Social concepts of dentistry and EBD Flashcards
What are the social determinants of health?
The social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work live and age and the wider set of forces and systems shaping the conditions of daily life.
What are the examples of social determinants of health?
Income, education, unemployment, food security etc.
What do social determinants of health shape?
Social determinants of health shape the distribution of midstream factors, which, in turn shape individual’s health.
What are oral health inequalities?
It is when differentials in health are caused by social circumstances.
Discuss why health care access and utilisation are not at the root of oral health inequalities
Even if access to healthcare is given, it does not mean that a population may be educated enough to understand the scope of their diagnosis thus may lead to worst individual outcomes and worst population outcomes as well as the fact that a multitude of other factors that may impact the health outcomes (like availability of clean water, food etc.)
What is the concept of social gradient?
When an individual becomes more socially secure, they show a higher level of oral health literacy and oral health outcomes.
Why are targeted interventions among the most disadvantaged groups are unlikely to eliminate oral health inequalities?
Hyper individualistic approach to health care may treat the immediate problem in the individual, but does not change the social determinants that have affected the individual in the first place
Describe the social gradient in oral health-related behaviours.
Oral health-related behaviours are also socially patterned: across several indicators of socioeconomic disadvantage and behaviours.
What can you say about socioeconomic status and sugar consumption?
As household income increase – sugar consumption in beverages decreases.
What can you comment on other oral health-related behaviours and social gradient?
Behaviours like smoking, alcohol consumption, oral hygiene practices and dentist visits are worst among the disadvantaged
What is the direct pathway to behaviour?
The lack of resources causes certain behaviour to appear
What is the indirect pathway of behaviour?
Due to psychosocial factors – certain behaviour patterns occur
Discuss how decontextualizing health-related behaviours from the social determinants of health encourages blaming the victims of inequality for their unhealthy lifestyles.
It just creates a cycle of stigmatization and disadvantage and will not improve their oral health outcomes.
Provide examples of interventions that reduce and increase inequalities in behavioural outcomes.
- Media campaigns
- Taxation
- Policies
- Health warning
- Bans of advertising
Discuss the role of dental practitioners in reducing inequities in health-related behaviours.
- Self awareness
- Deliver evidence-based clinical prevention
- Advocacy skills
What is racism?
Racism is the unjust treatment of social groups on the basis of racial or ethnic background
What are different levels of racism?
- Interpersonal - between 2 people
- Intrapersonal - except ideologies by a single person
- Structural racism – laws, rules and practices
How would you describe the relationship between different types of racism?
Iceberg – interpersonal at the top and structural at the bottom
In which way does racism affect oral health?
- Through reduced access to resources that are required for health - Intersectionality - multiple other ideologies intersect to discriminate e.g. racism + sexism
- Through psychosocial factors – behaviours or embodiment
- Through the undermining of dental health service provider-patient relationships
How can structural racism affect oral health?
Structural racism reinforces implicit bias of people. An example: dental services are structured in a way which is not culturally sensitive to different racial minorities making said minorities to be less likely to attend dental services because THEY DO NOT FEEL WELCOME. Yet is statistics, it would just say “x racial minority is more likely not to attend their appointments”. Which leads the practitioners to make assumptions
What is implicit bias?
In social identity theory, an implicit bias or implicit stereotype, is the pre-reflective attribution of particular qualities by an individual to a member of some social out group.
What is intersectionality?
The interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.
How can we fix racism?
- Structural changes – diversify racial makeup of training programs, increase the incentives for oral health personal to work in communities in which racially underpowered groups and many more
- Individual-level changes – speak up, support victims and take evidence
What is epidemiology?
The study of the distribution and determinants of health-related states and the application of this study to the control of health problems
What is the life course approach to epidemiology?
Study of long term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood and later adult life. Exposures early in life are involved in initiating disease processes prior to clinical manifestation.
models – exposures accumulate over the life – e.g. intersectionality
What are the two models in life course epidemiology?
- Critical period models – exposure during a specific period has lasting impact – e.g. during gestation
- Accumulation of risk
What is social-mobility?
It is shift in an individuals social status
What can you say about socio-economic circumstances and oral health?
Experiences of socio-economic disadvantage through the life course are related to various aspects of oral health. Socioeconomic factors may operate in critical windows of time, but also in cumulative and interactive ways over life. Models of critical period and accumulation of risk appear to collectively contribute to an understanding of oral health inequalities.
What is included in a health system?
- Policy - a more upstream factor
- Services - a more midstream factor
What is the role of policies?
- Shift the distribution of social determinants of health – e.g. education, welfare, employment, progressive taxation, anti-racist legislation, wage capping and so on
- Modify the mechanisms through which social determinants of health – e.g. health care access: increase availability of services, increasing accessibility of the services, increase accommodation of the services, increase affordability of the services, increase acceptability of the services. Behaviour: make healthier options the easier option, barriers, reinforce positive behaviour, oral health and nutrition policies in preschools, subsidize toothpaste and toothbrushes, subsidized healthy snacks, include oral health in mainstream messaging, promote oral health for children, taxation policies.