and poor general health. * The vast majority of dental care is provided in the private sector, with only approximately six percent of expenditure on dental care in the public sector. * Private sector dentistry is providing good quality oral health care for a majority of people living in Canada, but it is not a good model of health care provision for the vulnerable groups who suffer the highest levels of oral health problems. * There is no consensus on standards of oral health care provision among federal, provincial, territorial, and municipal governments in Canada. The small proportion of publically-funded oral health care services provided across the country varies enormously between jurisdictions. * There is no consensus among federal, provincial, territorial, and municipal governments across Canada on the use of a range of dental and other health care professionals that might improve access to oral health care services, particularly for groups suffering the greatest burden of oral diseases. * In Canada, tax legislation helps reduce the financial burden of dental care for those with private dental insurance. Those without such insurance do not have this benefit, yet these are the groups with the highest levels of disease and the greatest difficulty accessing dental care. In summary, analysis of the CHMS data illustrates major inequalities in oral health and access to oral health care across social groups in Canada. Compared to the rest of the population, vulnerable groups in Canada are i) less likely to have dental insurance; ii) more likely to avoid the dentist due to cost; iii) more likely to consult dentists only in emergencies; iv) more likely to have untreated dental decay, gum diseases, missing teeth, and dental pain; and v) more likely to avoid eating healthy foods such as fruits and vegetables due to oral health problems. The CAHS investigation also found that the differences in ability to access and use oral health care makes a major contribution to inequalities in oral health status. In a wealthy country with explicit policy goals of reasonable access to health care as part of the Canada Health Act, these inequalities and the resulting inequity should be a matter of national concern.

Abstract (French)

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