Rural and Remote Health Journal photo
African section Asian section European section International section Latin American section North American section
home
login/register
current articles
contribute
information for authors
status/user profile
links/forums
about us

Original Research

A comparative analysis of policies addressing rural oral health in eight English-speaking OECD countries

Submitted: 17 November 2015
Accepted: 23 March 2017
Published: 31 July 2017

Full text: You can view the full article, or view a printable version.
Comments: (login to access the comments on this article)

Author(s) : Crocombe LA, Goldberg LR, Bell E, Seidel B.

Citation: Crocombe LA, Goldberg LR, Bell E, Seidel B.  A comparative analysis of policies addressing rural oral health in eight English-speaking OECD countries. Rural and Remote Health (Internet) 2017; 17: 3809. Available: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=3809 (Accessed 25 September 2017)

ABSTRACT

Introduction:  Oral health is fundamental to overall health. Poor oral health is largely preventable but unacceptable inequalities exist, particularly for people in rural areas. The issues are complex. Rural populations are characterised by lower rates of health insurance, higher rates of poverty, less water fluoridation, fewer dentists and oral health specialists, and greater distances to access care. These factors inter-relate with educational, attitudinal, and system-level issues. An important area of enquiry is whether and how national oral health policies address causes and solutions for poor rural oral health. The purpose of this study was to examine a series of government policies on oral health to (i) determine the extent to which such policies addressed rural oral health issues, and (ii) identify enabling assumptions in policy language about problems and solutions regarding rural communities.
Methods: Eight current oral health policies were identified from Australia, New Zealand, Canada, the USA, England, Scotland, Northern Ireland, and Wales. Validated content and critical discourse analyses were used to document and explore the concepts in these policy documents, with a particular focus on the frequency with which rural oral health was mentioned, and the enabling assumptions in policy language about rural communities.
Results: Seventy-three concepts relating to oral health were identified from the textual analysis of the eight policy documents. The rural concept addressing oral health issues occurred in only 2% of all policies and was notably absent from the oral health policies of countries with substantial rural populations. It occurred most frequently in the policy documents from Australia and Scotland, less so in the policy documents from Canada, Wales, and New Zealand, and not at all in the oral health policies from the US, England, and Northern Ireland. Thus, the oral health needs of rural communities were generally not the focus of, nor included in, the oral health policy documents in this study. When the language of concepts related to rural oral health was examined, the qualitative analysis identified four discourse themes related to both causality and solutions. These ranked discourse themes focused on service models, workforce issues, social determinants of health, and prevention. None of the policies addressed the structural economic determinants of unequal rural oral health, nor did they specifically assert the rights of children in rural communities to equitable oral health care.
Conclusions: This study documented the limited focus on rural oral health that existed in national oral health policies from eight different English-speaking countries. It supports the need for an increased focus on rural oral health issues in oral health policies, particularly as increased oral health is clearly associated with increased general health. It speaks to the critical importance of periodic analysis of the content of oral health policies to ensure that issues of inequality are addressed. Further, it reinforces the need for research findings about effective oral health care to be translated into practice in the development of practical and financially viable policies to make access to oral health care more equitable, particularly for people living in rural and remote areas.

Key words: oral health policy, rural inequality, rural inequity, rural oral health, rural policy.

This abstract has been viewed 654 times since 31-Jul-2017.

   
 

   CONTACT US | COPYRIGHT AND DISCLAIMER | ADMIN ONLY