Community Dental Health

cover art

Cover Date:
June 2016
Print ISSN:
0265 539X
Vol:
33
Issue:
2

Do ‘poor areas’ get the services they deserve? The role of dental services in structural inequalities in oral health

Abstract: All over the world, we see that communities with the greatest dental need receive the poorest care – a truism first summarised by the Inverse Care Law in 1971. Despite efforts to attract dentists to under-served areas with incentives such as ‘deprivation payments’, the playing field is still uphill because of the fundamental inequalities which exist in society itself. Deep-seated cultural values which are accepting of a power difference between the ‘haves’ and ‘have nots’, and that emphasise individualism over collectivism, are hard to shift. The marketization of health care contributes, by reinforcing these values through the commodification of care, which stresses efficiency
and the transactional aspects of service provision. In response, practitioners working in deprived areas develop ‘scripts’ of routines that deliver ‘satisfactory care’, which are in accord with the wishes of patients who place little value on oral health but which also maintain the viability of the practice as a business. A compliance framework contrasting types of organisational (dental practice) power (coercive, utilitarian, normative) with types of patient orientation (alienative, calculative, moral) identifies where certain combinations ‘work’ (e.g. normative power – moral orientation), but where others struggle. Thus institutional structures combine with patients’ and the wider community’s demands, to generate a model of dental care which leaves little scope for ongoing, preventive dental treatment. This means that in poor areas, all too often, not only is less care available, it is of lower quality too - just where it is needed most.

Key words: oral health, inequalities, dental services, markets

doi:10.1922/CDH_3718-Harris04

Article Price
£15.00
Institution Article Price
£
Page Start
164
Page End
167
Authors
R.V. Harris

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