The health and social sectors are combining forces this week to put the spotlight on the human and financial costs of Australia’s failure to ensure equitable access to oral health and dental care.
Gordon Gregory from the National Rural Health Alliance (NRHA) and Tessa Boyd-Caine from the Australian Council of Social Service (ACOSS) report below on the background to a forum taking place in Canberra tomorrow.
Identifying areas for action to improve oral health
An important policy forum, Why has dental health been getting the brush off?, will be held tomorrow in Canberra with the aim of focusing public and political attention on the need to address the glaring inequities in dental health care.
A recent item in Crikey’s Tips and Rumours section hinted that the forum is arousing some sensitivities in Canberra. An anonymous, “unimpressed informant” contacted Crikey to express concerns that The Australian’s health reporter, Sue Dunlevy, is scheduled to address the forum on: How to keep the issue on the political and media agenda.
The tipster expressed the hope that “there will be a Q&A session after Dunlevy speaks at which one might ask if she believes the $500 million directed to a public dental health scheme in the last budget was indeed a ‘brush off'”.
It was certainly good news that the Gillard Government committed to an improved public dental health scheme in this May’s Budget. The majority of the new $515 million over four years will be for reducing public dental waiting lists. There is funding for the public dental service workforce, dental infrastructure in rural areas, extra support for the Voluntary Dental Graduate Year program, introduction of a graduate program for Oral Health Therapists, and $10 million for oral health promotion. (Oral therapists are fairly evenly distributed across Australia and provide a restricted range of clinical services, predominantly for school-aged children.)
Yet progress with these various commitments remains unclear.
What evidence is there of the $84 million to be spent this financial year on “alleviating pressure on public dental waiting lists” and “increasing the capacity of the dental workforce”?
Has the “blitz” on public dental waiting lists started to help Indigenous patients? What news of the trials of mobile dental facilities for Aboriginal and Torres Strait Islanders? How many dentists have been encouraged to rural and remote areas by the relocation grants?
These concerns are evident in the annual Community Sector Survey by the Australian Council of Social Service, released this week, which found that at least one in five community service organisations see dental health as the top policy priority for people experiencing poverty and disadvantage.
This week’s Forum will provide the opportunity to identify the immediate matters on which the pressure must be maintained, as well as considering some of the critical strategic questions about how to do so.
What will happen to the Medicare Chronic Disease Dental Scheme (CDDS)? (If the CDDS is closed down, even with the new commitments in the May Budget the net financial effort of the Commonwealth is unlikely to increase.)
And, most critical of all, are the commitments announced in May the first steps towards some sort of national scheme for dental care, funded through insurance, or will the mouth continue to be quarantined from the rest of the body?
The groundswell of concern about the terrible state of Australia’s dental health is reflected in the emergence of the National Oral Health Alliance in 2009, representing over a dozen bodies from within the community and health sectors, including practitioners, consumer groups and advocates. And five of those groups have come together to organise this week’s Dental Forum.
The Australian Council of Social Service (ACOSS), the Australian Healthcare and Hospitals Association (AHHA), the Australian Health Care Reform Alliance (AHCRA), the National Rural Health Alliance (NRHA) and the Public Health Association of Australia (PHAA) have been advocating for a better and fairer dental health system for many years.
Their views, as well as those of other members of the NOHA such as the Australian Dental Association, were directly represented to the National Advisory Council on Dental Health, which recently “provided advice to the Minister on options to address priority areas in dental health”.
There is a strong connection between general wellbeing and oral/dental care. Oral health affects diet choices and nutrition, appearance and self-esteem, and absenteeism from studies and work. And there is a strong connection between poor oral health and other chronic diseases. Yet for too long successive governments have given too little attention to the relationship between poor oral health and other impacts.
The NRHA is active on this issue because there are particular angles and difficulties in rural and remote areas. The government has acknowledged some of these in the targeting of the Budget commitments. The reliance on public dentistry increases with remoteness, with only 21 dentists per 100,000 people in rural and remote areas, compared with 54 per 100,000 in Major Cities. The rate of emergency dentistry increases with remoteness.
The long-standing interest of ACOSS in dental health lies in the social and economic impacts, particularly for those experiencing poverty or disadvantage, for whom poor oral health can undermine confidence in seeking employment or participating in their communities, as well as compounding risks of poor health and illness. Consequently, those with the worst oral health are often least able to address the problem.
This week’s Forum will seek agreement about how concerned citizens and organisations can best support governments in action to overcome the ‘two worlds of dentistry’ situation.
Currently there are readily accessible, high quality dental services for people in higher income brackets, supported by a billion dollars of federal spending via insurance rebates and Medicare funding. Middle and low-income earners face affordability barriers for private dentistry and a scarcity of resources for public dentistry provided by Sate and Territory governments.
Up to 7 million people living in Australia report that they delay or go without treatment for reasons of cost and service availability. Half a million sit on seemingly endless waiting lists for public dental treatment, with an average waiting time of two years. Children in the lowest socioeconomic areas have 70 per cent more decay in their teeth than children in the highest socioeconomic areas. At least one million work days are lost every year due to poor dental health.
While starting to deal with these immediate problems, Australia needs to invest in future oral health by emphasising prevention. This should entail an expansion of population oral health promotion activities, with first priorities being public funding for pre-school and school children – an age-targeted program for ‘routine dental services’. This could be built up from the existing state and territory school dental services and Medicare Teen Dental Plan.
Good dental care is expensive and cost is likely to remain a barrier unless and until there is a collective public recognition that more can and should be done.
The Policy Forum in Canberra this Wednesday will consider how interested parties (advocates, the public, media, professional associations) can work together and with governments to build a better dental health system. It is being organised by AHHA, PHAA, ACOSS, AHCRA and the NRHA.