Should you think this recent post was a little harsh, in condemning the obfuscation and lack of clarity in many health communications, try having a read of this recent report produced by the Department of Health and Ageing and the Australian Institute of Health and Welfare.
Titled Dental health of Indigenous children in the Northern Territory: progress of the Closing the Gap Child Oral Health Program up to 2011, it reports on 14,834 dental services provided to 8,317 children between August 2007 and the end of 2011 (about three-quarters of whom are included in the analysis).
The children account for about half of the Indigenous population aged under 16 from the NT prescribed areas (and what an Orwellian term that is).
A time-poor reader (wouldn’t it be nice if all documents/reports etc were written with this type of reader in mind) can get the general gist. This is that many Indigenous children suffer poor oral health; efforts are being made to improve the situation but the barriers are considerable; and some improvement is documented but the magnitude of the problem remains overwhelming. On average, children who were referred for a dental service during a child health check waited 18 months to have the service.
One of the more disturbing statistics was that 43 children had such severe problems they ended up requiring hospital treatment. What a terrible situation for anyone – but particularly for a child.
However, much of the real import of the report is buried under language like this (from the section upfront giving the “highlights”):
Compared with the national result from the 2006 Child Dental Health Survey, the proportion of children aged 5–12 experiencing dental caries among those who received dental services through the Closing the Gap Child Oral Health Program was 23 percentage points higher.
I’m not sure exactly what that means (and would be grateful if anyone can supply some figures to help with this).
Meanwhile, as the Greens step up their campaign for Denticare, Johanna de Wever from the Brotherhood of St Laurence in Melbourne writes below that oral health is an important social justice issue.
Access to dental care is not only a health issue
Johanna de Wever writes:
Advocating for universal dental care is not the usual work of the Brotherhood of St Laurence, which is better known for its work to achieve a fairer deal for those who experience poverty and disadvantage.
But it has become clear to us that dental care has a profound impact on our efforts to get people into work, education and back on track – let alone deal with problems they experience eating or talking, or the wider impact of poor oral health upon overall health.
Early research proved that dental care could make the difference for individuals trying to get into work, and our most recent report showed a cost to the economy of $1.3 – $2 billion in lost productivity per year, on top of more than $223 million in hospital admissions.
In Australia today low-income earners are 60 times more likely to lose all their teeth than high income earners, in fact one in six poorer Australians has no teeth at all. People often wait so long for treatment in the public dental service that there is no chance of tooth recovery or repair.
According to the AIHW report released earlier this month (Oral health and the use of dental services 2008), people with concession cards are more than twice as likely to have teeth removed at an appointment than someone from a higher income household.
Seventy-one per cent of concession cardholders actually paid a private dentist for their last visit, presumably because they were unable to wait the twelve month plus most common for public dental treatment in 2008. Our clients tell us now of waiting for up to five years for a first appointment.
The need for public dental assistance is so extreme that we are faced with a moral conundrum when we advocate for our clients. Should we help them access the public dental support they are entitled to, knowing that their inclusion will displace another? Perhaps they too, like our client, have been waiting for years for the treatment that will enable them to step out of stasis and into normal life – get a job, eat a favourite meal, smile in a photo.
By incorporating dental care into Medicare we will safeguard the health needs of our most vulnerable Australians. As health economists will tell you, universal access also cuts administrative costs, helps control prices, places more emphasis on primary and preventative care, and reduces unfair anomalies whereby those just above the cut-off point miss out.
While Medicare is not perfect, free treatment at public hospitals, bulk billing GPs and government subsidies for pharmaceuticals and specialists all help to keep healthcare much more affordable that it would otherwise be.
And, even more importantly, a universal system also ensures community ‘buy in’ because everyone pays for it and everyone uses it.
Access to basic primary dental care should be seen as the priority and creativity used in terms of how these services could be made accessible to those who need them – rationing by treatment type or patient need until the scheme is well established would be practical.
And just as nurse practitioners are now providing a range of basic primary healthcare services to consumers who might not have access to a bulk billing GP and who might otherwise go without access to care, oral health practitioners, rather than more expensive dentists, could play a role in providing primary dental care. This would be particularly important for rural and remote communities, many of whom cannot attract permanent GPs let alone dentists.
When Medicare (or Medibank as it was known) was first introduced, it was hard fought and so contentious the legislation was held up by the double dissolution of the Australian government. Now it is a source of great pride to Australians, and one I and many others deeply value.
One of the ALP’s proudest achievements is that they are the party that introduced Medicare, but by excluding dental care they didn’t really finish the job. The Greens should be congratulated for their commitment to the issue and for holding the Government to account, particularly important in a Budget that is as tight as this one.
At the upcoming Budget, I look forward to any news of a greater injection of funding into public dental care. But in the long-run, limiting reform to a piecemeal means-tested system is not the answer.
It’s time we accepted the same principle as Medicare when it comes to our teeth: good healthcare should be available on the basis of need, not ability to pay. To support our campaign go to www.dental.bsl.org.au
• Johanna de Wever is Senior Manager, Communications, Brotherhood of St Laurence