Despite widespread recognition of the oral health gap between Indigenous and non-Indigenous Australians, progress in addressing the underlying issues of cultural safety and cultural competence among providers has been slow.
The following piece, from a group of oral health researchers and educators, outlines why cultural safety is so central to Indigenous oral health and discusses some current activities focused on increasing the cultural competence among oral healthcare providers in order to improve the oral health of Indigenous Australians.
Cathryn Forsyth, Michelle Irving, John Gilroy, Stephanie Short and Marc Tennant write:
Indigenous Australians have higher rates of dental decay, gum disease and tooth loss than non-Indigenous Australians, with most of these conditions going untreated, resulting in tooth loss. Dental disease can significantly affect a person’s quality of life, including their ability to eat, sleep, work and socialize. This means that the impact of the oral health gap is to increase the disadvantage already experienced by Indigenous Australians in many aspects of life.
As oral health researchers and educators, we believe that it is time to change focus in reducing the health disparities of Indigenous Australians. To achieve this aim, one of the key areas for action is to increase cultural safety of oral health services and the cultural competence of oral health care providers.
Although Australia’s National Oral Health Plan and several Closing-the-Gap initiatives identified Indigenous peoples as a priority, the prevalence of oral health conditions continue to have an impact, with Indigenous peoples reporting that health services are not culturally safe. The Australians Human Rights Commission reports that Indigenous Australians experience difficulties in accessing culturally appropriate dental care to improve their health and well-being.
One reason for this is that mainstream dental education has a strong emphasis on restorative and surgical care (fillings, root canal therapy, crowns & dentures) based on a Western bio-medical model.
Cultural competence has been recognised as a strategy to improve oral health outcomes for Indigenous populations for more than a decade. As accreditation standards for dental schools previously did not include Indigenous cultural curricula this shift in focus has taken time to filter through to Australian dental schools.
Cultural competence curriculum framework
In 2007 a team at the Centre for Rural and Remote Oral Health, now the IRCOHE.net at The University of Western Australia, developed the original Aboriginal and Torres Strait Islander cultural competence curriculum framework for dental students.
Following this initial development changes in accreditation standards by the Australian Dental Council require mandatory Indigenous cultural knowledges to be incorporated into all dentistry and oral health programs within Australia. Consequently, cultural competence is gaining momentum, prompting further investigation into Indigenous cultural competence curricula development.
A lack of progress
Acknowledging the lack of progress in cultural competence development in dental services, A team of dental therapists, dentists and social scientists from the Universities of Sydney and Western Australia conducted a systematic review of Indigenous cultural competence in dentistry and oral health higher education. This review identifies specific content and strategies to incorporate Indigenous cultural competence into curricula:
- Provide students with the opportunity to reflect on their own stereotypes and biases to address individual and institutional racism
- Deliver an accurate historical understanding of the effects of colonisation on Indigenous Australians
- Instill knowledge of health disparities, community health and the social determinants of health using a combination of face-to-face and online teaching strategies
- Enable students to engage with Indigenous communities and complete reflective writing tasks based on their experiences with Indigenous communities during their course
Working with communities
The Faculty of Dentistry at University of Sydney is working with Aboriginal Community Controlled Organisations to provide student community placements in various Local Health Districts and other institutions around NSW to enhance student knowledge, skills, and understanding of Indigenous culture before they graduate.
One particular placement involves dental students working with the team at the Poche Centre for Indigenous Health to increase oral hygiene within schools and promote drinking water from the newly installed chilled filtered water systems, as healthy alternatives to high sugar beverages, within the Central Tablelands communities.
Additionally the Faculty of Dentistry at the University of Sydney has implemented various Indigenous student recruitment and retention strategies over the past few years to support several Indigenous students in the Bachelor of Oral Health & Doctor of Dental Medicine programs.
Strategies include: identifying appropriate university preparation courses; providing one-on-one support through the application process; development of an Aboriginal student support network; and access to academic tutoring and scholarship funding. Peak bodies in dental education could implement and promote these across the nation.
Finally, a review of Indigenous cultural competence curricula in the Bachelor of Oral Health & Doctor of Dental Medicine programs at the University of Sydney has been undertaken. This will provide insights into the barriers and enablers to incorporating Indigenous curricula into dental education. Reforms of this nature will facilitate attitudinal changes for future generations of dentistry and oral health practitioners to redress oral health inequalities experienced by Indigenous Australians.
Cathryn Forsyth and Michelle Irving are from the Faculty of Dentistry, The University of Sydney. John Gilroy and Stephanie Short are from the Faculty of Health Science, the University of Sydney. Marc Tennant is from the International Research Collaborative, Oral Health and Equity, The University of Western Australia.
This article is published as part of our ongoing #TalkingTeeth series.