Better oral health for all: what will it take?

As recently previewed, an important policy forum, Why has dental health been getting the brush off?, in Canberra this week aimed to focus public and political attention on the need to address the glaring inequities in dental health care.

Thanks to Lexia Smallwood and Gordon Gregory of the National Rural Health Alliance for providing this report, which includes some advice for what oral health campaigners can learn from the Every Australian Counts campaign, including:

• the importance of a united front

• engaging politicians as NDIS champions

• training and supporting campaign volunteers

• the power of social media.

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Oral health needs a population-based approach – and “effective policy entrepreneurs”

Lexia Smallwood and Gordon Gregory write:

‘A healthy mouth for every Australian’ was the catch-cry at a meeting of health advocates in Canberra this week. People from around 80 health consumer and provider organisations came together to agree on how best to secure better dental health care in Australia.

Those at the meeting were appalled at the stories told about children and young adults with numerous decayed and missing teeth; encouraged by the commitments made in this year’s Budget; and determined to continue to work together for a much-improved national oral health system.

The Communiqué from the event, together with a list of the organisations represented, is on the NRHA website, where you can also stream the presentations. The forum, titled Why has dental health been getting the brush off?, was organised by ACOSS, the AHHA, AHCRA, the PHAA and the NRHA.

Paul Dugdale, from the ANU, facilitated the event with his usual panache and good leadership. With the Government in what he called ‘delivery mode’, now is a good opportunity to get on the policy landscape – notwithstanding fiscal fears.

Tessa Boyd-Caine, from ACOSS, summarised the recommendations of the National Advisory Council on Dental Health (of which she was a member) and knitted them into the results of the annual Community Sector Survey by ACOSS, released this week. That survey showed that at least one in five community services see dental health as the top policy priority for people experiencing poverty and disadvantage.

Tessa pointed out that as part of its advocacy for greater spending on oral health, ACOSS had identified $8billion of federal budgetary savings. She was the first of many at the Forum to emphasise the need for a population-based approach to oral health care, and to advocate for a universal access scheme.

Tony McBride, Chair of AHCRA and also a member of the National Advisory Council on Dental Health, lamented the grossly inequitable access to oral health care, with patients paying 61 cents in the dollar, compared with about 12 cents for health services overall. He argued that dental care is at the margins, with little integration, no population health planning and the mouth still curiously separated from the body. This is despite the fact that there is a strong and well-known link between oral health and other chronic disease.

Tony welcomed this year’s Budget announcements, noting however that if they were to be ‘swapped’ with the Medicare Chronic Disease Dental Scheme, the net effect would be poorer. He nominated Medicare Locals as agencies that might do much in relation to oral health care.

Andrew McAuliffe, newly-arrived on staff at the AHHA, reminded those present that there are now more dental schools, more enrolments and more overseas trained dentists – yet still a major workforce distribution problem. He thinks the new Dental Foundation year a good initiative, as well as increases in the numbers of dental hygienists and therapists. Training efforts, he said, need to be targeted better at the community’s needs.

Ian McAuley, Health Economist Consultant, gave what he called a five-minute overview of national budgetary and new policy processes. He reported that Australia is the second-lowest taxing country in the OECD, with a fairly entrenched view that ‘the private sector is best’.  Ian described the health reform process as “timid” and lamented the fact that the approach to health care has shifted from ‘solidarity’ to ‘charity’. Perhaps surprisingly he asserted that there would be another push for major health reform in the not-too-distant future, and encouraged those at the Forum to be prepared for it.

Clive Wright, Immediate-past Chief Dental Officer with NSW Health, gave a fascinating and detailed address in which he drew on his close experience with dental services and their administration. He explained his personal drive to have governments manage oral health through public health and social determinant approaches, and explored the relationship between oral and general health.

He reminded his listeners of the National Oral Health Plan and referred to many of the starts – false and otherwise – made in the past towards better oral health services. Clive reminded the audience that it is not all about increased funding for dental health services. A stronger focus on fluoridation and health promotion presents an alternative paradigm.

Clive ended by analysing, using an appropriate theoretical approach, the readiness of Australia to succeed with advocacy efforts relating to better oral health.

Sue Dunlevy, Health Writer with The Australian, gave a clear, well-prepared and detailed explanation of the means by which better oral health could get a prime spot on the political agenda. Sue dealt with developments in the area over the past ten years or so, suggesting that successful advocacy requires a clear definition of the problem; an effective policy entrepreneur (“a reliable ‘go-to’ person for the media”); a single, agreed solution; and a window of opportunity (sometimes made available through good luck) for political adoption.

James O’Brien, Victorian Director of the Every Australian Counts campaign followed on well from Sue Dunlevy, by describing the practical steps and the success of the work relating to the NDIS. “We had to win,” said James. “We didn’t have a Plan B.”

He then proceeded to report on and analyse the activity. The whole of the disability sector united behind the objective of having a National Disability Insurance Scheme; disagreements were internalised and a united front presented. All parliamentarians were approached and asked to be the NDIS’ champion; campaign volunteers were trained and supported.

James argued that the use of social media had been (and still is) crucial to the campaign.

Those at the Forum felt inspired and informed by these speakers and agreed to continue their work to build an irresistible community of interest for improving oral health in Australia.