TY - JOUR
T1 - Structural determinants and children’s oral health
T2 - a cross-national study
AU - Baker, S. R.
AU - Foster Page, L.
AU - Thomson, W. M.
AU - Broomhead, T.
AU - Bekes, K.
AU - Benson, P. E.
AU - Aguilar-Diaz, F.
AU - Do, L.
AU - Hirsch, C.
AU - Marshman, Z.
AU - McGrath, C.
AU - Mohamed, A.
AU - Robinson, P. G.
AU - Traebert, J.
AU - Turton, B.
AU - Gibson, B. J.
PY - 2018/4/2
Y1 - 2018/4/2
N2 - Much research on children’s oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors—the so-called structural determinants of health—play a crucial role. Children’s lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children’s clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health–related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization’s Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries (N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children’s oral health. The structural determinants accounted for between 5% and 21% of the variance in children’s oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.
AB - Much research on children’s oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors—the so-called structural determinants of health—play a crucial role. Children’s lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children’s clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health–related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization’s Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries (N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children’s oral health. The structural determinants accounted for between 5% and 21% of the variance in children’s oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.
KW - Social determinants
KW - Quality of life
KW - Inequalities
KW - Caries
KW - Risk factors
KW - Deprivation
KW - Comparative
UR - http://www.scopus.com/inward/record.url?scp=85045058719&partnerID=8YFLogxK
U2 - 10.1177/0022034518767401
DO - 10.1177/0022034518767401
M3 - Article (Academic Journal)
C2 - 29608864
AN - SCOPUS:85045058719
SN - 0022-0345
JO - Journal of Dental Research
JF - Journal of Dental Research
ER -