(part 5 of a Croakey series on health reform)
One of the things that keeps the health round interesting for journalists (but must drive policy makers mad) is that it is such a fertile field for disagreement. I can hardly think of a clinical or policy issue where there are not competing views and interpretations of the evidence.
One of the few areas where it’s difficult to find a fight in the health reform debate is the need to ensure more equitable access to dental care. How best to achieve that is, of course, another matter.
Amy Stockwell, who works at the Brotherhood of St Laurence in Melbourne, has been wondering with some frustration why the health reform plans are lacking teeth.
“There is a gap in the post-coital, post-COAG grins: dental policy. It’s not sexy. It’s not election winning.
But it is a barrier to work, social and family life for a significant number of people on low incomes. While the political rhetoric has been all about smiling hospital visits and the States’ sweet surrender, I guess it is unsurprising that no one is talking about rotting teeth.
The proper funding of public dental care has been neglected, not only in the discussions about health reform in recent weeks, but for decades. If health policy is the demanding, high-maintenance sister of social policy, then dental policy is the distasteful, shifty cousin that only turns up at occasionally when there’s a free feed or a cheap shot.
No one likes dental policy. The States and the Feds have been batting it back and forward for years. In the mid-90s, the Labor government introduced the Commonwealth Dental Health Program, which the Liberal government promptly dismantled.
The Liberal government introduced a scheme for those suffering chronic and complex illness, the Enhanced Primary Care (EPC) dental program, which the current Labor government is taking apart.
The closure of the EPC dental program, twice blocked in the Senate, prevents the rollout of the new Commonwealth Dental Health program. The National Health and Hospitals Reform Commission says to make a completely new! new! new! system and call it Denticare.
Meanwhile, in Frankston, Victoria, a recent Brotherhood of St Laurence (BSL) trial found that people who are highly disadvantaged are suffering physically, emotionally and economically because they have teeth that are rotting, dying, chipped, broken or in need of dentures. (For a short version, see this media release)
Waiting times for dental treatment in that region is up to 41 months. 90% of BSL trial participants reported pain, and 80% had difficulty eating. Under half took regular pain medication.
One young man with a history of homelessness undertook self-dentistry with a hammer and chisel. One mother had children who had never seen her with teeth. Some participants in the trial were afraid to laugh or smile, and talked with their hands in front of their mouths.
The reality for people on low-incomes living in this region is that if you need to get to a dentist, there is a strong chance you won’t be able to see one for a significant period. But the BSL study showed, if you do get timely treatment, you may feel better (physically and emotionally), and be able to get into work or into study.
As politicians continue to debate the more glamorous acute aspects of health reform (hospitals! Rebates! More doctors!), some low-income Australians are relying on pain meds and antibiotics, and can’t enjoy good food because they simply can’t chew it.
Aside from implications for their physical health, this has a profound impact on their self-esteem, as well as being a significant barrier to participation in study and work. Indeed, it makes poor economic sense to have 650,000 Australians on dental waiting lists that are years long, adding strain to other health services, welfare and business.
Here’s an idea: let’s treat teeth like we treat all of the other bits in the body, including the mind. Let’s fully incorporate dental care within Medicare and recognise teeth as being both an important part of health care and the responsibility of a single, coordinated funder (the Commonwealth).
The public dental system is not working for the people who need it the most. It’s rotten and needs an overhaul.”